Should High-Risk Populations Be Screened for Multiple Sclerosis?

I think that sets a useful foundation.

So, Helen, in your argument, you mention a specific precedent, and that is the one of Parkinson's disease, where prodromal screening is already happening within research protocols, and the Movement Disorder Society criteria can identify prodromal Parkinson's with 99% specificity.

We don't have an equivalent tool for MS yet, How far behind do you think the MS field is and what would we need to do to close that gap?

I think we're really close and I think it's worth reflecting on why Parkinson's disease field is so much further ahead than MS.

Historically, multiple sclerosis wasn't thought to have a prodromal phase until relatively recently, which is a real shame because in Parkinson's disease, they were already talking about the concept of a prodromal phase back in the 80s.

And today it's well recognised that Parkinson's disease has a lengthy prodromal phase lasting 10 or more years.

And now that they have created and validated research criteria, to identify people in the prodromal phase of Parkinson's based on decades of knowledge that's been accrued.

So we've got a lot of catch up there here in MS.

So sort of echoing what you said, they're combining traditional risk markers.

So we can do this in MS already.

Traditional risk markers in Parkinson's, that's sex and age, similar to MS. They're also including in that criteria to identify people in the prodromal phase of Parkinson's disease, environmental and lifestyle related exposures, family history.

You can also layer on, it's optional, layer on various biomarkers if you have that kind of information.

And combined with prodromal signs and symptoms, Each feature will kind of alter your probability that you're in the prodromal phase of Parkinson's disease.

And then you can develop this overall score, which gives you a probability that individual is in a prodromal phase of Parkinson's disease.

And it's being used to actively enrol people in clinical trials.

with a view of trying to prevent classical onset of motor onset Parkinson's disease and ultimately benefit long-term outcomes of people at very high risk of going on to have classical motor onset symptoms.

So I think we can do something like this in MS.

I think we're close.

I think, though, there's still a lot we don't know.

A lot of our prodromal signs and symptoms are quite non-specific.

So there's a lot of work still needed to be done and ongoing to differentiate MS from other, say, immune-mediated diseases and understand how some of these prodromal features might cluster within groups of individuals.

But I think now is the time that we can start putting these kind of criteria together and testing them in high-risk populations.

Yeah, so the scientific opportunity here is very real because, like you say, a lot of the information is out there.