Category Archives: ECTRIMS2013

Mapping MS in Canada and around the world

Conferences like ECTRIMS are a great platform for scientists, academic institutions and health organizations to announce breakthrough discoveries and important medical and research news.

During this year’s ECTRIMS meeting in Copenhagen, the Multiple Sclerosis International Federation (MSIF) announced the release of a very important document called the Atlas of MS. Made possible by the work of many individuals in the health and government sectors, the Atlas of MS provides a detailed overview of the patterns of MS prevalence, diagnosis, and treatment around the world. Not only does it reveal the number of people with MS in different countries, but also highlights the distribution of resources and services for people with MS in these areas.

The objective of the atlas is to assist governments, policy makers, non-profit organizations, and private industry in making informed decisions around the treatment and support for people with MS. The Atlas also encourages researchers to engage in international collaboration and raises awareness about MS in various areas.

Ultimately, if MS communities around the world can identify gaps in research, healthcare, government polity and support programs, they will be able to develop the necessary tools and practices that will address these gaps and build a better future for people affected by MS. More information on the Atlas of MS and key findings can be read in detail on the MS Society website.

I felt a sense of pride when I learned that many Canadians contributed to the development of this critical resource, including staff at the MS Society and MS Society-funded researchers. I had an opportunity to speak with one of the researchers at ECTRIMS. Dr. Helen Tremlett (pictured below at ECTRIMS with neurologist Dr. Penelope Smyth from Calgary) is an associate professor in the Faculty of Medicine and epidemiologist at the University of British Columbia. Dr. Tremlett is interested in observing the effects of MS on people. Specifically, she looks at the relationship between MS and: pregnancy, family relationships, disability, other chronic health conditions and use of therapies.

Dr. Helen Tremlett is pictured here (left) with Dr. Penelope Smyth from Calgary, Alberta

Here are the some of the highlights from my interview.

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What triggers MS?

There are many things about MS that we still do not know, but arguably the most important of these is cause. Pinning down the cause of MS has been a top priority amongst MS researchers for decades and, despite a growing body of promising evidence, the question of cause remains unresolved.

What we are learning more about are the ‘triggers of MS’, which are factors that may be contributing in one way or another to the development of disease. I already mentioned in a previous post that gender has a lot to do with MS susceptibility and severity, and recently the MS Scientific Research Foundation – an MS Society affiliated research funder – launched an extensive, multi-year study that identified different genetic and lifestyle factors which were found to be associated with MS. The study, led by Professor George Ebers who is pictured above, uncovered several important insights about MS triggers (read examples here and here).

ECTRIMS was a great platform to discuss the newest data on MS triggers. It was clear from the lectures that we are moving closer to understanding how genes, lifestyle habits, geographic location and environmental surroundings can impact one’s risk of MS. Here are some of the interesting things I heard at the conference.

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Managing MS through physical activity

We all know without a doubt that exercise is good for us. The abundance of health benefits associated with a steady exercise regimen has made exercise an ideal complementary treatment for various diseases. But is this the case for MS?

For years, neurologists have advised people with MS to avoid physical activity as it could worsen neurological symptoms. However, new evidence suggests that exercise is, in fact, highly beneficial for people with MS and can lead to marked improvements in:

– Mobility
– Fatigue
– Depression
– Cognitive functioning

Despite the surge in scientific data reporting positive effects of exercise in MS, the fact remains that fewer than 20% of people with MS engage in adequate amounts of physical activity and the level of activity decreases over time. From speaking to many people affected by MS, I can understand why they would not be so inclined to head out to a gym or sign up for a structured exercise treatment program given the physical challenges they face on a daily basis.

According to Dr. Robert Motl, who presented on exercise in MS at ECTRIMS, there may be an effective way to boost physical activity in people with MS without having to impose a structured, supervised exercise training program.

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Insights on inflammation – an expert view

Our immune systems are designed to fight off disease, and one way they do this is through a complex, highly controlled process known as inflammation. We know that in MS, the immune system misbehaves, and inflammation occurs not only to ward off harmful agents, but also to inflict damage on nerve tissues which comprise the brain and spinal cord.

Researchers around the world are trying to determine how inflammation drives MS disease. I met with esteemed neuroimmunologist Dr. Amit Bar-Or, who shared some valuable insight on inflammation and MS. As I mentioned in my last post, Dr. Bar-Or is both a research scientist and neurologist, which allows him to combine both clinical and laboratory expertise when trying to investigate the full impact of inflammation in MS. I wanted to know how far we’ve come in the last decade in terms of our understanding of inflammation, and what the future holds for this promising avenue of MS research. This was his response.

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MS disease – what happens beneath the surface?

There is an ongoing debate on whether inflammation causes nervous system damage in MS, or if the damage occurs first followed by inflammation. MS Society funded researcher and neurologist Dr. Amit Bar-Or from the Montreal Neurological Institute at McGill University provided an overview of the mechanisms of inflammation during ECTRIMS. He emphasized that, regardless of what comes first – inflammation or tissue damage – inflammation is occurring in MS. But why is inflammation occurring, and what is causing it? Research is ongoing to find definitive answers for such questions.

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Interview: Dr. Erin MacMillan

Since we are on the topic of progressive MS, I thought it would be a great time share this insightful interview with Dr. Erin MacMillan who is a MS Society-funded postdoctoral fellow at the University of British Columbia. It was interesting to hear that Dr. MacMillan has a backgound in physics and we wanted to learn more about how she applies her extensive physics knowledge to detect early changes in the brain of people with MS, as well as what her research could mean for progressive MS.

