May is Multiple Sclerosis Awareness Month

What is Multiple Sclerosis (MS)?

• MS attacks parts of a person's brain and spinal cord. Typical symptoms are extreme fatigue, visual and sensory problems, disequilibrium. Eventually, loss of muscle control leads to paralysis.
• Canada has one of the world's highest national rates of MS -about 1,100 new cases each year. Some 50,000 Canadians have MS. More than one in five patients are in Quebec.
• MS is one of the most common neurological diseases among young Canadians. Children as young as two can develop MS. The disease typically strikes people in their prime years, between 15 and 40.
• Women are twice as likely as men to contract MS.
• The cause of MS is still unknown. Scientific evidence suggests that a major component is an auto-immune disease that affects myelin, a substance coating axons, the thin strands that carry signals between brain cells.
• MS has several forms:
1. Relapsing-remitting MS at onset: the most common form, in which periods of acute symptoms alternate with periods of remission of variable duration although generally the disease will progress over time.
2. Primary progressive MS: the rarest form---symptoms worsen steadily from onset with no remissions.
3. Secondary progressive MS: this form occurs in patients with relapsing-remitting onset. Eventually their symptoms progress steadily without further remissions.
• Some drugs can temporarily help to control symptoms or to extend remission periods.
• MS can be detected in its early stages by Magnetic Resonance ImagingMRI scans that reveal scars in the nervous system that are typical of the disease.

The Neuro ---On the front line of MS Research

MS and Children

Dr. Amit Bar-Or of the Neuro and Dr. Tanuja Chitnis of Harvard University have published evidence that babies with certain physiological characteristics could be at greater risk of acquiring MS. In a comparison study of control subjects, they concluded that the onset of childhood MS is associated with a smaller head size, smaller brain volume as well as a smaller volume of the brain's thalamus.

MS can strike children at a very young age. Increasingly, pediatric MS is recognized as a disorder requiring separate study. Researchers have only a limited understanding of the pathogenic mechanisms that cause MS to develop and progress in children and adolescents. The rarity of child MS might mean that the pediatric immune and central nervous systems have specific qualities that prevent MS. But researchers cannot say whether MS manifests itself in children for the same reasons that it begins in adults. Discovering why certain young people develop MS would be valuable, especially because children are more at risk of developing MS if they have experienced one of the several forms of acute demyelinating syndrome.

MS and Sleep

Sleep complaints are common in MS, but there's little objective data on sleep abnormalities and their relationship with patient symptoms. Some telling conclusions were made in a rare scientific study of MS and sleep by Dr. Daria Trojan with her Neuro colleagues, as well as with colleagues from the McGill University Health Centre's Respiratory Division and Sleep Laboratory, and Respiratory Epidemiology and Clinical Research Unit.

The researchers found that the most frequent sleep disorder in MS patients is a respiratory disorder during sleep called obstructive sleep apnea (OSA). The investigators used polysomnography (or complete overnight sleep studies) to diagnose OSA, and then evaluated the relationship between fatigue and OSA. Polysomnography employs electrodes to register the biophysiological changes that occur during sleep-brain and muscle activity, heart rhythm, and breathing patterns.

The study concluded that there was a significant association between fatigue and OSA in MS patients. In addition, they found that respiratory-related sleep disruption was likely responsible for increasing fatigue in MS patients. MS subjects were generally found to have more fragmented sleep than control subjects, perhaps because they have a lower arousal threshold. As a result, respiratory events would be more likely to rouse patients from sleep.

However, other studies have shown that fatigue in MS can also be related to other factors. Other investigators have found a relationship of MS fatigue with reduced glucose metabolism in the brain, or with loss of neurons and axonal degeneration. MS patients might also feel fatigue because parts of their central nervous system try to compensate excessively for MS symptoms.

endMS Network

Neurologist at the Neuro, Dr. Jack Antel, is Scientific Director of the endMS Research and Training Network. EndMS is a nationwide $20 million program sponsored by the Foundation of the Multiple Sclerosis Society of Canada. In 2009, endMS established five collaborative training centres at academic and health institutions across Canada.

The five centres stage MS workshops and conferences, and promote research transfers and trainee/mentorship programs. By contributing to national MS programs, endMs helps to create an integrated nationwide network of trainees and researchers.

The Québec-Ottawa endMS centre includes McGill University, the University of Ottawa, Laval University, and the Universities of Montréal, Québec and Sherbrooke along with affiliated hospitals and MS Clinics. Among the members of the executive committee is Dr. Louis Collins of the Neuro's McConnell Brain Imaging Centre.

Canada's first MS Clinic

The Neuro operates Canada's oldest clinic devoted to MS patients. Each year, The Neuro's clinic treats some two thousand patients.

Under the direction of Dr. Yves Lapierre, the MS Clinic has a multidisciplinary staff of neurologists, nurse specialists, physiotherapists, occupational therapists and social workers. A multidisciplinary approach ensures the best way to help not only patients suffering from reduced mobility, but families trying to cope with the needs of their afflicted loved one.

Patients may participate in important clinical trials of new MS drugs at the Neuro's Clinical Research Unit.

More than 50 members of The Neuro's staff are conducting laboratory and clinical studies related to MS. They employ the finest scientific equipment--from brain imaging scanners to the latest cell biology tools-to study the disease in all its aspects and at every stage. The Neuro's basic scientists and clinical physicians cooperate closely to translate research into patient therapies.

MS Researchers at the Neuro

Dr. Yves Lapierre, Director, MS Clinic. A neurologist, Dr. Lapierre undertakes clinical drug trials and designs programs that prescribe MS drugs in the most effective way to prevent relapses.

Dr. Jack Antel, neurologist, examines human neural and immune cells to understand how their interactions contribute to MS. He studies the role of glial cells in the nervous system, as well as the variables that contribute to remyelination.

Dr. Douglas Arnold, neurologist. Using the latest brain-imaging techniques, Dr. Arnold diagnoses and tracks MS lesions in the brain, and analyzes the effectiveness of MS therapies.

Dr. Amit Bar-Or, neurologist and immunologist, researches the properties of immune cells, stem cells and their interactions with neural cells. He directs the Neuro's Experimental Therapeutics Program, which translates basic science findings into the development of novel therapies for MS.

Dr. Alyson Fournier, research scientist, studies the nature of nerve cell injuries. She is looking for ways to repair nerve cells damaged by MS.

Dr. Tim Kennedy, research scientist, investigates how myelin forms during neural development, and how it is maintained in the mature brain. His research aims to promote mechanisms that stimulate remyelination.

About the Montreal Neurological Institute and Hospital
The Neuro is an academic medical centre dedicated to neuroscience. As a research and teaching institute of McGill University, The Neuro is at the centre of the neuroscience mission of the McGill University Health Centre. The eminent neurosurgeon Wilder Penfield founded The Neuro in 1934. Since then, The Neuro has achieved international renown for its integration of research, outstanding patient care and advanced training. The Neuro has a world-class staff in cellular and molecular neuroscience, brain imaging, cognitive neuroscience, as well as in the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. For more information, visit theneuro.com.