POSSIBLE PRECURSORS
MS study finds warning signs
Conditions such as sleep problems, irritable bowel syndrome and depression are more common among multiple sclerosis patients five years before they develop medically recognized signs of the disease, a new study from the University of British Columbia suggests.
Prof. Helen Tremlett at UBC’s division of neurology is the lead author of the largest study to examine the medical records of people who accessed care for various symptoms that aren’t classic manifestations of MS.
During the five years before the first signs show up, multiple sclerosis patients are up to four times more likely to be treated for sleep problems, she said. Irritable bowel syndrome is twice as common, and rates of fibromyalgia, musculoskeletal pain, depression, migraines, and anxiety disorder are also higher.
The research involved examining the health records of 14,000 multiple sclerosis patients in B.C., Saskatchewan, Manitoba and Nova Scotia between 1984 and 2014. The data were compared with 67,000 patients without the disease in those four provinces.
Tremlett said much more research is needed to expand on the study published Monday in the Multiple Sclerosis Journal. In the future, it could lead to earlier diagnosis and treatment to slow damage to the brain and spinal cord.
The research establishes a socalled prodrome period for MS, when early symptoms can point to later development of a disease, she said. Such data already exist for Alzheimer’s disease, which can be preceded by cognitive impairment, and Parkinson’s, which may follow long-term constipation, suggesting it could start in the gut, not the brain.
“We’re trying to do a similar thing with MS, which is, can we find what is happening in those years leading up to MS onset?”
The study provides some clues to the puzzle that is multiple sclerosis, an auto-immune disease that causes inflammation in the central nervous system resulting in injury to myelin, the protective sheath that covers nerves. The damage can lead to physical disability and cognitive impairment.
“I think it will facilitate how we move forward in trying to identify and diagnose people with multiple sclerosis earlier,” said Tremlett, who is also a Canada Research Chair in neuroepidemiology and multiple sclerosis.
“The second piece, and this is also very important, is that if you want to know what causes multiple sclerosis, you have to be very careful that you don’t inadvertently measure what’s going on in this prodromal period and assume that causes multiple sclerosis.”
Tremlett said future research could also pinpoint patterns of the disease related to sex, age, or how symptoms may differ between the two types of multiple sclerosis: relapsing-remitting, which affects about 90 per cent of patients, and primary progressive.
Sharon Roman, 49, was diagnosed with multiple sclerosis at age 30 after experiencing extreme fatigue, slurred speech and trouble balancing, which had her bumping into walls.
“I thought I was working out too much. My friend kept saying, ‘There’s something wrong with you and I’m going to call you every day until you go to the doctor.’”
A second attack included loss of bladder control, spasms and double vision.
Roman had also experienced symptoms including anxiety and depression years earlier, but chalked them up to a changing stage in her life.
“The closer we come to finding the course of the disease, the closer we come to finding a cause and a potential cure,” said Roman, who is now on about six medications to manage symptoms including neuropathic pain and sleep problems.
Marilyn Lenzen, 58, suffered from overwhelming fatigue, which she thought was due to the long hours she spent travelling around British Columbia and Yukon as part of her sales job.
She would sleep all weekend and didn’t tell her doctor about the tingling and numbness, which would come and go.
“The pain is so bad it felt like somebody had elastic bands around my calves,” she said, adding an MRI determined her diagnosis of multiple sclerosis at age 40, when she was in the prime of her career and family life.
Her hope is that more research will slow down the progression of the disease to prevent others from suffering life-changing disability.