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May is Multiple Sclerosis (MS) Awareness Month, an ideal time for the global MS community of more than 2.3 million people to share their stories, campaign and raise awareness about the neurological disease. In Canada, MS Awareness Month holds even greater prominence, as Canada has one of the highest rates of MS in the world with 93,500 living with this debilitating condition.

Classified as an autoimmune disease of the central nervous system, MS affects the brain, spinal cord and optic nerves. Symptoms include extreme fatigue, lack of coordination, weakness, tingling, impaired sensation, vision and bladder problems, cognitive impairment and mood changes.

The physical symptoms of MS can be crippling, but it’s the emotional symptoms that often go untreated and can be extremely difficult to overcome. This includes depression, persistent anxiety and extreme irritability. Lack of knowledge about the disease adds to the stress experienced by those who are newly diagnosed.[i]

While our understanding of MS continues to evolve, there is still no known cure. However, researchers are making significant breakthroughs on risk factors, treatment options and symptom management. Learn more about the state of MS research and what’s in store for the future below.

Facts about multiple sclerosis[ii]:

    • MS is the most common neurological disease affecting young adults in Canada
    • MS is most often diagnosed in young adults aged 20 to 49, but younger children can also be diagnosed with the disease - an increase of 82 per cent from 1990 and 2016
    • Women are three times more likely to be diagnosed with MS
    • MS was recognized as a distinct disease in 1868, but it was not until the 20th century that progress was made on symptom management
    • It remains unclear what causes MS and most people that are diagnosed have no known risk factors
    • Average length of time it takes to get a diagnosis is five years
    • Total per capita healthcare cost for adults with MS aged 20 and older is approximately $16,800
    • The MS Society of Canada recognizes four different kinds of MS: Clinically-isolated syndrome, relapsing-remitting MS, secondary-progressive MS and primary-progressive MS

What is multiple sclerosis?
Multiple sclerosis is an autoimmune disease in which the immune system attacks the protective sheath of nerve fibers, known as myelin, causing communication issues between the brain and the body. This can result in permanent nerve damage, impacting a patient’s ability to walk. Described as a “tailor-made disease” by patients and physicians, MS affects people to varying degrees. While there is no cure for MS, treatment options are available to help speed the recovery process, manage symptoms and alter the course and potential severity of the disease.[iii]

Why is MS so prevalent in Canadians?
“That’s the million dollar question,” says Uyen Nguyen,  Executive Director, Synaptic: Spinal Cord Injury and Neuro Rehabilitation Centre. According to Statistics Canada, Canada’s rate of MS is approximately 290 cases per 100,000 people. This far surpasses the United Kingdom, the country with the second-highest prevalence rate of 203 cases per 100,000. Sweden is third at 189.[iv]

While Canada continues to demonstrate proportionately high numbers compared to other nations, researchers have yet to uncover why. Several theories have been posited, including Canada’s distance from the equator, which limits our exposure to the sun and decreases our skin’s ability to generate sufficient vitamin D. Earlier exposure to viruses, genetic predisposition and high rates of smokers have also been viewed as contributing factors to Canada’s higher MS rates.

What we do know is that both genetics and environmental factors are at play when assessing why MS impacts Canadians more so than citizens of other western nations.

How has MS research evolved over the past 10-20 years?
Researchers are still struggling to identify the causes of MS; however, exciting progress has been made in other areas of research, most importantly the medical community’s understanding of brain functionality. Nguyen explained that 20 years ago, researchers believed the brain functioned similar to a house, where each area is designated for a certain task - the kitchen for cooking, the bedroom for sleeping, and so on. When one room of the home was damaged, the individual was unable to perform the functions traditionally done in that space. Fast forward 20 years, and we now understand that the brain can adapt and heal, changing its own structure and function in response to mental experiences, a phenomenon called neuroplasticity.[v]

Other significant advancements in MS research include the role of diet and nutrition in symptom severity and the importance of exercise in mitigating the effects of MS. Clinical trials are also ongoing to evaluate stem-cell therapy for progressive MS. Several studies have also shown that chemotherapy can be used to destroy the damaged immune system, which can then be replaced with immune system stem cells. This can effectively halt the development of new MS lesions. While this strategy is still being tested, the effect of the treatment is that it appears to reset the immune system so that it can no longer attack the brain. Pharmaceutical research, exploring “susceptibility genes” and the role of early and sustained therapies are also being explored by the medical community.[vi]

What are the current treatment options for MS?
While there is no cure for MS, there are treatment options available to speed up recovery from attacks, slow the progression of the disease and manage MS symptoms. Oral and pharmaceutical interventions have been known to treat MS attacks and modify the disease’s progression. Plasma exchange, which occurs when plasma is removed and separated from blood cells, then mixed with a protein solution and put back into your body, has also been known to treat MS attacks. Please consult with your physician to learn more about which treatment option may be right for you.[vii]

