Monday, 4 December 2017

Guest Post: an update from Saúl Reyes

It has been a while since I last wrote a post for this blog and figured it was time to update you all! I have recently completed my training with Professor Giovannoni and it really confirmed my desire to pursue a career in MS. I am back home in Colombia just getting ready to finish my residency in Neurology. I am incredibly grateful for the time I spent with the Barts and The London Neuroimmunology Group. Every member of the team was very passionate about MS and brought that excitement to teach me. I am delighted to be able to keep in touch with you all through this blog. Please enjoy my new post and don't forget to leave your comments below!


Besides assessing MS-related complications, physicians and patients need to be aware that physical and psychiatric comorbidities are common in MS. Co-morbidity in MS has been a very active and profuse research topic lately, and it's not hard to see why: They adversely affect health outcomes! Actually, it has been suggested that comorbidities could partially explain the heterogeneity of outcomes in terms of diagnostic delay, treatment compliance, health-related quality of life, disease progression and survival. 

The study below is another piece of evidence in support of investment in, and greater attention to, strengthening our holistic approach to the disease. 

Depression, anxiety, hypertension, dyslipidaemia, stroke and chronic lung disease are among the most common comorbidities in MS. As you can see, some of them are preventable and to a large extent treatable! As the wise saying goes, “Many ignore what they don’t want to deal with. Ignoring does not change things. It does not make them go away”. The need to think about strategies to integrate comorbidity management into MS care is critical. We do have a responsibility to help MSers age healthily!


Thormann A, Sørensen PS, Koch-Henriksen N, Laursen B, Magyari M. Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality. Neurology. 2017 Oct 17;89(16):1668-1675.

OBJECTIVE: To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.

METHODS: We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.

RESULTS: We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44–2.80]; ,0.0005), cardiovascular comorbidity (4.04 [2.78–5.87]; ,0.0005), lung comorbidity (1.93 [1.42–2.62]; ,0.0005), diabetes comorbidity (1.78 [1.04–3.06]; 0.035), and cancer comorbidity (2.10 [1.20–3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67–3.01]; ,0.0005), cerebrovascular comorbidity (2.47 [2.05–2.79]; ,0.0005), cardiovascular comorbidity (1.68 [1.39–2.03]; ,0.0005), lung comorbidity (1.23 [1.01–1.50]; 0.036), diabetes comorbidity (1.39 [1.05–1.85]; 0.021), cancer comorbidity (3.51 [2.94–4.19]; ,0.0005), and Parkinson disease comorbidity (2.85 [1.34–6.06]; 0.007).

CONCLUSIONS: An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with pre-existing chronic disease and of optimum treatment of comorbidity in MS is critical.


by Saúl Reyes

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