Injury preceding the classical recognition of multiple sclerosis: A population-based study

Area of Science:

• Neurology
• Epidemiology
• Public Health

Background:

• Investigated the link between injuries and multiple sclerosis (MS) preceding diagnosis.
• Examined fractures, dislocations/sprains/strains, and burns as potential early indicators.

Purpose of the Study:

• To determine if specific injuries occur more frequently before MS is clinically recognized.
• To explore the potential for earlier MS detection through pre-diagnostic injury patterns.

Main Methods:

• Conducted a cohort study in British Columbia, Canada (1991-2020) using health administrative data.
• Compared injury risk in the six years before MS diagnosis (demyelinating claim or symptom onset) to matched controls.
• Employed modified Poisson regression, high-dimensional propensity scores (hdPS), and targeted maximum likelihood estimation (TMLE) for analysis.

Main Results:

• MS cases showed a higher risk of fractures (adjRR=1.28), dislocations/sprains/strains (adjRR=1.20), and burns (adjRR=1.40) before their first demyelinating claim.
• Sensitivity analyses using hdPS and TMLE confirmed these associations, with slightly reduced relative risks.
• Similar, though weaker, associations were observed before MS symptom onset in the clinical cohort.

Conclusions:

• Injuries including fractures, dislocations, and burns are more prevalent in the period before MS diagnosis.
• These findings suggest that certain injuries may serve as early warning signs for multiple sclerosis.
• Earlier recognition of MS could be facilitated by considering these pre-diagnostic injury patterns.