The Doctor’s Notes column includes analysis from Dr. Ben Thrower, MS Focus senior medical advisor. Dr. Thrower draws from the top news stories of the quarter and explains what the news means to you, the person with MS. Study: A group of symptoms precedes first definitive signs of MS During the five years before people develop the first clinically recognized signs of multiple sclerosis, they are up to four times more likely to be treated for nervous system disorders such as pain or sleep problems, and are 50 percent more likely to visit a psychiatrist, according to new research from the University of British Columbia. The study was published in Multiple Sclerosis Journal. Dr. Thrower: If you ask a person with MS “when were you diagnosed?” and “when did you have your first symptoms?”, you will likely get two different answers. For many with MS, the road to a diagnosis can be long, frustrating, and frightening. On the other hand, study after study shows that early treatment of MS leads to better chances of preventing future disability. Obviously, one cannot begin treatment without a diagnosis. Diagnostic guidelines for MS, like the McDonald Criteria, are constantly being revised to improve the speed and accuracy of the diagnostic process. This study shows that there may be clinical clues that could also lead to a more rapid diagnosis of MS. However, some of the early symptoms identified by the researchers are common and nonspecific. Study links exposure to paint and varnish to increased MS risk People who have been exposed to paint, varnish, and other solvents and who also carry genes that make them more susceptible to developing MS may be at much greater risk of developing the disease than people who have only the exposure to solvents or the MS genes, according to a new study. The study was published in Neurology. Dr. Thrower: MS results from a complex combination of genetic and environmental factors that result in an immune system gone awry. Many different environmental factors have been linked to a higher risk of MS, including viral exposures, distance from the equator, and diet. Cigarette smoke is a toxin that has been linked to a higher risk of MS and more MS relapses in those already diagnosed. This study looks at other exposures, specifically paint and varnish as a risk for developing MS. As the authors state, the downside to this study is that it is based upon self-reporting. Clearly, we have no control over our genes, but as research uncovers environmental factors that result in a higher risk of MS, we need to pay attention. A child whose parent has MS has a higher risk of developing MS. We can’t undo those genetics but we can limit the environmental risks by maintaining a healthy body weight, eating a healthy diet, getting vitamin D levels checked, avoiding cigarettes, and using appropriate safety gear when working with toxic substances. Drug may block death of brain cells in MS Researchers at the University of Alberta discovered a unique process of brain cell death that affects the cells that are most vulnerable in MS. After identifying the process called pyroptosis, or fiery death, the researchers were able to block the enzyme in the brain that is responsible for it, using a drug that could potentially treat MS. The study was published in the journal PNAS. Dr. Thrower: Prior to 1998, many thought MS was a purely demyelinating disease with little thought given to the damage we now know occurs to the nerve fibers, or axons, themselves. The exact mechanism of how demyelination, axonal damage, and neurodegeneration all come together remains unclear. The discovery of a previously unknown mechanism of oligodendrocyte death, a “fiery death” no less, could be truly big news indeed. The tested drug, VX-765, inhibits Caspace-1 and is in testing for some forms of epilepsy. In the mouse model of MS, VX-765, appeared to help prevent disability. Stay tuned. Disappearing lesions may predict disability development For decades, clinicians treating MS have interpreted the appearance of new or expanding brain lesions on magnetic resonance imaging scans as a sign that a patient’s disease is getting worse. Now, after conducting both a five-year study and a 10-year study, MS researchers in the Jacobs School of Medicine and Biomedical Sciences at University at Buffalo are finding that it may be the atrophy, or disappearance of these lesions into cerebrospinal fluid, that is a better indicator of who will develop disability. The five-year study was published in the Journal of Neuroimaging. The findings from the 10-year study were presented at the annual meeting of the American Academy of Neurology. Dr. Thrower: MRI remains one of our most useful tools in the diagnosis and management of MS. The most obvious abnormality on MRI for people with MS is the “white matter lesion.” Healthcare providers, researchers and people with MS frequently focus on these areas of demyelination with questions such as; “How many?’ and “Any new ones?” Maybe these are not the most important questions though. Disability in MS has actually been shown to correlate better with measures of neurodegeneration like black holes and atrophy. This current study emphasizes that point. FDA approves Gilenya for pediatric relapsing MS The U.S. Food and Drug Administration has approved Gilenya (fingolimod) for the treatment of children and adolescents from 10 to less than 18 years of age with relapsing forms of MS, making it the first disease-modifying therapy approved for these patients. This expands the age range for Gilenya, which was previously approved for patients aged 18 years and older with RMS. Dr. Thrower: The management of pediatric MS has been one of the great unmet needs, along with treating progressive forms of MS and neural repair. MS usually begins in early adulthood, but we are increasingly aware that MS may also strike children. The approval of Gilenya for children between ages 10 and 18 represents the first such treatment option for kids. Children cannot be treated like “little adults” and hopefully more treatment options will be targeted at this group in the future.