Older men presenting with primary progressive multiple sclerosis may have a higher risk for developing an aggressive form of the disease, according to a new study led by researchers at the Brain Research Centre.
The study, published online June 6 in the Journal of Neurology, Neurosurgery, and Psychiatry, is one of the first to identify and describe patients with aggressive MS by means of three explicit, clearly defined, and unambiguous criteria that can be used by others.
“We identified between 4-14% of patients as having aggressive MS, depending on which definition we used,” says Suresh Menon, the study’s first author and a UBC postdoctoral fellow at the time of the study. “We also found that one in seven patients who developed MS before age 40 required assistance to walk by the time they reached 40 years old.”
Aggressive MS has a rapid disease course, leading to significant disability in multiple neurologic systems in a relatively short time after disease onset. There are typically three disease courses in MS—relapsing remitting, primary progressive, and secondary progressive. The classification of MS as aggressive or benign is largely based on the speed at which the disease progresses.
“While older men who were initially diagnosed with primary progressive MS may have higher odds of developing the aggressive form of the disease, we found that three out of every five patients with aggressive MS were actually younger women who were initially diagnosed with the relapsing remitting form,” says Helen Tremlett, the study’s senior author, an Associate Professor in the UBC Faculty of Medicine, and a member of the Brain Research Centre at UBC and VCH Research Institute. “This highlights the variability of MS in affecting a broad demographic.”
Previous studies have shown that MS is generally more prevalent in women than men, and the most common form of the disease at time of diagnosis is relapsing-remitting. Because the course of the disease is unpredictable, it is not uncommon for it to change over time.
“Very little is known about the prevalence or incidence of aggressive MS, despite it being the most challenging type to deal with,” says Tony Traboulsee, an Associate Professor in the UBC Faculty of Medicine, Head of the UBC Hospital MS and Neuromyelitis Optica Programs, and a member of the Brain Research Centre. “This study will help us in better understanding the treatment needs of patients with aggressive MS, as well as help to better inform the planning of future experimental clinical trials and other research studies.”
The researchers accessed anonymized clinical data of 5891 patients with MS residing in British Columbia who visited a BC MS Clinic between 1980 and 2009. Using this data they developed three criteria for aggressive MS: 1. patients who reached an Expanded Disability Status Scale (EDSS) score ≥ 6 within five years of MS onset; 2. patients who reached an EDSS score ≥ 6 by age 40; and 3. patients who reached secondary progressive MS within three years of a relapsing onset-course.
Disability in MS patients is measured by EDSS in eight functional systems, and provides a score between 0 and 10. A score of six means a walking aid is required. In this study, patients without an EDSS score were excluded.
This research study was supported by a McDonald Fellowship Salary Award to Dr. Menon from the Multiple Sclerosis International Federation. Salary funding to support some of the researchers was provided by the MS Society of Canada, the Canadian Institutes of Health Research, the National Multiple Sclerosis Society, the Michael Smith Foundation for Health Research, and the Canada Research Chairs program.
Prof. Tremlett is a Canada Research Chair in Neuroepidemiology and Multiple Sclerosis. Dr. Traboulsee is the MS Society of Canada Research Chair.
The Brain Research Centre comprises more than 225 investigators with multidisciplinary expertise in neuroscience research ranging from the test tube, to the bedside, to industrial spin-offs. The Centre is a partnership of the UBC Faculty of Medicine and VCHRI. www.brain.ubc.ca
The UBC Faculty of Medicine provides innovative programs in the health and life sciences, teaching students at the undergraduate, graduate and postgraduate levels, and generates more than $200 million in research funding each year. www.med.ubc.ca
Vancouver Coastal Health Research Institute (VCHRI), a world leader in translational health research, is the research body of Vancouver Coastal Health Authority. VCHRI includes three of BC’s largest academic and teaching health sciences centres — Vancouver General Hospital, UBC Hospital, and GF Strong Rehabilitation Centre — as well as many other hospitals and public health agencies across Vancouver Coastal Health. VCHRI is academically affiliated with UBC Faculty of Medicine and is one of Canada’s top funded research centres receiving between $80-100 million in research funding annually. Over 1500 personnel are engaged in a variety of research centres, programs and evolving research areas. www.vchri.ca