May 31, 2004
The London Free Press
A Canadian doctor's curiosity about why kids contract one of life's most mysterious diseases may also bring answers for the 50,000 Canadian adults who suffer from it. The disease? Multiple sclerosis. The doctor? Brenda Banwell of The Hospital for Sick Children's MS Clinic.
Dr. Banwell says the disease is one in which the body directs antibodies against proteins in the myelin sheath surrounding the nerves of the brain and spinal cord. The resulting inflammation causes scarring (sclerosis) and it is this damage that can block or delay impulses travelling to or from the brain.
Banwell's study is significant because MS is seen as a disease that first occurs between the ages of 20 and 50 and in twice as many women as men. But Banwell thinks that MS is also a children's story: Attacks occur in children eight to 16 but most are not properly diagnosed as MS.
About 100 children in Canada go to hospitals annually with a first initial attack and approximately 40 kids are diagnosed with MS. The $4.3-million study is the first to look at how the disease changes children's brains. Adults who have been studied have had changes going on in their brains for years before being diagnosed.
"The risk of developing MS after an initial attack of the immune system on the brain or spinal cord is currently unknown," says Banwell. "We do not know the key triggers of the disease process, nor do we know how these triggers interact with an individual's immune system."
Studying kids from the time of the first attack allows scientists to explore the biological factors involved in the disease process. Twenty-two hospitals across Canada will take part in the study.
Over a five-year period, they'll look more closely at the immune systems of kids who have that first attack; they'll find out if there is something unique about these kids' brains that somehow sets off the immune system. One goal is to determine if a particular combination of symptoms in a child will predict whether that child is at higher risk of developing MS after that first "isolated" attack.
As with any illness, the earlier the diagnosis, the better chance a patient has of managing the disease. A study this week in the Journal of American Medical Association reported many patients who have MS report a good quality of life.
MS is not caused by a simple genetic error, so complex theories as to its causes abound. The fact that twice as many women as men are affected leads scientists to assume hormones are involved: "In kids we see equal male and female patients," says Banwell. "Once kids hit puberty . . . the female predominance begins."
Many sufferers believe the toxic environment is a cause of MS, but Banwell says that theory hasn't panned out. One viable theory, currently under investigation, is the impact of the sun: MS is common in parts of the world that have less sunlight (Canada and Scotland, for instance). Another theory rests with the Epstein-Barr virus because of its capability of making immune cells express a protein that is similar to the white matter of the brain. Still another is that the white matter in the brain of MS patients is structurally different from non-MS brains.
While many of the study's participants will come through the hospitals that first investigate their symptoms, Banwell is still trying to reach pediatricians, family physicians, and parents -- all of whom, because they don't even think of MS as a children's disease, miss the opportunity for early diagnosis.
Symptoms of MS can last hours or days and may include numbness, weakness or paralysis in one or more limbs; brief pain; tingling sensations; involuntary jerking muscles; impaired vision; fatigue; dizziness.
When these symptoms come and go, as they can in MS, they're dismissed as viruses, stress, fleeting visual problems or fatigue.
"Saying it was just a virus will mean that these kids will not be closely
followed," says Banwell. "And some of them may be at risk for further attacks."
Copyright © 2004, The London Free Press