KOCHI: Multiple Sclerosis (MS) also known as ‘Canadian’s disease’ is diagnosed 1 in every 75000 individuals in India. Though the disease is said to affect people irrespective of age, those who fall between 20-50 years of age are more susceptible.
The disease which affects the central nervous system damages tissues in multiple areas including, the brain and spinal cord making it a potentially disabling disease. Although the causes and pathogenesis remain unclear, studies have suggested the cause to be genetic or autoimmune. Also, certain risk factors such as low vitamin D, smoking, lack of sun exposure, and adolescent obesity, have shown a significant association with MS. As per a recent publication in January 2022, Epstein Barr Virus (EBV) also has been found to have an association with the disease.
MS can trigger a cascade of events in the immune system leading to the death of nerve cells with demyelination (any condition that causes damage to the protective covering that surrounds nerve fibres in your brain) and dysfunction. Individuals affected by MS, usually present with spasms, fatigue, lack of control over urination and defecation, and walking difficulties like tremors and unsteady gait. Symptoms such as vision loss (partial or complete), numbness, tingling and loss of power are some of the symptoms that come rarely with the disease.
As per the National Multiple Sclerosis Society, about 85% are initially diagnosed with Relapsing-remitting MS (RRMS), characterized by on and off-active symptoms called flares. Between these flare-ups, there are periods of recovery or remissions. Of which 90% reach a stage called secondary progressive MS (SPMS), in which symptoms gradually worsen and the affected individual is likely to experience increasing levels of disability, which includes difficulty in walking, fatigue, and cognitive problems. According to the review article of 2021 in Frontiers in Neurology, the transition from RRMS to SPMS appears to be age-dependent, with the forties being the most common age group.
Due to the lack of specific diagnostic criteria for progression, a diagnosis of MS can only be retrospective, limiting a doctor’s ability to treat MS in the early stages. Diagnostic tools for MS include MRI scans and Laboratory tests including CSF and serum analysis.
The presence of Immunoglobulins (Antibodies) in cerebrospinal fluid (CSF) and serum indicate the possibility of MS. Patients with high IgG index in serum and CSF along with the presence of Oligoclonal Bands (OCB) in electrophoresis are diagnostic of MS. There is no such cure for MS but several treatment modalities which could slow the progression are, disease modifying therapies (DMT), stem cell therapy. Rehabilitation and physical therapy can also help improve and maintain the individual’s ability to perform. MS is taxing to live but it’s rarely fatal.By Dr Bhavya Saxena, Pathologist Operations, Metropolis Healthcare Limited.