MS Prodromedary Prize
A study in Saudi Arabia found that the most important risk factor for the development of MS was consumption of camel milk (odds ratio 2.50) (Alkhawajah et al. Neuroepidemiology 2022;56:97-103).
Who was that masked man? award
A pandemic-era survey reported that 25% of MS patients were unable to recognize people when they were wearing a mask (Kumcu et al. Neurol Sci 2022;43:1549-1556). A separate study found that patients with SPMS were poor at interpreting other people’s emotional states (Argento et al. Eur J Neurol 2022;29:505-514). The metric used was the poetically-named Reading the Mind in the Eyes test developed for autism by Simon Baron-Cohen, cousin of Borat.
Whatever happened to? no-prize
Winner: Epstein-Barr. After a 12-year dormancy period, EBV re-emerged as a putative cause of MS (Bjornevik et al. Science 2022;375:296-301). EBV enjoyed a brief period of celebrity and acquired a nickname – the ‘gluten of MS’ (Drosu et al. Mult Scler Relat Disord 2022;64:104007). But by mid-year the virus had returned to its conversational latency phase. There were few studies at ECTRIMS and EBV did not even rate a mention in the International Advisory Committee’s review of the pathophysiology of MS (Kuhlmann et al. Lancet Neurol 2022, epublished November 18, 2022). Watch for an EBV recurrence at next year’s ACTRIMS Forum.
Runner-up: monkeypox. Asked some authors, Should we be alert? (Boldrini et al. Mult Scler Relat Disord 2022;67:104228). To date, no cases have been reported in MS. So, no.
Feast & Famine prize
A Cochrane review of dietary interventions in MS came up with the unsurprising conclusion that any evidence on the effects of diet on MS is sparse and uncertain (Amatya & Khan. NeuroRehabilitation 2022;50:161-163). A separate systematic review this year reached a similar conclusion (“more studies are needed”) (Atabilen et al. Nutr Neurosci 2022;Nov 17:1-13).
This is the fourth Cochrane review of the topic. Reviews were published in 2007 (“data are insufficient” (Farinotti et al. Cochrane Database Syst Rev 2007;(1):CD004192), 2012 (“evidence is lacking”) (Farinotti et al. Cochrane Database Syst Rev 2012;12:CD004192), and 2020 (“evidence is uncertain”) (Parks et al. Cochrane Database Syst Rev 2020;5:CD004192).
Under your nose endowment
Anosmia came to fame as a COVID effect but was there all along. A study of treated RMS patients found that two-thirds experienced hyposmia (Wnuk et al. Ear Nose Throat J 2022;101:640-644). Olfactory impairment was not related to relapses, new MRI lesions or EDSS score but was correlated with fatigue and dimethyl fumarate use.
Evidence-adjacent-based medicine
Health Canada approved two bivalent boosters against COVID-19 in 2022 despite having no clinical or safety data. For the approval, the safety evaluation was based on the safety seen with prior vaccines. Efficacy was inferred from other vaccines and was based on immunogenicity rather than clinical outcomes.
The Counterfactual COVID Cup
The Auditor General found numerous problems with the Public Health Agency’s response to the COVID-19 pandemic: PHA was unprepared, it underestimated the potential impact of COVID, had not updated or tested its national pandemic response plan, never finalized its health data-sharing agreements with the provinces/territories, and failed to follow-up with travellers to ensure they were complying with quarantine orders (www.oag-bvg.gc.ca/internet/English/parl_oag_202103_03_e_43785.html).
Still, it could have been worse, said Dr. Theresa Tam and colleagues in PHA’s counterfactual analysis of the pandemic (Ogden et al. Can Commun Dis Rep 2022;48):292-302; see link below). The authors noted that the consequences of unrestrained SARS-CoV-2 spread were dire – look at Italy. Without public health measures, the death toll in Canada could have been up to 800,000 (which assumes a 2.3% case mortality). Instead, COVID mortality in Canada was 1.1% (higher than the rate in Italy or the U.S. as it turned out), suggesting the case reporting was in itself counterfactual. Counterfactuals still to come: what if the healthcare system were adequately funded?
Ogden et al. Free download at www.canada.ca/content/dam/phac-aspc/documents/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-7-8-july-august-2022/ccdrv48i78a01-eng.pdf).
Persistence Prize
This year saw the 27-year follow-up of the Copolymer-1 trial (Ford et al. Mult Scler 2022;28:1729-1743); median duration of drug exposure was 9.8 years. The completion rate for the long-term extension was 20.7%, which was lower than the completion rate for the original study authors (40%).