Progressive MS – Where are we today?

I mentioned earlier that progressive forms of MS are still without an effective treatment, which has been recognized by the MS scientific community as a major gap that needs to be addressed.

According to Dr. Robert Fox from the Cleveland Clinic, who opened today’s session on progressive MS, there are a number of clinical trials underway showing the therapeutic potential of several treatment. Dr. Fox will be leading one of the trials, which involves evaluating the safety and tolerability of the anti-inflammatory drug ibudilast in people with progressive MS (read about the trial Stem cells are also being looked at for their ability to treat progressive as well as relapsing-remitting MS. Amiloride – an oral drug used to treat high blood pressure – has been shown to have nerve-protecting qualities and is now in early trials for progressive MS. Dr. Fox noted that, in the future, there should be increased focus on regenerative treatments for MS that can rebuild the tissues in the central nervous damaged from inflammation.

In an effort to address the growing need for research in progressive MS, Dr. Fox announced at ECTRIMS that several MS Societies from around the world are joining forces in a collaboration that will leverage the necessary resources to speed up the creation of progressive MS therapies. The MS Society of Canada has been a key player in this initiative since the very beginning when there were only a few of us who came together to brainstorm how we would tackle this critical priority in MS research. Today, thehas expanded immensely, engaging the best and brightest researchers around the globe.

I, along with many of my peers here, am hopeful that the work funded by the Alliance will solve the complex puzzle of progressive MS. That is not to say that there isn’t already some excellent research happening in the field right now. Dr. Ciccarelli and her lab from the UK presented interesting data from their study on progressive MS today.

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Interview: Dr. Yinshan Zhao

I had an opportunity to chat with Dr. Yinshan Zhao, a statistician working with the Multiple Sclerosis/MRI research group at The University of British Columbia. Dr. Zhao presented her data on the use of magnetic resonance imaging (MRI) for measuring responses to therapy here at ECTRIMS. I was happy to hear that her study, funded by the MS Society of Canada, was recently accepted by the Journal of American Statistical Association, a leading journal in statistical research. I wanted to touch base with Dr. Zhao to hear more about her work and its application in the clinic.

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More treatment options for MS

One of the main topics being covered at ECTRIMS is MS treatment. Treatments for MS, whether disease modifying therapies (DMTs) or rehabilitation strategies, have reached an overwhelming number over the last two decades, before which there was no approved treatment available. With so many options to choose from, new questions begin to arise, such as:

  1. Which therapy or therapies should a person with a particular form of MS take?
  2. When is the best time to begin a treatment regimen?
  3. What are the long term effects of DMTs?

Researchers from around the world have come to ECTRIMS to share new data that is helping to answer some of these questions.

MS treatment – revolution or evolution?

While the management of relapsing-remitting forms of MS has been declared by some as a ‘revolution’, treatment for other, more severe types of MS remain elusive.

“There are, to date, nearly 10 treatments available for relapsing-remitting MS, but there is still no therapy for progressive MS” – says Professor Per Soelberg Sørensen, Chair of 2013 ECTRIMS during a press conference. “This would likely classify progressive MS treatment as more of an ‘evolution’ which requires further research”.

There is, however, a silver lining for people with progressive MS as well as relapsing-remitting MS – early treatment. This is a topic that received much attention over the past few days, as there is growing evidence showing that treating MS as early as possible can have a significant impact in long-term treatment response, quality of life, and disease progression in people with MS. Professor Hans-Peter Hartung from Germany noted at yesterday’s symposium that early diagnosis and treatment is key in reducing disability and maximizing quality of life. Professor Gavin Giovanni, who presented shortly after, added that initiating treatment with DMTs at the first signs of relapse has major benefits. This was demonstrated in trials involving early treatment with natalizumab (Tysabri, Biogen Idec) which led to better relapse recovery, improvements in areas such as cognition, vision and fatigue, and a stable EDSS score (an important measure of disability).

There have been several other presentations discussing the positive outcomes of managing MS in the earlier phase of disease, labeling this period as the ‘window of opportunity in MS treatment’. Data from a presentation by Dr. Aaron Miller from the USA showed that early treatment with teriflunomide (Aubagio, Genzyme, A Sanofi Company) can lower the likelihood that someone with clinically isolated syndrome (a single, isolated neurological episode) will convert to clinically definitive MS and, in patients who are already relapsing, decrease the risk of new relapses and lesions seen on MRI scans. A number of related trials have confirmed the benefits of early treatment in preventing people with CIS from developing MS.

Silencing the disease from the start

During this morning’s opening lecture, Professor Giancarlo Comi from Italy noted that the extent of tissue damage in the brain in late stage MS depends on the events which take place earlier on. Thus, if treated early, people with MS may experience a much more positive outcome. In addition, treating MS at the early signs of tissue damage can avoid exhaustion of the protective mechanisms used by our brains to recover from such trauma.

It’s quite exciting to hear about the new frontiers in MS treatment, and we look forward to hearing more in this area over next few days.

Until next time!

A brief hello

As soon as I arrived in Copenhagen I headed straight to the Bella Center and jumped into the first session I could get to. Since then it has been back-to-back presentations, meetings, and interviews. Amidst the craziness of ECTRIMS I managed to touch base with my team and have a quick chat about what is coming up in the days to follow. Listen in!