Large health claims databases are used to investigate risk factors for MS and other inflammatory diseases, with a focus on Epstein-Barr Virus (EBV) and infectious mononucleosis. This research aims to identify prevention opportunities, support earlier detection, and reduce disease burden for people affected by these conditions.
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Hormonal transitions such as puberty, pregnancy, and menopause may affect MS and other neuroinflammatory diseases. In our current work, we are studying menopausal symptoms in women with MS including how they affect frequency, quality of life, and MS symptoms.
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CANOPTICS is the first prospective national study in Canadian adults tracking diagnosis, treatment, and outcomes in people living with NMOSD and MOGAD. The goal is to develop better treatment approaches, reduce disease activity, and improve patients’ quality of life.
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The Epstein-Barr Virus (EBV) has been identified as a critical environmental trigger of MS and lupus, and may also contribute to other inflammatory diseases. In our work we have identified all cases of infectious mononucleosis ("mono"), the symptomatic form of EBV infection, that were followed by the development of MS, lupus, rheumatoid arthritis and inflammatory bowel disease in Ontario. MS and lupus begin, on average, around 10 years after infectious mononucleosis, but the first "prodromal" signs of the disease can be observed many years earlier, soon after infectious mononucleosis/EBV. This work will inform strategies to prevent MS and other inflammatory diseases including the case for an EBV vaccine, which is currently in clinical trials.
In other work, we have found that certain populations such as immigrants in Canada are at lower risk for MS but their risk increases with the proportion of life spent in Canada which indicates the importance of environment and lifestyle (e.g. diet, sunlight exposure) in the development of MS. Educating the public including immigrants may help to prevent MS and facilitate earlier diagnosis in those affected.
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We are currently enrolling for the "MS Hot Spot Study" which investigates vasomotor symptoms (hot flashes and night sweats) and other menopausal symptoms in women with MS. Menopausal symptoms have long been dismissed in women living with MS by their neurologists and other physicians. Because temperature dysregulation is already disrupted in women with MS, vasomotor symptoms may be more pronounced and exacerbate their pre-existing disability. Better understanding of these symptoms will improve recognition and treatment approaches.
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CANOPTICS was launched by Dr. Rotstein in 2021 and we currently have more than 350 participants across Canada with NMOSD, MOGAD, and other rare demyelinating disorders. We are very grateful to all of our participants! CANOPTICS incorporates clinical data, patient-reported outcomes, links to health claims data, and blood sample collection for biomarker studies. Using CANOPTICS data, we were the first group to report evidence for a prodromal phase in NMOSD. This knowledge may allow for earlier diagnosis of NMOSD, a devastating neurologic condition which can lead to blindness and paralysis, and earlier treatment in the future to prevent permanent disability.