Multiple Sclerosis affecting youngsters: Neurologist explains causes, treatments

'It's not my favourite disease. And I've had a couple,' 'Friends' star Christina Applegate famously said a few years ago on a renowned TV interview, in which she revealed that she was diagnosed with the rare condition of Multiple Sclerosis. A condition in which our immune system turns against its own body affects around 2.8 million people worldwide. It can be abbreviated as MS.

According to data, 1,500 to 2,000 people in Kerala are currently affected by MS. It is not completely curable, and management is the only solution. Dr Sruthi S Nair, Professor and In-Charge of Neuromuscular and Multiple Sclerosis at the Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, speaks to us about this rare disease.

Coating of nerves is lost
Multiple Sclerosis is a chronic neurological disease. It primarily affects the central nervous system, including the brain, spinal cord, and optic nerves. It is an autoimmune disease, meaning a part of our immune system turns against our body. This causes the coating around nerves, called myelin, to be lost in many parts of the brain. This is called demyelination.

Increase in Kerala
Apart from MS, other diseases also cause demyelination. For example, Neuromyelitis Optica Spectrum Disorder and MOG Antibody Disease. However, when all are considered, MS is the most common globally. This condition is rare in India. According to studies in the 1980s, only one in a lakh people in India had this disease. But according to figures from the last 10-20 years, MS has started affecting 5 to 10 in a lakh people. Accordingly, it is estimated that 1500 to 2000 people in Kerala currently have MS.

MS is relatively common in younger individuals. The disease usually affects people between the ages of 15 and 45. It is more common in women than in men. The number of autoimmune diseases like MS is increasing over the years. Treatments are available for MS. Treatment can significantly reduce the severity of the disease and the intensity of upcoming complications.

Cause of the disease
Like most diseases, MS has both environmental and genetic causes. Environmental factors are the most significant among them. While it is difficult to pinpoint them precisely, certain viral infections are considered major causes. For example, Epstein-Barr virus (EBV) infection in childhood. Obesity at a young age, smoking, and low sunlight exposure can also cause MS.

The highest number of MS patients is found in countries like Europe and North America. This might be due to lower sunlight exposure there compared to here. Genetic transmission of the disease is less likely. It is not a disease that spreads within families or through heredity.

Two types, symptoms
This disease manifests in two ways. The relapsing-remitting type is seen in 80 per cent of people. Demyelination occurs in any part of the brain, optic nerve, or spinal cord. This is followed by the associated complications. This can be improved with treatment.

Primary progressive MS is another type. Progressive neurological problems are observed. The symptoms will manifest depending on which part of the body is attacked first. Common difficulties include tingling in the hands or feet, decreased vision in one eye, loss of balance, weakness, and double vision. Additionally, there are problems with urine control, memory issues, pain, muscle pain, and mental fog. Examinations may often appear normal. These are called invisible symptoms of MS.

One after another
MS is a condition that attacks the body intermittently. First, there will be an attack. Then there will be partial or complete recovery. But after some time, another attack will occur. After several such attacks, disability due to the disease will develop. Many difficulties will remain. In this manner, after some time, the disease can also progress to secondary progressive MS, where it gradually worsens.

Multiple Sclerosis causes significant physical disabilities within 15-20 years of the onset of the disease. The occurrence of this disease at a young age disrupts the lives of these individuals. It significantly impacts their job prospects and financial stability.

Diagnosis, treatment
MS is confirmed by clinical examination and MRI of the brain and spinal cord. In addition, CSF (Cerebrospinal Fluid) studies by lumbar puncture, optic nerve tests, and blood tests are also performed. This helps determine whether the observed issues are associated with MS or with other demyelinating diseases similar to MS. In the last ten years, there has been significant progress in MS treatment. The first treatment for MS arrived in the 1990s. There were some injections like Interferon and later Glatiramer. These were injections that had to be taken daily or weekly, like insulin. However, in the last 10 years, stronger and more effective treatments have become available. New treatments became available in India from 2015 onwards.

Various medications
The name of the MS treatment is Disease-Modifying Therapy. All of these work by suppressing abnormalities in the immune mechanism. Monoclonal antibodies and S1P modulators are highly effective drugs. Interferon, Glatiramer, and some oral medications provide moderate effects. The decision on which medication to administer is based on the patient's condition and safety. Long-term disability has been significantly reduced with these medications.

Not completely curable
This therapy is not 100% effective. Many are long-term treatments. Disability development has been reduced through these. Many of them can lead normal lives. It is essential to increase the capacity to cope with an attack. For this, lifestyle changes are necessary.

Appropriate diet, exercise, ways to reduce mental stress, adequate sleep, strong relationships, and social activities can help reduce MS-related problems. It can also provide solutions for depression, anxiety, and memory problems.