From Point A to Point B

Multiple Sclerosis (MS) is a complex disease, but Ruth Ann Marrie has a simple way of summing it up. “It’s like the game of telephone,” she says.

If you’ve ever played the game, you know how easy it is for a message to get scrambled by the time it goes from the first player to the last, breaking down and changing as the words are whispered down the line.

When the last person reveals the final mixed-up sentence, it’s usually pretty funny. That’s where the similarities between MS and the kids’ game stop.

MS affects the central nervous system, which includes the brain, spinal cord and optic nerves.

Inflammation affects the lining of the nerves—myelin—causing the signal to slow or degrade as it passes from point A to point B. Just like ‘telephone,’ the results can be different from one patient to the next and from one occasion to another. The end result may range from numbness in the extremities to difficulty walking, loss of vision that ranges from partial to complete, or cognitive impairment.

It’s no laughing matter.

Marrie, a professor of internal medicine (neurology) and community health sciences in the Rady Faculty of Health Sciences, directs the MS Clinic at Winnipeg’s Health Sciences Centre, and says MS can be a confusing disease, both for patients and for medical professionals. While some individuals will initially develop progressively worsening symptoms—others will present with the relapsing/remitting type.

For those patients, the symptoms will appear then disappear, often to be followed by a period of wellness until the next relapse. That makes it harder for clinicians to make a diagnosis, and if symptoms are very mild, may make it hard for the individual affected to realize that there is a problem that needs attention.

“It’s a challenging disease,” Marrie admits. She’s been studying it for over a decade, working on a variety of ongoing and overlapping studies to help understand the full scope and nature of MS. As each piece of the puzzle drops into place, Marrie says more questions are raised. But the picture also becomes a bit clearer.

One area that’s come into focus is the fact that MS patients are often affected by comorbidities—additional diseases and health problems on top of their MS.

“There’s a broad range, but we often see diabetes, high blood pressure, high cholesterol or heart disease,” says Marrie.

And the difference between the general population and MS patients can be staggering.

“Up to 50 per cent of people with MS will develop depression at some point—that’s far higher than the general population.” How much higher? Two to three times, Marrie says. “That’s fairly substantial.”

She and her team are exploring how these additional problems affect the progression of the disease, how patients use the healthcare system, whether they’re hospitalized more often, and if their stays are longer. But the mental health factor—a current priority in Marrie’s research, funded by the Canadian Institutes of Health Research—is trying to uncover how psychiatric illness impacts the disease.

“We already know that people with other conditions in addition to MS are more likely to have fatigue and to have greater pain.”

Then those problems create new ones, says Marrie.

“If you have MS and these other health conditions, it actually increases your depression and anxiety. And that has a big impact on your quality of life.”

Work on a cure is still ongoing. But for Marrie, there are still huge wins to be made if we can do a better job of managing a patient’s mental health until the disease can be limited altogether. Her five-year study, now just about at the two-year mark, will follow 1,000 people to get a better understanding of the relationship between MS and depression and anxiety, as compared to the relationship between depression and anxiety in inflammatory bowel disease and rheumatoid arthritis.

“We really hope this will allow us to understand what we should be doing to move forward to improve outcomes,” she says.

Marrie’s research recently received a significant injection of funding, with her being awarded the Waugh Family Chair in MS Research, funded by the Waugh Family Foundation.

She will lead a team of internationally recognized MS specialists and help advance our understanding and treatment of the disease.

It’s research that’s important for all Canadians— there are roughly 100,000 with the disease—but it’s a particular concern for Manitobans. “As of 2013, Canada has the highest number of people with MS per capita,” says Marrie. “If you ask someone if they have a family member or a co-worker that’s been affected by MS, you find out that it has a very broad-reaching effect.”

Through both her research and her clinical work, Marrie has met countless MS patients and their families. “It’s amazing to me what they manage to do despite the challenges they face,” she says.

“I want to keep focusing on what we can do to continue to reduce those challenges so that people can really meet their potential.”

Annette Elvers