MS Awards 2023 – Oddities and observations


Modelling MS Endowment
Move over EAE – researchers have introduced a new wrinkle to MS animal models. Seems that MS is remarkably similar to the necrotizing meningoencephalitis (NME) that affects Pug dogs (Windsor et al. Am J Vet Res 2023; epublished November 6, 2023). The condition is also known as Pug Dog encephalitis. As with MS, genetic factors and autoimmunity contribute to the etiology of NME. The early clinical courses are similar although the main pathological feature of NME is necrosis rather than demyelination. Interestingly, an earlier genome-wide association study of NME identified genes of interest, including DRB1 and DQA1, both of which play a role in MS (Greer et al. Tissue Antigens 2010;76:110-118).

For Better/Far Worse Prize
A Dutch study examined whether marriage protects against psychological symptoms in people with MS. Alas, no. Those who were married or in a stable relationship had higher levels of depression and anxiety (Lo Buono et al. Mult Scler Relat Disord 2023;79:105051).

Mixed Messaging Medal
The smart phone is emerging as the go-to digital tool for evaluating MS patients, but it may be a mixed blessing. Phones can be used to assess cognition and anxiety in MS patients (Chen et al. Digit Health 2022:8:20552076221143234), although excessive phone use may actually cause cognitive impairment and anxiety (Hadar et al. PLoS One 2017;12:e0180094. Demirci et al. J Behav Addict 2015;4:85-92). Smart phones can identify a risk of falls (Hsieh et al. Front Digit Health 2022;4:828686), but phone use has also been shown to increase the risk of falls in people with neurological conditions (Bianchini et al. J Med Internet Res 2023:25:e41082).

The Grumpy Guerdon
And another thing. Smart phone use is becoming the new benchmark of daily functioning. The ability to take selfies has been used to assess dexterity (Gopal et al. Ann Clin Transl Neurol 2023; epublished October 25, 2023); and a Neurokeys app will now evaluate dysfunction according to speed of texting and emoji use (Lam et al. Eur J Neurol 2022;29:522-534). In the Lam study, the combined metric of emoji sentiments and the length of words was a better measure of disability worsening than the EDSS.

HIPPOcratic Award
Hippocrates was keen on “riding’s healing rhythm”. And a new systematic review has found that horse-assisted interventions (hippotherapy) can benefit a range of neurological conditions (Mittly et al. Syst Rev 2023;12:224). As for limitations ask Richard III: there’s never a horse when you need one.

Barista Cup
A Mendelian randomization study tried grinding the data to determine if coffee consumption was causally related to neurological diseases, such as MS, PD, AD or ALS (Zhang et al. Eur J Clin Nutr 2023; epublished October 16, 2023). There was no connection. The only link was to migraine, but the group’s conclusion was tepid at best: coffee consumption may trigger migraines or prevent them.

Are We There Yet? Award
MSBase reported this year that the risk of SPMS was a question of latitude (Sharmin et al. Brain 2023;146:4633-4644). As you might expect, SPMS risk increased as you moved farther from the equator. As you might not expect, only one of the four highest-risk countries could claim much distance from the equator (Canada, latitude >49° N). All of the others – Oman (21° N), Tunisia (33° N), Iran (32° N) – were subtropical by Canadian standards.

Scents and Sensibility Trophy
The ability to discriminate odours is a significant biomarker of worsening disability, according to the MS clinic in Innsbruck (Berek et al. Mult Scler 2023; epublished October 18, 2023). The six-year study found that a decline in odour discrimination and identification scores was predictive of EDSS worsening (hazard ratio 1.40), progression independent of relapse activity (PIRA) (HR 1.49) and cognitive deterioration (HR 1.79).

Glossarian Gold Star
A new initiative is seeking consensus on the terminology used in exercise research. The group’s moniker is MoXFo, which perches uncomfortably between acronym, abbreviation and glossolalia (Mansoubi et al. Mult Scler 2023;29:1551-1560). There was agreement on ‘balance’ and ‘physical activity’, but the group failed to achieve consensus on how to define ‘exercise’.

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