UBC researcher suggests multiple sclerosis may develop earlier than people think

CBC

2 days ago

A new study is challenging what is known about multiple sclerosis (MS) and when it develops in the body.
Helen Tremlett, senior author of the University of British Columbia study, says the research findings indicate that MS may start earlier than previously thought.
MS is a neurological disease of the central nervous system that can impact the brain, spinal cord and optic nerves. Fatigue, numbness, vision problems, and difficulty with balance are common symptoms, and there is no known cause or cure.
Treatments include disease-modifying therapies that target the immune system to reduce inflammation and prevent nerve damage, as well as lifestyle changes and medications to manage symptoms.
The study published in JAMA Network Open analyzed 12,000 people's health records in B.C., and found that those with MS began using health-care services at higher rates 15 years before patients experienced their first MS symptoms.
"We were able to find that up to 15 years before MS symptom onset, people were more likely to have visited a doctor than you'd expect compared to individuals who did not develop MS," Tremlett told CBC's The Early Edition.
Common symptoms in that 15-year window before an MS diagnosis included fatigue, dizziness, pain, anxiety and depression.
She says that psychiatric visits increased at the 12-year mark before MS onset, and overall visits, including to eye specialists and neurologists, increased the closer people got to their diagnosis.
Tremlett says future MS research needs to go further back in time to study what causes it.
"We need as researchers to go back much further in time before MS symptom onset, so we don't think that something causes MS when in fact the disease has already started."
She says that in the future, there is the potential to diagnose and treat people with MS sooner, but "we're not there yet."
Tremlett says the majority of people who experience the symptoms mentioned and who visit the hospital will not develop MS, so the findings are not a cause for general concern.
Mental health issues first to arise
When discussing MS symptoms, Tremlett says that "mental health-related issues seem to kick up first."
"Maybe you feel depressed because you have all these other signs and symptoms, and no one seems to know what's going on because they're too general to be picked up as MS."
She says that the study uncovered that MS can have a prodromal phase — when subtle symptoms appear before hallmark signs — something that wasn't thought to be true before.
Living with MS
Allison Markin was diagnosed with MS in 2003.
The Penticton, B.C., resident says that at that time, there weren't many studies on the disease that went beyond testing the effectiveness of medication on patients.
"Studies like this are important because they paint a bigger picture of MS," Markin told CBC News.
Markin says she had all the right symptoms, but awareness about the disease was lacking back then. She was diagnosed with MS when she was 31.
She says that through more research and studies, people who live with MS can better manage their symptoms, and that the general public can become better educated about disabilities that aren't visible.
Markin says if she had been properly diagnosed sooner, "I probably would have had a better course of treating myself."
'Implications bigger than the paper,' says Ottawa doctor
Mark Freedman, professor of medicine at the University of Ottawa, and director of the MS research unit at the Ottawa Hospital, says that the UBC research paper has larger implications.
"Someone who complains of fatigue or brain slowing, depression, these are common symptoms that anybody would have, but it seems to be more prevalent amongst the MS patients," Freedman told CBC News.
"If you started screening everybody with those symptoms for an abnormal MRI, we would probably find that there's a number of folks who in fact have MS, and we can make that diagnosis at that stage."
He says that Tremlett has had several "very strong" research papers that describe the MS prodrome phase, and that in her recent paper, the symptoms reported aren't traditionally correlated with MS — opening the door for more diagnoses so that people can better support their health.
"It's a very important and timely paper," he said.
Rural health
Rheanna Robinson, an Indigenous woman who was diagnosed with MS when she was 19, says the symptoms were hard to determine at that age, and with the main one being fatigue, she summed up being tired to living a busy adolescent life with friends and school.
"Even though I was very young ... it did equip me in different ways to think about opportunities and challenges that I may be encountering," the Prince George resident told CBC News.
Robinson, who is board director with MS Canada, an organization that helped fund the UBC study, says that patients in rural areas don't always have access to doctors, but it's important they receive a diagnosis and are reflected in the data.
She says data about Indigenous health, especially in northern communities, is an important gap to address in future MS research.