Multiple Sclerosis (MS) Support Group

From The Times
August 31, 2009
Blood test could predict severity of multiple sclerosis
Coloured MRI brain scan showing multiple sclerosis
Mark Henderson, Science Editor

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A blood test that could predict the severity of multiple sclerosis (MS) is being developed by British scientists, promising to improve clinical management of the neurological disorder.

Research has identified a biological marker in blood that seems linked to patients’ prognosis after the first MS attack, paving the way for a new approach to assessing how the illness will progress. If a blood test based on the biomarker can be validated, it could be used with MRI scans and other methods to improve diagnosis.

Patients whose MS is thought likely to progress quickly could be started swiftly on therapies that can reduce the frequency and severity of attacks, while those at lower risk could be spared medication they do not need immediately. More accurate ways of assessing prognosis could also help to prepare patients for what they should expect in the future, removing the uncertainty that can be a distressing feature of the disease.

The research, led by Rachel Farrell, of the Institute of Neurology at University College London, and funded by the MS Society, also offers new insights into the biology of MS that could improve understanding of the causes of the condition.
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MS is a neurological disorder that affects about 100,000 people in Britain, and the most common disabling condition of the young. It is an autoimmune disease, caused when the body’s immune system attacks the myelin sheaths that insulate nerve fibres, causing transmission errors. Symptoms can include a loss of sensation and balance, fatigue, paralysis, pain, memory problems, vision problems, incontinence and sexual dysfunction.

After a first attack of MS-type symptoms, the disease can develop in several ways. A small proportion do not have more attacks, while most start with the relapsing-remitting form of MS, with attacks followed by periods of recovery. Most of these go on to develop secondary progressive MS within 10 to 15 years of diagnosis, in which symptoms worsen over time. About 10 to 15 per cent of patients have primary progressive MS, in which symptoms worsen steadily from the start, without periods of remission.

The condition is diagnosed from symptoms and MRI scans that look for characteristic lesions in the brain, as well as lumbar punctures to identify abnormalities in cerebrospinal fluid. The new research, published in the journal Neurology, suggests that a blood test could be added to this suite of diagnostic tools, to improve accuracy and assess an individual’s likely prognosis. In the study, Dr Farrell’s team investigated links between MS and Epstein Barr Virus (EBV), a virus to which about 90 per cent of people have been exposed. Almost everybody with MS has been infected with EBV, and adults who get it are at raised risk. This has led scientists to question whether a reactivation of latent EBV might be a factor in the onset of MS.

Dr Farrell said: “It’s very interesting that people who are negative for EBV don’t get MS. The question is: do you need EBV to develop MS, or is there something about the immune system of people without EBV that also means they don’t get MS?”

In the study, the scientists looked for antibodies to EBV in 50 people who have had an attack with MS-type symptoms but who have not had MS diagnosed, 25 people with relapsing-remitting MS, and 25 people with primary progressive MS.

“We wanted to see if reactivation of the virus triggered relapses, but we found no evidence of that,” Dr Farrell said. “But when we looked at the pattern of antibody response, we found people with a higher level of antibodies had more lesions. The suggestion is that a higher antibody load is indicative of a quicker progression of MS. We have identified something that may be used as a biomarker. This may be useful in identifying those who are going to go on and develop MS.”

Such a test, she said, could be particularly useful in deciding whether to prescribe drugs such as beta interferon and glatiramer acetate (Copaxone) to people who have had an initial MS-type attack. They can reduce the frequency and intensity of relapses, but they are burdensome because they must be injected daily.

Susan Kohlhaas, research communications officer at the MS Society, said: “People with MS find the uncertainty of what the future holds very daunting so more knowledge about what might lie in store could be a big help.”

Debilitating symptoms will get progressively worse

• Symptoms can include weakness, fatigue, loss of sensation or balance, pain, paralysis and blindness
• Most people with MS have the relapsing-remitting form of the disease, in which attacks are interspersed with periods of remission
• Relapsing-remitting MS generally turns into secondary progressive MS, in which symptoms worsen steadily
• About 10 to 15 per cent of patients have primary progressive MS, in which the disease worsens steadily from the first attack
• Treatments include beta interferon and glatiramer acetate (Copraxone), which can reduce the severity of attacks, and the slow progression of the disease
• Almost everybody who develops MS has previously been exposed to Epstein-Barr virus
Source: MS Society
Posted on 08/31/09, 03:08 pm