The Palouse known as an MS hot spot

September 14, 2007

By Communications staff, Washington State University

The unique beauty of the Palouse has inspired glorious names — Paradise Creek… Paradise Ridge… Paradise Street. Yet people in the small towns dotting this bit of heaven also live with a vague uneasiness — the hidden and unpredictable threat of multiple sclerosis.

That threat drew researcher Brett Parmenter to WSU in 2006. As assistant professor in the Department of Psychology, she is in eastern Washington — one of the nation’s hot spots for MS — for the singular chance to help answer questions about this puzzling disease.

What is MS?
MS is a debilitating neurological disorder that reportedly affects more than 400,000 people in the U.S. and up to 2.5 million worldwide.

Its name refers to the many scar-like lesions that form on nerve cells — or axons. Axons conduct electrical impulses throughout the body and are covered with an insulating sheath of fatty material called myelin.

For unknown reasons, the body’s immune system may turn against myelin and attempt to destroy it with white blood cells. These cells secrete an array of inflammatory compounds that eventually strip away the myelin, leaving damaged axons behind.

MS can cause symptoms such as fatigue, numbness, impaired vision, loss of balance, bladder dysfunction, paralysis and even death.

Silent symptoms
“We are still just learning how MS affects the brain,” said Parmenter. “Research shows that MS doesn’t just affect the white matter (myelin), but also attacks the deep grey matter structures like the thalamus. Each person is affected differently — and we can’t predict which symptoms an individual might have.

“One of the more common symptoms of MS is cognitive impairment, which affects about 30 to 70 percent of patients,” she said. “My research is focused on trying to find out why some people have cognitive impairment and others don’t.”

She also is looking into the relationship between that and MS-related fatigue — one of the “silent” symptoms, along with slowed thinking and tingling or numbness, that are not apparent to others. About 90 percent of patients rate fatigue as one of the most debilitating symptoms of MS, she said.

Important research
Collaborating with Parmenter on these studies is Roy Kanter, neurologist at the Holy Family Hospital MS Center in Spokane. (See ONLINE @ www.holy-family.org/Services/MultipleSclerosis.asp)

Kanter said that in recent years, it has become more apparent that MS patients face subtle but significant cognitive problems.

“There is often a kind of memory loss as well as decreased ability to concentrate. There also can be problems with processing speed and multitasking,” he said.

“Brett’s research is important, as there are few others investigating the area of cognitive impairment in MS,” Kanter said. “Though we don’t know how to prevent MS, our knowledge base of the disease has grown dramatically.

“We should be able to greatly slow down the progression of disability in the future. We may even come up with a cure in the next 10 to 12 years,” he said.

Uncertain causes
The cause of MS remains uncertain.

“We know that it increases the further away from the equator you live,” Parmenter said. “It affects more women than men, especially those of northern European heritage.

“Most people are diagnosed between the ages of 20 and 40 but some aren’t diagnosed until their 50s or 60s. And there can also be pediatric onset of MS in children or teenagers.”

Though research has revealed a genetic component to MS, it can only account for about a quarter of the cases. More likely, MS is caused by a combination of factors including genetics, diet, latitude/sunlight exposure and environmental contamination.

Hot spots
Clusters of MS are scattered across the U.S., often in regions of heavy industry or agriculture.

“Buffalo, New York, is a hot spot,” said Parmenter. “As part of the rust belt, it is an area with a lot of industry and pollutants, although how these may be related to the disease is unknown.

“There are also hot spots in Kansas, Minnesota and North Dakota as well as locations in Missouri,” she said.

“We don’t have a certain hypothesis for why the Palouse area is so highly affected. It could be populations here have a genetic predisposition, which is triggered by something in the environment.” Conventional wisdom has speculated that “something” might be agricultural chemicals and pesticides, or perhaps fallout from the Hanford nuclear projects that took place in the 1950s.

There are no published studies documenting the prevalence of MS in eastern Washington; however, a research team headed by William Lambert of the Oregon Health and Sciences University is in the process of collecting relevant data. Team members are counting actual numbers of cases of MS by age and gender for each county in eastern Washington. Their analysis is under evaluation by the Centers for Disease Control and is due to be released to the public in early 2008.

Call for volunteers
Parmenter is conducting studies on cognitive impairment associated with MS and is calling for volunteers over age 18 — both people with MS and those without it to serve as controls.

For one study investigating the role of sex hormones in MS, she is asking for women age 55 and younger. They will take part in blood draws and cognitive tests.

In another study on brain processing speed, Parmenter is looking for volunteers of both sexes to take part in tests evaluating memory and problem solving.

To participate, contact Parmenter at 335-5547 or e-mail parmenter@wsu.edu.

One woman’s story

Millie (not her real name) was diagnosed with MS three years ago at age 54, but her neurologist feels she probably has had it since she was 27. She recently graduated from WSU and is working on a master’s degree. As a participant in Brett Parmenter’s study on multiple sclerosis, Millie agreed to talk about her condition using an assumed name.

“There is a stigma about MS,” she said, “and people can be judged incorrectly sometimes, so I really need to think about whom to tell. Even with laws to protect us, there are ways …for people… to get around them.”

Looking back, Millie can see the signs of MS. She would feel fine one minute and the next lie down with extreme fatigue. She began having memory problems.

Her doctors typically said, “You have two kids, a lot of stress, you’re active…it’s normal.”

It wasn’t until she came to the Palouse and found herself unable to do a simple class assignment that she called her nurse practitioner in a panic and was subsequently diagnosed through an MRI.

“I’m so thankful she took the time to get to know me and listen to me,” said Millie. “I knew I wasn’t crazy.”

With treatment, Millie’s condition has remained fairly stable. But obtaining the medication is difficult. Only certain insurance companies will cover the cost of what may be a $2,000 per month drug bill.

Her insurance, Washington Basic Health Care, would pay only about $30 of the cost. With perseverance, Millie received funding from a nonprofit organization associated with the drug she takes, called Copaxone ©. Without that, she would have to go without medication.

“People with MS have to pay their health insurance before they buy food or pay rent,” Millie said. “We can’t lose it for 10 minutes or we can’t get reinsured — we are considered a bad risk.”