This presentation was part of the 2023 Holistic Health and Wellness Forum for MS held on May 17 in Southfield, Michigan.
Taylor Gonyou, DO is a neurology fellow at the Michigan Institute for Neurologic Disorders (MIND). Recent medical advancements have led to finding blood tests (biomarkers) to track Multiple Sclerosis disease activity and determine the best treatment options for patients, as well as monitor treatment response. Learn more about the future of precision medicine and these biomarkers.
You may be asking yourself, what are biomarkers? Biomarkers are anything a healthcare professional can use to monitor a patients progress. Early treatment of MS is critical and the more biomarkers we can use to detect and treat multiple sclerosis the better. Scientists are finding biomarkers in the blood or spinal fluid in addition to imaging technologies that have been a staple of multiple sclerosis monitoring for several decades.
MRI (magnetic resonance imaging)
In MS patients an MRI determines if a person is having a relapse. Using contract shows acute demyelinating plaques (or new or active lesions that are typical of relapsing MS). However MRIs can’t monitor smoldering MS also known as PIRA (progression independent of relapse activity.)
OCT (optical coherence tomography)
Optical coherence tomography is an imaging test that involves shining a light in the eye to measure the thickness of the layers in the back of the eye. Thinning layers equate to disability progression.
Spinal tap or lumbar puncture
In the spinal fluid O bands are shown in 90% to 95% of people with MS. Most people don’t want repeat lumbar punctures but neurofilament light chain (NfL) is a protein in the blood and spinal fluid that is associated with axonal damage (the nerve fiber that controls sensation or movement). When the axons are damaged they release neurofilament light. Sixty percent of people with MS have reduction in axons at all spinal levels (this is also the case in ALS and Alzheimer’s.)
Blood tests
Precision medicine is using individual tests to give individual care. The Octave disease activity test measures 18 specific proteins in the blood that cooralate with disease activity and disability. They use an algorithm to give patients a score in low, medium or high chance of a relapse or new lesion in the next 60 days. Anyone can get this test. Octave offers a financial assistance program to make it more affordable for those whose insurance doesn’t completely cover it.
When should we use biomarkers?
- Routine surveillance over time
- For the newly diagnosed we can measure biomarkers without DMT (disease modifying therapy) and look to see if score goes down after a DMT is administrated
- Monitoring symptoms and relapses
- Identify patients who are stable who can safely stop DMTs
Dr. Gonyou will be presenting about current research with Epstein Barr Virus and the onset of Multiple Sclerosis. She is a Fellow at the Michigan Institute for Neurologic Disorders in Farmington Hills, Michigan. She graduated from Michigan State University College of Osteopathic Medicine and completed her Neurology Residency at Beaumont Health.