Avid readers of this blog will have probably noticed that Prof G has been increasingly focusing on new initiatives recently. One of these is Preventive Neurology – as part of this we have received a large grant to set up a Preventive Neurology Unit, based at the Wolfson Institute of Preventive Medicine within QMUL.
But what does preventive neurology have to do with MS, given that we can’t even be sure as to the cause of MS? And how will this work?
Having been away from QMUL and Barts-MS for a few years, I’ve now taken up a post as a Senior Lecturer in the Preventive Neurology Unit to develop strategies to prevent MS. So I thought I’d introduce some of these, and how the unit might work towards this over the next few years.
Firstly what do we mean by preventing MS? The most obvious interpretation of this is preventing MS from actually developing, which would be fantastic, but is clearly a very long term goal. I think it is also important to think about how we can prevent disability from developing in people who already have MS – not just MS-related physical disability, but cognitive problems, and also other health problems that can increase disability such as fractures.
In terms of preventing MS from developing, we are looking at risk factors that have previously been associated with MS development; and one of the most interesting of these is infection with the Epstein-Barr virus, EBV. As many of you will know, if we look hard enough we find evidence of EBV infection in (almost) 100% people with MS, but only about 95% of controls without MS. Looking at this the other way round, if you haven’t been infected with EBV you are extremely unlikely (i.e. it is almost impossible) to get MS. It is also clear that if you have symptomatic infection (infectious mononucleosis, or glandular fever) your risk of MS is even higher.
We don’t understand why, when infected, it is that some people do get MS and others don’t and this is something that we need to understand better and that we are working on. We also need to look at whether treating infectious mononucleosis, and/or suppressing the levels of EBV in the blood after infection have any effect on MS risk or MS activity.
One of the ways that we can start to do this is by looking at people who haven’t yet developed MS who may go on to do so in the future, and following them up over a long period of time to see who develops MS, and then go back and look at what has happened before their MS developed. We know that the people at highest risk of developing MS are relatives of people who have MS, and we would be keen to work with people with MS and their relatives to work out how we can do this. This study is something that will take many years, and will also need the help of all of the MS community to have enough people enrolled in such a study to make it meaningful. So if readers of the blog have any comments/suggestions it would be great to hear them, either via the blog or via email (preventMS@gmail.com).