- For MS to be formally diagnosed, people need to experience at least two attacks of neurologic symptoms (e.g. visual blurriness) at different times.
- A single attack is known as a first demyelinating event (FDE) or clinically isolated syndrome.
- Australian researchers have built a model to identify predictors of progression, taking into account the role of multiple factors.
In a study supported by MS Australia, researchers have investigated genetic, neurological, MRI and environmental risk factors that might predict progression from a first demyelinating event (FDE; first attack and precursor to MS) to clinically definite MS.
Previous studies have mainly focused on one or two factors in combination, but this study truly looks at multiple factors to understand what drives progression to MS.
Published in Brain Communications, 215 participants who experienced an FDE between 2003 and 2006 were recruited as part of the Ausimmune study.
Baseline data were collected, including demographics, time spent outdoors, physical activity and MRI. Blood samples were also collected to determine vitamin D levels, antibodies to Epstein-Barr virus (EBV) and human herpes virus 6, and to explore genetic factors that might be contributing to progression.
The researchers followed the participants, and follow-up data were collected two to three years later. This included whether any of the participants went on to develop MS or not and whether there were any changes in environmental exposures during the follow-up period.
For participants where follow-up data were available, 77% had a second demyelinating event and were therefore diagnosed with clinically definite MS within the two to three-year period.
Using the data, the researchers developed a model and found the best predictors of progression from an FDE to clinically definite MS were:
- younger age at FDE;
- being a smoker at baseline;
- lower sun exposure;
- lesions in specific regions of the brain at baseline and;
- certain inherited genes
There was no association between EBV and herpes virus 6 antibody levels or vitamin D levels, and progression to clinically definite MS.
This study provides significant and clinically relevant information on multiple factors that may influence whether someone who has an FDE will eventually develop MS.
Studies like this one are essential to help us understand the complex interaction between environmental and genetic factors which might lead to MS.
Interestingly, given the broad range of treatments currently available to people who experience an FDE, studies like this will become more and more challenging as those treatments modify the course of MS.
