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Multiple Sclerosis

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Although I am an optimist, there is no particular nice way to talk about multiple sclerosis (MS)- the most common disease of the central nervous system caused by the body’s own immune system failure. The exact causal reasons and triggers are not clear and treatment remains of limited scope and benefit, even to those able to receive it. Further, over the long-term is it a progressive illness with devastating results for sufferers, causing disability in 50% of patients within 15 years and shortening their life span by up to 10 years on average.

Despite the major advances in the last 20 years from when MS was considered untreatable, let me explain why this illness still remains such a medical challenge. Afflicting young adults between 20-50 years of age, the name MS is taken from the disease process, thought to be caused by inflammation, wherein the special cells that insulate the nerves in the brain and spinal cord get destroyed (or at least do not repair themselves) resulting in hardened plaques at many points that prevent the nerves from working as normal. Being widespread and central, the symptoms that result are understandably varied and severe.

The most troubling symptoms reported by patients include; weakness, rigidity, fatigue, loss of balance, cognitive impairment, visual disturbance, bladder dysfunction and depression. Of these, the visual and motor symptoms are the most common. However, different symptoms affect different patients at different times and to different degrees. The individual symptom pattern is the key to grading their type of multiple sclerosis, choosing treatment options and predicting their likely outcome.

The main distinction is between those with a slow gradual decline in function and those with a ‘relapsing-remitting’ course of sudden episodes of symptoms that then recover (often back to normal but sometimes not quite.) The latter is more favourable as this is where drug therapy is available and most effective.

This ‘relapsing-remitting’ type is also the most common form. Sometimes, if there is more than one attack with clear symptoms a diagnosis can already be assumed, but further investigations are required to confirm the diagnosis in the form of magnetic resonance imaging (looking for plaques around nerves), spinal fluid samples (looking for inflammation) and nerve speed tests (looking for slowing). Sufferers have on average one attack per year.

Treatment aims to fight the disease in three ways. Firstly, against active symptoms themselves like pain by virtue of painkillers- for example codeine based preparations available on DokterOnline and by steroids. Secondly, by decreasing the frequency of relapses to avoid the symptoms returning with the aid of immune system drugs. The use of these, thirdly, works to decrease the likelihood of disability in the long term.

Although there are approximately ten available immune system modifying drugs for multiple sclerosis the two most commonly used are Beta-interferon and Glatitramer Acetate. They are proven to be safe and effective in reducing frequency of relapses (by 30%.) However, they can have significant side effects causing some patients to find it difficult to adhere to and it still remains difficult to predict long-term survival.

Faced with such tough choices, approximately 50% of patients seek alternative therapies in the form of diet, acupuncture, yoga or vitamin D supplementation. However, there is no evidence that these measures work. But, as I remain an optimist, there is still hope of better treatments and cures as further research is very much active and on-going to understand how the immune system interacts and how to regenerate the nerve coating to better treat MS.

© Syed Z Arfeen
Medical Advisor
December 2015

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