You may know that Canada has the highest rate of multiple sclerosis (MS) in the world, with an estimated 100,000 Canadians living with the disease. But did you know that approximately 85 percent of Canadians with MS are initially diagnosed with treatable relapsing-remitting multiple sclerosis (RRMS)?

Effective therapies exist for RRMS

The three main types of multiple sclerosis are PPMS (primary-progressive multiple sclerosis), SPMS (secondary-progressive multiple sclerosis), and RRMS, which is by far the most common. The two main presenting types of MS are RRMS and PPMS, which unfortunately does not yet have any approved treatments. The number of women and men affected by PPMS are approximately equal, and the onset tends to be in one’s 40s or 50s. In RRMS, for which numerous effective therapies are available, women are affected two to three times as often as men and most people are diagnosed in their 20s and 30s. Over time, people living with RRMS can transition to SPMS.

“MS is distinct from many other common chronic neurological diseases because the median of onset is in one’s late 20s and early 30s,” explains Dr. Jiwon Oh, a physician at St. Michael’s Hospital and a leader in MS research and treatment. “So as you can imagine, this is a disease with the potential to significantly impact people’s lives.”

RRMS is characterized by clearly defined attacks of new or increasing neurologic symptoms, which are followed by periods of remission, during which symptoms may improve or disappear. While some symptoms may continue and become permanent, there is no apparent progression of the disease during periods of remission. Although not all people with MS will experience all symptoms, the most common include vision problems, spasticity or stiffness, bowel and bladder problems, fatigue, episodic bouts of numbness, and problems with cognition (learning and memory or information processing). 

Early diagnosis is key

MS attacks the protective covering — myelin — of the brain and spinal cord, as well as the axons underlying myelin, causing inflammation and damage. When this happens, the usual flow of nerve impulses is interrupted or distorted. Because the relapsing phase of the disease is characterized by ongoing inflammation, it is essential to diagnose the disease and begin treatment as early as possible.

Medical history and a neurological exam are fundamental to diagnosing MS, but such a diagnosis is only made once other potential causes for symptoms have been ruled out. As there is no one test that can be used to diagnose MS, doctors leverage a variety of available tools in diagnosing patients as quickly and accurately as possible.

“Although diagnosis can sometimes be challenging in the initial stages, the increased availability and use of magnetic resonance imaging (MRI) has greatly facilitated the diagnosis of MS, and we are now able to identify MS earlier,” says Dr. Oh. “Another huge benefit of using new technologies such as MRI is that they help us to personalize treatment for individual patients, which is currently a huge unmet need in clinical practice.”

Having multiple treatment options for MS is beneficial for patients

As MS is a variable disease, and no single pathway, diagnostic test or reliable biomarker has yet been identified to predict how patients will fare on specific treatments, it is essential MS patients have multiple treatment options, as well as the flexibility to transition to another treatment when needed. Moreover, there are genetic variants within the disease that have been shown to vary significantly across different populations and individuals, heightening the need for individualized therapies.

There are a growing variety of ways to manage MS symptoms, ranging from pharmacological treatments to non-medicinal strategies such as physiotherapy, occupational therapy, and diet and exercise programs. Given that MS is a lifelong and, as yet, incurable disease, the long-term safety and tolerability of treatments are important considerations in selecting therapies for individual patients, both in terms of efficacy and compliance.

“One of the greatest difficulties we have is that MS is an extremely variable disease, so when you’re diagnosing someone it can be tricky to decide on the right course of treatment,” says Dr. Oh. “That’s why we need technology not just for diagnosis, but for helping us to tailor treatment appropriately.”

An exciting time in MS research

Twenty years ago, tailoring MS treatments to individual patients was unheard of, but the treatment scenario of multiple sclerosis has radically changed. Dr. Oh points to the fact that there were no disease-modifying treatments available until the early 1990s, and it was not until 2005 that a shift truly occurred. Now, the increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses to the absence of any signs of MS.

“Since 2005, we have nearly tripled the agents available to treat people with RRMS,” says Dr. Oh. “In part because of the increased treatment options, but also because our understanding of MS is very quickly changing, doctors have become much more aggressive in terms of identifying MS early and quickly changing treatments as required by a patient’s needs.”

Researchers such as Dr. Oh continue to work toward finding the cause of MS, developing better treatments with fewer side effects, and ultimately hope to cure the disease. But in the meantime, it is heartening and important to know that through a variety of currently available treatment options, health and wellness, including emotional well-
being, can be achieved even in the presence of a chronic illness or disability such as MS.