MSVirtual 2020 and Studying Prodromes (Early Signs of MS)
ECTRIMS, the European Committee for Treatment and Research in Multiple Sclerosis, is the premier annual MS research meeting. Every three years, ECTRIMS combines with ACTRIMS, the Americas Committee for Treatment and Research in Multiple Sclerosis, to meet in North America instead of Europe. This was to be the year when I could finally attend this conference in person, but we all know the plans of 2020 have been significantly altered for every event. Instead, I found myself covering this meeting online, along with 8,000 other participants in MSVirtual2020.
Attending the conference virtually
Despite having to do this conference via virtual connections, it has been excellent and I must admit there are advantages to staying home and not going through the stress of travel, hotels, and navigating huge conference halls. I’ve been able to sit in the comfort of home and hear from international experts in the field of MS. The very first talk challenged the audience to think differently about diagnosing MS.
Opening the program with the plenary talk was Dr. Helen Tremlett, University of British Columbia, sharing research and her questions about MS prodromes. Prodromes are those symptoms that appear before a clinical diagnosis for a chronic disease is sought (or even considered). Prodromes are understood for mental health and more recently adopted for Parkinson’s disease and are just now being looked at for MS.
Use of healthcare services
Dr. Tremlett shared studies that point to differences between people with MS and their healthy peers that can be observed up to five years or more in advance of a neurologist diagnosing multiple sclerosis. The differences appear in the use of healthcare services for conditions we would not necessarily think of as MS, including dermatology, psychiatry, irritable bowel syndrome, fibromyalgia, and headaches/migraines. When researchers compared clinical records, they found people who had not yet been diagnosed with MS used healthcare services for these areas in greater frequency than non-MS patients. In some medical specialties, the difference is dramatic, especially mental health where there is a 50% increase in physician/psychiatrist visits with pre-MS people.
Where was this research conducted?
This research work was done using the health records in Canada and has results similar to studies done in England and Germany using their national health records. A large scale study was done in Norway using medical records of their military members to compare the cognitive scores of men who were eventually diagnosed with MS, to their conscripted peers. The Norwegian showed a statistically different cognitive level up to two years earlier for the men with MS.
Validating prodromes for MS could lead to earlier diagnosis
How many of us say looking back before we were diagnosed with MS there were symptoms we could not explain? If prodromes for MS are validated and accepted, their use could help many people be diagnosed sooner. This earlier diagnosis could also lead to better long-term outcomes with less accumulation of disability.
Ruling out other chronic conditions
Dr. Tremlett had many examples of increased use of healthcare services by people before they were diagnosed with MS, but she was also cautious in having clinicians immediately adopt MS prodromes without further study. She pointed out the obvious, that other chronic conditions may also have the same prodromes, and distinguishing which ones are MS-specific have to be backed up with other tests such as MRIs.
Looking ahead to more research around prodromes
Her message and the prominent placement of her talk were clear – we can look for prodromes to be a new topic for conversation in research areas and a push to adopt them in the clinic when working on diagnosis for MS.
Wishing you well,
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