In one of our recent Facebook Live Q&A sessions, I was asked what I thought the biggest hurdle was that needed to be overcome in multiple sclerosis research.  Whilst funding problems are something that we have discussed at length, this article is going to be about something different – in particular, differences.

“No two people experience multiple sclerosis in the same way!”….how many times have you heard that phrase?  Whilst it may not be 100% accurate, it reflects the fact that we know MS is a very complex and complicated disease.  It can present in many different ways that result in many different outcomes in lots of different people.  In the science world, we say that it is a heterogeneous disease, meaning “diverse in character or content”.  For people, this leads to a lot of uncertainty after diagnosis about what their life will be like and what treatments are best suited to them.

But does this also impact on research into multiple sclerosis?

The answer is most definitely yes and probably for a couple of reasons.  One has to do with ‘time snapshots’, but I will deal with that in another article.  For now, I want to focus on the idea that has floated around for a while about the possibility that multiple sclerosis is one disease with many different causes.  Some may argue that, if this is the case, then MS is actually an ‘umbrella’ term for a number of different diseases that all look the same. However, for simplicity, I prefer the first description.

Let’s think about a research project trying to identify the cause of multiple sclerosis.  In the first example, we will assume that there is a single cause….just like a flu being caused by a virus.

The diagram below illustrates the hypothetical study that we have done – 10 people with MS and 10 healthy controls.  We have looked to see whether being born in April is the cause…those born in April are shown in red.

We can see that 2 people in the MS group were born in April, whereas none of the healthy control group were.   However, 2 out of 10 isn’t very convincing and if a single cause does exist, then we have no way of explaining how the other 8 have multiple sclerosis.  In this situation, we would conclude that being born in April does not cause MS.

Now let’s change our mindset when thinking about multiple sclerosis to that other idea – one disease, multiple causes.  Here we run the same experiment again, except we now look at being born in April (red), eating brussel sprouts (green) and living along a coastline (purple):

So firstly, let’s summarise the results:

Born in April:  2 in MS group, 0 in healthy controls

Eats brussel sprouts:  3 in MS group, 3 in healthy controls

Lives along a coastline:  1 in MS group, 0 in healthy controls

So what does this mean?  Well the fact that the numbers are the same in both groups suggests that eating brussel sprouts isn’t a cause of multiple sclerosis.  However, the other two conditions are found only in people in the MS group…though both in small numbers.  In our first hypothesis (e.g. one cause), we would have ruled both of these out as being causes of MS.

This conclusion changes slightly when we are open to the possibility of more than one cause.  Although only 2 people were born in April, maybe that is the cause for them and the other 8 have different causes.

Why is this a hurdle?  Well, you may have already realised the issue…if that second situation is true, our standard way of analysing these experiments will not work.

It’s important to say we don’t know which of these situations is true, but I think we have to at least remain open to the second possibility to ensure we don’t rule out potential correct answers.  It is just one of the many difficulties of researching such a complex, complicated and varying disease.  Fortunately, many dedicated and talented people continue to work tirelessly to find those answers as quickly as possible.

Lastly, don’t be worried if you are born in April, eat brussel sprouts or live along a coastline…those causes are fictitious, used purely for the purposes of my examples.  For further reassurance, just think, who in their right mind eats brussel sprouts!

One Response

  1. Linda La Rowe

    The current focus by pharmaceutical companies is to address the creation of lesions in the brain and attempt to block the antigens creating the lesions. That is taking the immune suppressant approach. That is why all DMDs are immune suppressants.

    What if the disease is not stimulated by a mysterious virus? One would think that researchers already know this or they would be trying to identify the virus…or maybe they have just given up.

    If I were a serious researcher, I would be pounding on the doors of Dr. Raymond Damadian (original inventor of the MRI and the Upright MRI) and Dr. Scott Rosa. They have observed the relationship of a biomedical issue causing or at least contributing to MS as well as other neurodegenerative diseases. They feel these diseases are related to head or neck trauma, causing the blockage in the flow of CSF in the cervical spine. When CSF flow is blocked, it backs up in the ventricles of the brain (where it is produced), and leaks into the brain. It also creates pressure in the brain over twice the normal pressure when in the upright position.

    This is not just theory…it can be visualized using software and hardware developed by Dr. Damadian and his team at Fonar. They can see the CSF, measure the flow rate, as well as the CSF pressure within the brain, see currents and back jets, and watch the leakage as it occurs. Other MRIs do not see CSF…much like air. It was using the Upright MRI and the latest software that made it possible. It was when scanning an MS patient that Dr.Damadian observed her CSF pressure in the brain more than doubled normal in the upright position; it was normal when scanned recumbent. Thus, being able to see the CSF and scan in the weight bearing position began a whole new realm of focus for research. Doctors have been able to see blood flow…it has been identified in MRI scans by Dr. Zamboni (CCSVI) and yet so much denial has existed to this. If researchers would combine the results of CCSVI and CSF flow, many of the puzzle pieces to what causes MS would fall into place.

    When the CSF flow is blocked, The CSF pressure increases in the brain. This intense pressure restricts the blood flow which weakens the veins (BBB compromise). Now we know that there is a micro lymphatic system in the brain and it is probably also restricted by too high CSF pressure in the brain. The brain needs CSF flow and allow the micro lymphatic system to cleanse the brain, and it needs blood flow to bring nutrients to the brain…is it any wonder MS patients are challenged? When the CSF leaks, it leads right to the lesions. What if lesions are proof that the body is actually trying to protect the nerves from the carrotion of the CSF? I am challenging you to find the answers?

    If you unblock the CSF flow, you stop the leakage. If you stop the leakage, you stop the progression of the disease. And your body tries to heal itself.

    I know because I have MS (34 years) and have been in the SP stage for 14 years. Dr. Damadian and Dr. Rosa helped me 5 years ago. I have seen my scans and CSF blockage and have regained some abilities I had lost for as many as a dozen years even though in SP 9 years at the time.

    Respectfully,
    Linda La Rowe

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