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The multiple sclerosis prodrome : a systematic review and an evaluation of fatigue, sleep disorders, anemia and body pain

University of British Columbia

Background: Findings from several studies suggest that the first symptoms of Multiple Sclerosis (MS) predate onset by years, consistent with the presence of an MS prodromal phase. This thesis aims to evaluate evidence of an MS prodromal syndrome and to determine whether fatigue, sleep disorders, anemia or body pain are elevated preceding MS onset. Methods: A systematic review was undertaken of studies assessing symptoms or conditions prior to, or at, MS onset or diagnosis. A population-based matched cohort study using linked health care and MS-specific clinical databases in British Columbia, Canada, was conducted to compare the prevalence of fatigue, sleep disorders, anemia and body pain between MS cases in the five years preceding a first demyelinating claim or MS symptom onset and general population controls. Using random effects zero-inflated negative binomial models, the frequency of physician visits for these same conditions was similarly compared prior to a first demyelinating claim only. Results: Among the 28 studies identified in the systematic review, several conditions, including anxiety, depression, migraine and cognitive impairment, were more frequently observed prior to, or at, MS onset or diagnosis. However, comparative population-based studies were largely lacking. The prevalence of fatigue, sleep disorders, anemia and body pain over the 5 year period preceding the first demyelinating event, as well as sleep disorders and body pain over the 5 year period preceding MS onset, was higher among MS cases than general population controls. Sex and age modified findings, with a stronger positive association observed between MS and anemia among men, and between MS and body pain among individuals aged 30 years and older, prior to a first demyelinating event. Approaching the first demyelinating event, the frequency of physician visits for fatigue, sleep disorders, anemia and body pain increased among MS cases relative to controls. Conclusion: This dissertation reveals a paucity of population-based studies investigating the suspected MS prodrome and provides evidence that fatigue, sleep disorders, anemia and body pain are elevated in the MS prodrome.

Text

2020-07-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/68230

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/