Understanding Biomarkers: Tools for Living Well with MS

Biomarkers are like health clues that your body gives off. Found in your brain, blood, spinal fluid or other parts of the body, these measurable signs help doctors better understand your health. Think of them as guides that help answer important questions like:

• “Do I have MS?”

• “How is my MS changing over time?”

• “Is my treatment working as it should?”

For people living with MS—or those wondering if they might have it—biomarkers offer a way to help take some of the guesswork out of the process. They help you and your healthcare team make more informed decisions about your care and could offer answers earlier and a clearer path forward.

"Biomarkers empower people living with MS by providing earlier answers and a clearer path forward."

1. Getting Answers Faster

   For many people, getting an MS diagnosis can feel overwhelming. If it took a while to receive a diagnosis it may have also been frustrating. Symptoms can vary widely, and some may overlap with other health conditions, which could make it harder to diagnose. Biomarkers provide neurologists with tools to help confirm an MS diagnosis more quickly and accurately. 

   For example, a test like a magnetic resonance imaging (MRI) scan can reveal specific signs of MS in the brain or spinal cord, helping neurologists rule out other conditions. Similarly, biomarkers in spinal fluid, like oligoclonal bands, can provide evidence of MS-related immune activity. The sooner you have a diagnosis, the sooner you can begin managing the disease. 

2. Personalizing Treatment Plans

   Every person with MS experiences the disease differently, and treatments don’t always work the same way for everyone. Biomarkers give neurologists a way to tailor treatments to meet your unique needs.

   Blood biomarkers like neurofilament light chain (NfL) can indicate nerve damage. Tracking these levels over time can show whether a specific medication is slowing disease progression. This means your neurologist can make adjustments to find the treatment that works best for you, minimizing side effects and maximizing benefits. 

3. Tracking Progress with Confidence

   Living with MS often comes with some level of uncertainty—how do you know if your treatment is working or if the disease is progressing? Biomarkers can provide objective measurable data that help take some of that uncertainty away. 

   For example, MRIs can track changes in your brain, like the appearance of new lesions or the shrinkage of older ones. Eye-tracking assessments, a new and non-invasive tool, can reveal changes in brain function over time, including changes related to cognition (thinking, concentration, memory). These tools empower your MS healthcare team to respond quickly to changes, helping you stay one step ahead. 

MRI Scans 

An MRI scan is an important tool for diagnosing and monitoring MS. It creates detailed pictures of your brain and spinal cord, helping neurologists see areas affected by the disease. Some specific MRI biomarkers include:

• Central Vein Sign (CVS): A dark dot or line inside a lesion, often seen in MS, that helps neurologists rule out other conditions, or confirm a diagnosis of MS.

• Paramagnetic Rim Lesions (PRL): Chronic lesions with inflammation, linked to greater disease severity.

• T2/FLAIR Images: Show both new and older inflammation, helping neurologists monitor disease activity.

• Enhancing T1 Lesions: These highlight areas of active inflammation, especially when contrast dye (gadolinium) is used.

• MRIs can also measure brain atrophy, or loss of brain volume, which is a sign of disease progression. 

Blood Tests 

Blood tests can reveal biomarkers like NfL, a protein that shows nerve damage. Elevated levels of NfL may mean that MS is more active. These tests are simple and becoming more widely available, offering a less invasive way to monitor the disease.

Spinal Fluid Tests 

A spinal fluid test (also called a lumbar puncture) is another valuable tool. By analyzing the fluid surrounding your brain and spinal cord, neurologists can detect:

• Oligoclonal Bands (OCB): Proteins that indicate abnormal immune activity in MS.

• Kappa Free Light Chain (KFLC): Another sign of increased immune system activity.

• Glial Fibrillary Acidic Protein (GFAP): Linked to nerve damage and disease progression.

Eye Tracking Assessments 

Eye tracking is an exciting new tool recently approved in Canada. Using cameras and sensors, this technology measures how your eyes move when you focus on an object or follow a moving target. Changes in these eye movements can indicate how MS is affecting your brain function and if changes are coming from motor or cognitive symptoms. Eye tracking is non-invasive, easy to perform, and could be done both in the clinic or at home in just a few minutes, making it a valuable addition to the toolkit for monitoring MS progression.

Optical Coherence Tomography (OCT) 

OCT uses light waves to create detailed images of your retina. It can measure the thickness of the retinal nerve fibre layer, which is often thinner in people with MS. While currently used mostly in clinical trials, OCT offers another potential way to monitor MS-related damage. 

“Living with MS can feel unpredictable, but biomarkers offer a way to bring clarity to your care.” 

Ask Questions

You don’t need to be a scientist to benefit from biomarkers. When you meet with your neurologist, ask them:

• “What tests do I need, and what will they tell us?”

• “How often should I get these tests?”

• “Are these tests covered by provincial health insurance?”

By being proactive, you can make sure you’re getting the tests that will provide the most useful information for your care.

Understand Your Results

Biomarkers may sound technical, but your MS healthcare team is there to help you understand them. Remember, you can ask if you need more information. For example:

• “Does this MRI show new lesions or older damage?”

• “What does my blood test tell us about my disease activity?”

• “What does this result tell me about how my current treatment is working?”

Taking the time to understand your results can help you feel more confident and informed about your treatment plan. 

Research into biomarkers is advancing rapidly, bringing new tools and possibilities for people living with MS. For example:

• Non-Invasive Testing: Blood tests and eye tracking are becoming more common, offering less invasive ways to monitor MS. 

• Better Personalization: As more biomarkers are discovered, neurologists will have even more tools to customize treatments for people. 

• Earlier Interventions: Biomarkers like NfL will help neurologists detect MS activity earlier, making it possible to start treatments more quickly.  

While biomarkers are improving MS treatment and care, access to them, including financial coverage, will vary depending on where you live. Speak to your MS healthcare team to learn about access to biomarkers available to you.