SUMMARY
- Canadian researchers funded by the National MS Society compared health records of 14,428 people with MS to 72,059 controls and discovered that people with MS use more health care (medications, doctor visits, hospitalizations) during the five years before their first symptoms of MS.
- These findings suggest that there might be a measurable MS “prodrome”: an early emergence of unrecognized symptoms indicating the onset of disease.
- Further study is necessary to determine the complex reasons for these increases in healthcare use. Finding a prodromal phase in MS could facilitate faster recognition, diagnosis, and management of MS, and may generate new opportunities to understand the origins and triggers of MS.
- Early and ongoing treatment with disease-modifying therapy is supported by the MS Coalition, which includes the National MS Society. Even earlier diagnosis and treatment for MS may better slow disease activity and prevent future disability.
- The paper was published early online in Lancet Neurology on April 20, 2017.
DETAILS
Background: It has become increasingly apparent in some diseases that involve nerve damage − Parkinson’s, Alzheimer’s, Huntington’s disease, and possibly ALS -- that the damage starts years before symptoms are recognized. There is growing evidence suggesting that MS also develops before it manifests as ‘classic’ symptoms (currently recognized as related to MS), but there is no established way to detect it in the absence of the signs and symptoms that lead directly to an MS diagnosis. This has important implications for uncovering the causes, understanding the way MS develops, improving detection and diagnosis, developing better targeted treatments, and preventing disease and disease progression. The origin of MS is poorly understood and the disease can be difficult to diagnose. The search for an MS “prodrome” − symptoms that suggest an earlier disease onset − is critical.
The Study: Researchers funded by the National MS Society (Jose Wijnands, PhD, University of British Columbia; Charity Evans, PhD, University of Saskatchewan; John Fisk, PhD, Dalhousie University; Ruth Ann Marrie, MD, PhD, University of Manitoba; and Helen Tremlett, PhD, University of British Columbia) and colleagues capitalized on the unique health system and research networks developed in Canada to analyze 20 years’ worth of health data from four provinces -- British Columbia, Saskatchewan, Manitoba, and Nova Scotia. They looked for a measurable prodromal period before individuals had experienced their first neurologic symptom caused by inflammation or demyelination (damage to nerve-insulating myelin). The study compared hospital, physician, and prescription records for 14,428 people with MS to 72,059 people without MS (controls) for the five years before the first reported symptom or health claim leading up to a diagnosis of MS.
Results: Overall, people with MS had more and longer hospitalizations and physician claims, and filled prescriptions for more drug classes than controls during each of the five years before their first health claim for a neurological episode indicative of MS. The annual rate that people with MS used health care increased steadily between five years and one year before the first claim leading to a diagnosis of MS. In the year before the first claim, people destined to develop MS had a 78% higher rate of hospitalizations, an 88% higher rate of physician service use, and a 49% increase in the number of drug types (classes) for which prescriptions were dispensed.
Additional research is needed to understand the reasons for the increased health care use and how to use this information to identify early manifestations of MS.
The paper was published early online in
Lancet Neurology on April 20, 2017.
Comment: The results of this important study suggest that MS begins earlier than it has currently been possible to detect, and that there may be an opportunity to recognize, diagnose and treat MS earlier than is now possible. The findings also suggest that studies to identify factors that might trigger the onset of MS should be done earlier (before the ‘prodrome’ begins) to offer new opportunities for its prevention. In addition, further studies may identify symptoms not currently recognized as attributable to MS.
Early and ongoing treatment with disease-modifying therapy is supported by the MS Coalition, which includes the National MS Society. Even earlier diagnosis and treatment for MS may better slow disease activity and prevent future disability.
Additional funding sources: José M.A. Wijnands receives salary support from the Michael Smith Foundation for Health Research /The Koehle Family Foundation, Ruth Ann Marrie holds the Waugh Family Chair in Multiple Sclerosis and Helen Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis.