Friday, 5 May 2017

MS ProDrome

Wijnands JMA, Kingwell E, Zhu F, Zhao Y, Högg T, Stadnyk K, Ekuma O, Lu X, Evans C, Fisk JD, Marrie RA, Tremlett H. Health-care use before a first demyelinating event suggestive of a multiple sclerosis prodrome: a matched cohort study. Lancet Neurol. 2017  pii: S1474-4422(17)30076-5
BACKGROUND:Degenerative processes in neurodegenerative diseases can start years before clinical manifestation. We aimed to establish whether a multiple sclerosis prodromal period exists by examining patterns of health-care use before a first demyelinating event.
METHODS:In this matched cohort study, we used data from linked health administrative and clinical databases from four Canadian provinces (British Columbia, Saskatchewan, Manitoba, and Nova Scotia) to compare hospital, physician, and prescription use data from people with multiple sclerosis and matched general population controls in the 5 years before the first demyelinating disease claim (health administrative index date) or clinically reported symptom onset (clinical index date). Rate ratios (RRs) were estimated using negative binomial regression and combined across provinces using random effect models. The primary outcome was all-cause use of health care during each of the 5 years before the health administrative or clinical index date.
FINDINGS:The health administrative cohort included 14,428 multiple sclerosis cases and 72,059 matched controls for whom data were available between April, 1984, and April, 2014. Annual health-care use increased steadily between 5 years and 1 year before the first demyelinating disease claim in people with multiple sclerosis compared with controls (from RR 1·26 [95% CI 1·16-1·36] to 1·78 [1·50-2·10] for hospital admissions; from 1·24 [1·16-1·32] to 1·88 [1·72-2·07] for physician claims; and from 1·23 [1·06-1·41] to 1·49 [1·41-1·59] for prescriptions, assessed as drug classes). Similar patterns for physician claims and prescriptions were observed in the cohort with available clinical symptom onset (3202 individuals with multiple sclerosis and 16 006 controls), although the differences in use in each of the 5 years mostly did not reach statistical significance.
INTERPRETATION:More frequent use of health care in patients with multiple sclerosis than in controls in the 5 years before a first demyelinating event, according to health administrative data, suggests the existence of a measurable multiple sclerosis prodrome. These findings have clinical and research implications, including the establishment of an earlier window of opportunity to identify and potentially treat multiple sclerosis.
FUNDING:National Multiple Sclerosis Society.

So this study suggests that people with MS use the health care system more frequently a few years before MS is diagnosed. Howevewr the results failed to reach statistical significance in most cases saying you can't really make any conclusions. However profG will point to education tests performed on every one in Argentina sat 18 and it appears that people who subsequently got MS did worse on the tests years before thier MS appeared. The migration studies suggest if you move before the age of 15 year you have the risk of where you live in/move too. After 15 you have the risk of birth. So this suggests there is a period of time before MS is dignosed when there is susceptibility.


  1. Is 15 years old exactly? Or maybe on average 15 years old?

  2. There is a range of opinion and evidence on this matter. Probably best to migrate pre-teens particularly if the environmental trigger is EBV infection in teenagers. Sadly we don't know for sure. If your mum or dad has MS, you have an approximately 1:50 risk of getting MS, how far should you move while young? Form Aberdeen to Malta (possibly reducing risk by two thirds - Simpson et al JNNP 2011 82 1132-1141)? Arguably the 98% likelihood of not getting MS provides sufficient reason to live near family and lifelong friends. Perhaps taking vitamin D might attenuate the latitude risk.


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