Physical therapy, including stretching and strengthening exercises, is also a proven treatment to mitigate MS signs and symptoms. PoNS Treatment™, authorized in Canada in March, may be an effective treatment option for improving the gait and walking of patients with MS. The PoNS Treatment™ is a 14-week program that combines in-clinic and in-home use of the PoNS™ device guided by a Certified PoNS™ Trainer. The PoNS™ device, short for Portable Neuromodulation Stimulator, is an innovative, non-surgical medical device that gently stimulates the surface of the tongue, exciting the neural network flowing to the brain. This neural activity is believed to enable neuroplasticity, which may reactivate and change the neural network, compensating for previously lost function. The device is intended for use as a short term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from MS and is to be used in conjunction with physical therapy.

What are the greatest challenges in MS treatment?
According to Nguyen, one of the greatest challenges with studying and treating MS is the fact that no two patients are the same. There is no protocol or recipe for working with MS patients, as their journeys are extremely unique. Since it is a moving target, it is much more challenging to treat their condition, as treatment options that work one week may be less effective the week after. This requires clinicians to step back and assess a person’s quality of life, developing an individualized clinician package, as opposed to recommending common disease-modifying therapies. This also poses a challenge for medical professionals when it comes to prescribing drugs - it is difficult to know which drug should be given to which patient and at what stage of MS, considering the uniqueness of the disease.[viii]

Another challenge is the model of academic research, noted Nguyen. She explained that while there are a number of qualified scientists and medical researchers doing important work in studying MS, there are gaps in how research is structured and funded. For example, if a researcher is awarded funding for a specific project and their hypothesis turns out to be incorrect, or the results of that study are inconclusive, the response is often to allocate more money towards finding a solution. There is no finish line. Nguyen believes that from ideation to implementation, there have to be pillars in between to ensure medical research is moving forward.

What does the future of MS research and treatment look like?
There are a number of studies and clinical trials underway to evaluate and treat the physical symptoms of MS. Researchers are working towards a greater understanding of myelin-producing stem cells in the brain that could help treat myelin damage, which would ultimately reduce some of the more serious symptoms associated with MS. A more thorough understanding of the link between vitamin D and MS is also underway to determine how effective supplements could be in treating MS. Pharmaceutical solutions are also in progress, with drug manufacturers focused on neuroprotection - developing medication to protect nerve cells from damage to slow or stop the progression of MS.[ix]

While these are all positive advancements in the future of MS treatment, Nguyen is hopeful that research will be heavily focused more on discovering possible genetic and environmental origins of the disease and potential risk factors. This information could be extremely valuable in the creation of disease-altering treatments that modify the course of the disease as opposed to symptom mitigation.

To learn more about PoNS Treatment™ for MS, please visit the clinical evidence page.

[i] “Emotional Changes,” National Multiple Sclerosis Society, 2019. (Accessed May 2020) https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-.Symptoms/Emotional-Changes

[ii]   Gilmour, Heather, Pamela L. Ramage-Morin and Suzy L. Wong, “Multiple Sclerosis: Prevalence and Impact,” Statistics Canada, January 2018,(Accessed May 2020). https://www150.statcan.gc.ca/n1/pub/82-003-x/2018001/article/54902-eng.htm

[iii] “Multiple Sclerosis: Symptoms and Causes,” Mayo Clinic, April 2019 (Accessed May 2020) https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269

[iv]  Gilmour, Heather, Pamela L. Ramage-Morin and Suzy L. Wong, “Multiple Sclerosis: Prevalence and Impact,” Statistics Canada, January 2018,(Accessed May 2020). https://www150.statcan.gc.ca/n1/pub/82-003-x/2018001/article/54902-eng.htm

[v]  Doidge, Norman. The Brain's Way of Healing: Remarkable Discoveries and Recoveries From the Frontiers of Neuroplasticity. New York, New York: Viking, 2015.

[vi]  Garry, Tom, “What’s New in MS Research,” Multiple Sclerosis Association of America, March 2019. (Accessed May 2020)  https://mymsaa.org/news/new-in-ms-research-march-2019/

[vii]  “Multiple Sclerosis,” The Mayo Clinic. April 19, 2019. (Accessed May 2020).  https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274

[viii]  Piehl, Fredrik, “A changing treatment landscape for multiple sclerosis: challenges and opportunities,” Journal of Internal Medicine, vol. 275. June 2014: 364-381.    https://onlinelibrary.wiley.com/doi/pdf/10.1111/joim.12204

[ix]   Silva, Patricia, “5 Areas of Research That Could Change the Future of MS Treatment,” Multiple Sclerosis News Today, July 2017. (Accessed May 2020) https://multiplesclerosisnewstoday.com/2017/07/17/areas-research-future-ms-treatment/