Detecting Symptom-Free Phase of Multiple Sclerosis May Improve Management

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Multiple Sclerosis

Recent studies identify indicators of the presence of a neurodegenerative disease, such as Multiple Sclerosis (MS), in an individual much before the appearance of symptoms. The period in which an individual has a disease without showing symptoms is called the prodromal stage.

 

Neurodegenerative disorders are a group of disorders that are characterized by a progressive loss of structure and function of neurons in the brain and spinal cord. Multiple Sclerosis (MS) is a neurodegenerative autoimmune disease which attacks myelin, a protective and insulating layer supporting neural connections. Without myelin, nerve cells are exposed, making them vulnerable to damage and slowing sensory or motor signals through the nerve, to and from the brain. When substantial myelin is lost, the ability to conduct signals can be permanently affected.

Individuals present with symptoms of weakness, tingling, impaired sensations, and vision defects. These may progress to lack of coordination, bladder problems, and mood changes which finally end with the inability to acquire knowledge and understand through thought and experience. Unfortunately, there is no cure for MS and treatments are limited.

The difficulty of treating MS encouraged researchers to look at the existence of a prodromal period, that would help in the early detection and prevention of the disease. One such study published in Lancet Neurology was conducted in four Canadian Provinces (British Columbia, Saskatchewan, Manitoba, and Nova Scotia), where data of MS patients was assessed from April 1984 to April 2014. The data looked at the period before the diagnosis of MS was made to identify common characteristics. Results from this study clearly showed the existence of a prodromal stage in individuals with MS evidenced by higher health system use in the five years before the first symptom. The number of visits augmented in the year before symptom-based diagnosis was made. This augmentation was computable simply by looking at the health care use. Hospital admissions were up by 78% and physician service use was shown to be up by 88% in patients who had potential of acquiring MS, compared to the general population. Furthermore, a 49% rise in the number of drug classes for which medications were dispensed was observed.

The trigger that begins the degenerative process in MS is not well understood, and existing treatments are only partially effective. In the past decade, research has indicated that degenerative processes begin well before symptoms emerge. One of the traits identified by the study is the occurrence of increased hospital use, five years before symptoms are evident. This is a clear indicator of the presence of a prodromal period for MS. Patients observed paying frequent hospital visits should be assessed for a history and examination that could point towards the presence of MS. This assessment should be done thoroughly with clear emphasis on whether the patients day-to-day routine has been changed or altered due to physical fatigue, weakness, or any other physical complaint the patient might have. This conclusion urges further investigations to identify traits of neurodegenerative conditions when obvious symptoms are not present.

 

Written By: Dr. Apollina Sharma, MBBS, GradDip EXMD

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