Paper analyses tools tracking MS progression

Katherine Kenyon is first author on a paper reviewing tools for
monitoring symptoms in MS.

by Anne Crawford

Monitoring symptoms is crucial for the effective management of Multiple Sclerosis (MS), a debilitating neurological disease that is one of the leading causes of disability in young and middle-aged adults.  

Central Clinical School PhD student Katherine Kenyon has published a paper in ‘The Cerebellum’, reviewing tools used by clinicians and researchers to do this. 

“This hasn’t been done for a while,” Katherine said. “I focused on an update of how we measure cerebellar function,” she said.

The review describes current tools used to monitor cerebellar function and emerging technologies including advanced neuroimaging, automated speech analysis, and home-based electronic testing. Cerebellar symptoms are common in MS, with up to one third of people with MS experiencing them, the paper says. Cerebellar function is also related to increased future disability.

“The cerebellum is a key area involved a lot in movement and coordination, and with MS that’s something that’s generally affected, so monitoring its function during the course of the disease can help track the progression of MS,” Katherine said. “It can also help with understanding how we can help people with MS manage their symptoms.”

Symptoms of the potentially disabling disease are many and varied, according to the individual person, and can include loss of vision, pain, fatigue, muscular problems impairing coordination and difficulty in speaking. 

A combination of clinical, neuroimaging, and task-based measures is usually used to diagnose and monitor MS. Katherine reviewed literature about a range of quantitative tests that look at aspects such as fine motor control including gait and balance. 

“One of the biggest symptoms of MS is ataxia, which is a difficulty in muscle movement,” she said. “There are specific scales and specific tests used to look at that. 

“I looked at functional MRI which looks at how brain activity changes. There’s also structural MRI that can find particular areas of the brain that have been damaged, called lesions,” she said.

Analysing speech, such as tone or the ability of the person to control volume, is another way of measuring MS progression. 

The paper reviewed new digital monitoring using smart phone apps and a pedometer-style device that tracks gait and balance. It did not include cognitive testing.

Its conclusions?

“The paper showed that there is no one measure or test that covers everything,” Katherine said. “There’s no one size that fits all.”

Some of the measurements used were not specifically created with MS in mind, so using several techniques gives a better all-round picture of how the patient is faring, she said.

New technologies that can be used at home had the advantage of providing greater access to monitoring for people with MS, particularly as the disease worsens. “As it progresses generally things like walking become harder until they’re dependent on a wheelchair, which makes getting into the clinic for appointments more difficult.

“While the digital monitoring doesn’t replace face-to-face appointments with specialists or replace imaging, I think it has a very good place in terms of monitoring because it’s easier to access, and you can do it in your own time.”

Compliance could be a downside – getting the person to use the app if you’re not physically there, she said.

Katherine is particularly interested in monitoring and analysing speech. 

“My thesis broadly looks at speech in MS and specifically using functional neuroimaging to see if we could maybe use speech as a marker of disease progression,” she said. Her first two studies after the review paper are looking at control and people with MS groups to assess the helpfulness of particular speech tasks. 

Her main supervisor on this paper is senior author Associate Professor Anneke van der Walt.

Kenyon KH, Boonstra F, Noffs G, Butzkueven H, Vogel AP, Kolbe S, van der Walt A. An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis. Cerebellum. 2022 Jun 27:1–15. doi: 10.1007/s12311-022-01435-y. Epub ahead of print. PMID: 35761144; PMCID: PMC9244122.