Can MS Be Halted Out of the Gate?

Many if not most people in and around the MS community will know there are different classifications of multiple sclerosis. We all know of relapsing-remitting MS (RRMS), with its on-again, off-again symptoms; secondary-progressive MS (SPMS), in which relapses generally stop but symptom progression continues and disability worsens; and primary-progressive MS (PPMS), which acts almost like a different disease, with steady symptom progression from the very beginning.

Researchers, clinicians, and patients alike have found these disease course descriptors — or “types” of MS — troublesome for quite some time. So much so, in fact, that the International Advisory Committee on Clinical Trials in Multiple Sclerosis are revisiting the classifications of the disease, according to an essay in the National MS Society publication Momentum.

Identifying MS in the Early Stages

But one category of multiple sclerosis isn’t always MS — but sometimes becomes MS. That type is known as clinically isolated syndrome (CIS).

CIS is a single demyelinating episode in the central nervous system accompanied by inflammation that lasts for at least 24 hours. The list of symptoms that can present in CIS are exactly the same as those of multiple sclerosis, and more than one symptom can be caused by the singular episode.

Another variation on early signs of MS that may or may not become MS is radiologically isolated syndrome (RIS). In RIS, a person has no symptoms of MS, but findings on an MRI done for other reasons reveal lesions indicative of MS.

Two questions researchers would like to answer are who among the people who have CIS or RIS will develop MS, and at what point should they be offered disease-modifying therapies for MS to prevent disease progression?

Predicting Who Will Develop MS

Now, because of research published in JAMA Neurology, doctors may be able to more accurately predict whether a person’s RIS is likely to develop into multiple sclerosis.

Through a series of tests for biomarkers — measurable substances in the body or other observable signs — as well as following up on a number of environmental factors, researchers believe they have found several predictors of impending MS diagnosis.

That the authors of the study used the term “prognostic factors” brought to mind a scarfed old woman sitting behind a crystal ball in a velvet tent filled with burning candles and smoldering incense. For many of us, our ability to predict when the next attack will happen, whether a DMT will work, and how long a particular symptom will last has been about as accurate as a crystal ball.

But if these research-based prognostications of the future can be refined into a set protocol, then the right people could be put on MS medication, while those with very low risk can be spared the inconvenience, the side effects, and — let’s face it — the expense of drugs they may not need.

The hope would also be that by treating those who show probability of advancing from CIS or RIS to multiple sclerosis, the eventual development of the disease might be halted altogether.

New Possibilities Feel Like Science Fiction

For someone like me, who has lived with the disease since my early adulthood and was diagnosed as the third DMT was approved, this is almost science fiction coming true rather than a bad fortuneteller’s augurations. It’s a hope we dared not hope for: If caught early enough and treated aggressively, MS could be stopped in its tracks.

“How do you eat an elephant?” goes the old question. “One bite at a time” being the answer. Well, this seems to this writer with MS to be an awfully big bite of the elephant in our room.

Wishing you and your family the best of health.

Cheers,

Trevis