Researchers in the fields of MS, type 1 diabetes, Parkinson’s disease and other experts, including people affected by MS gathered in a virtual workshop to understand the earliest window when MS begins and to identify key research priorities that will enhance early detection of MS with the ultimate goal of preventing onset of MS disease symptoms.
MS Canada, in partnership with the National MS Society (USA), convened a virtual workshop led by Canadian researchers, Drs. Helen Tremlett (University of British Columbia) and Ruth Ann Marrie (University of Manitoba), focused on the MS prodromal phase. A prodrome is an early set of signs or symptoms indicating the onset of a disease (read more here and FAQ below). The workshop aimed to identify key research priorities to further our knowledge of the MS prodrome, enhance global collaboration, and accelerate progress. Participants included international researchers and clinicians with expertise in MS, neurology, epidemiology, genetics, imaging and immunology, and people affected by MS in addition to researchers with expertise in type 1 diabetes and Parkinson’s disease to learn from diseases that have defined prodromal phases. The outcomes of this workshop are summarized in a recent article published in Nature Reviews Neurology.
To summarize, the workshop identified the following key research priorities needed to develop criteria for identifying individuals within the prodromal stage who are at greatest risk of being diagnosed with MS:
- Obtain worldwide prevalence estimates for MS that include age and biological sex. Gather global population-based data on those with MS that includes information on their age and biological sex. This information will be used to calculate the probability that an individual will develop MS with markers of prodromal MS.
- Identify new markers of the prodromal stage of MS. Additional markers are needed to better identify those at greatest risk of MS within the prodromal period. Markers also need to be identified and validated in populations with differing ancestries. The markers can be clinical, genetic, imaging, or blood- or cerebrospinal fluid-based.
- Quantify the association between prodromal markers and the probability or risk of developing MS. Identify informative markers that can be quantified into likelihood ratios for developing MS.
- Develop and validate criteria for the prodromal stage of MS for research. Utilize identified markers and quantified likelihood ratios to develop prodromal criteria that can be used to assess an individual’s likelihood of developing classical MS over a defined period and validate them. These criteria can be used by researchers to identify those at greatest risk of MS and enroll them in clinical trials to test interventions that prevent the transition to MS.
The ultimate goal of this work is to develop and validate standardized criteria for identifying individuals in the prodromal stage of MS who are at the greatest risk of being diagnosed with MS, providing an earlier window for intervention in order to prevent the transition from prodromal MS to classical MS.
Frequently Asked Questions:
What is a prodrome?
A prodrome is an early, often non-specific, set of signs or symptoms indicating the onset of a disease, before more typical symptoms or signs appear.
Do other diseases have prodromal stages?
Yes, prodromal stages are well-recognized in several neurodegenerative and immune-mediated diseases such as Parkinson’s disease, schizophrenia, type 1 diabetes and rheumatoid arthritis.
Does MS have a prodromal stage?
MS is an inflammatory and neurodegenerative disease in which both genetic and environmental factors contribute to disease development. There is emerging evidence to support the presence of a prodromal stage in MS.
Research has shown increased hospitalizations, physician visits and prescription drug use is increased at least five years before MS symptom onset or a first demyelinating event. Common non-specific symptoms such as headache and other pain-related disorders, fatigue, urinary symptoms, and psychiatric symptoms have been identified in this period before MS symptom onset, a first demyelinating event, or MS diagnosis. Additionally, blood levels of a biomarker, neurofilament light chain (NfL) that detects neurodegeneration, has been shown to be elevated 6 years before MS signs or symptoms were reported.
How will a better understanding of the MS prodromal stage benefit those living with MS?
If we can better identify individuals in a prodromal stage of MS, it may offer the opportunity to prevent, or delay development of classical symptoms of MS. To get here, we need to fully characterize and understand the MS prodrome and have a validated set of criteria to ascertain individual’s risk, in addition to understanding windows of opportunity for intervention to prevent and delay onset of MS.
To learn more about this study:
Click here to read a lay summary explaining Dr. Tremlett’s work on the MS prodrome, written by Sharon Roman.
Click here to listen to Jon Strum’s podcast RealTalkMS, episode 265 on September 27, 2022 – ‘Making MS Research Accessible to People Affected by MS (and Why That Matters!) with Sharon Roman’ (timestamp 18:43 minutes).
Click here to listen to Jon Strum’s podcast RealTalkMS, episode 255 on July 19, 2022 – ‘An important paper focused on how identifying the prodromal phase of MS can lead to disease progression’ (timestamp 3:54 minutes).
For more information about the research, click here.
Reference:
Article entitled “From the Prodromal Stage of Multiple Sclerosis to Disease Prevention“ published in Nature Reviews Neurology – read more here