Why is this study important?

Most people who live with multiple sclerosis (MS) develop some kind of impairment that makes daily functioning more challenging. However, the degree of MS-related disability varies widely from person to person. Many different factors determine how disability evolves over time and whether it gets worse, including MS type, stage of disease, age, and the presence of other diseases (comorbidities).

Health care providers have been working to decode the risk factors that are likely to worsen the disability caused by MS. Being able to predict these factors with accuracy enables providers to make optimal treatment decisions and to personalize care for each person with MS. Such predictors also play an important role in preparing people with MS and their caregivers for any challenges that lie ahead and helping them to cope with changes in treatment plans and lifestyle choices.

Who is at risk for worsening disability?

Health care providers look at different aspects of a person’s life and health status to try to determine whether MS-related disability will improve, stay the same, or worsen over time. Some risk factors, known as clinical factors, include the age and sex of the person, the disease stage, and the history of MS relapses. For instance, male sex and being older than 45 years are considered reliable predictors of worsening disability. Experiencing progressive disease from the onset of MS and incomplete recovery after MS episodes are also harbingers of increasing disability over time.  

While clinical factors cannot be changed, others, such as comorbidities and lifestyle choices, are modifiable. Diseases that affect the blood vessels, including diabetes, heart disease, high blood pressure, high cholesterol levels, and diseases of the arteries in the legs are likely to increase MS-related disability. Studies have shown that the odds of worsening disability increase even more when several of these comorbidities are present. Obesity and the presence of psychiatric disorders such as depression can also predict disability worsening in adults with MS. Managing these disorders, in addition to adequate MS treatment, is key to increasing quality of life for people who live with MS.  

Lifestyle choices such as smoking, alcohol use, and habitual sedentary behavior can have a negative impact on the progression of disability. Health care providers, caregivers, and family members all play an important role in promoting lifestyle changes and providing people with MS with the support they need to adopt and maintain healthy habits, which can slow the progression of disability.  

Are there tests to predict worsening disability?

Traditionally, imaging studies of the brain and spinal cord have been used to measure the progression of MS. Extensive damage in certain areas of the nervous system seem to be better predictors of a higher MS-related disability burden. Loss of brain volume in a deep-brain structure known as the thalamus, measured by magnetic resonance imaging (MRI), is considered a strong predictor of worsening disability in progressive MS. Additionally, MRI studies have shown that a higher number of lesions, as well as a loss of volume, in the cerebral cortex (the membrane that envelops the brain hemispheres) and the spinal cord are linked to worsening cognitive impairment and physical disability in people with MS.

Eye damage such as thinning of the optic nerves is also seen consistently in people with MS who develop worse disability over time. Optical coherence tomography, a test that can measure such damage, is a promising tool for predicting future disability in MS.   

What does the future hold?

Providers may soon be able to routinely use blood tests that can predict future severity of MS-related disability more accurately than other tools. Certain proteins are released in the bloodstream when neurons are damaged by diseases such as MS. Among those, neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) have shown up in higher levels in the blood of people with MS included in clinical studies and have been linked to more severe disability. Research continues, but these lab tests are likely to ease the task of predicting which individuals with MS are likely to experience worsening disability.

In addition to identifying risk factors, starting highly effective therapies early in the disease course may reduce long-term disability, according to recent research. If you have MS, discuss your risk factors with your health care provider. Together, you can come up with the best strategies for reducing your odds of future disability.

Original Article