BENGALURU: The incidence of Multiple Sclerosis in India, a demyelinating disease that damages myelin sheath (the protective covering surrounding nerve fibres in the brain, optic nerve and spinal cord), has increased, specially among younger women. Doctors say it affects them during their productive age.
“While there is no concrete evidence, the medical fraternity suspects that increased stress leads to multiple sclerosis in young girls and women in the age group of 15 to 45. Seven in 10 cases we receive are girls. Climate change could also be a cause is climate change. At National Institute of Mental Health and Neuro Sciences (NIMHANS) alone, between 1980 and 1990, there were 63 cases and between 1990 and 2002, there were 243 cases. Since 2006, we have observed a rise. The disease affects the eyes leading to loss of vision, blurry vision, pain in limbs, swaying while walking, loss of balance, trouble with bladder control, affects speech, etc,” said Dr P Satish Chandra, senior consultant, Neurology, Apollo Hospitals and former director vice-chancellor and senior professor of Neurology, NIMHANS.
The auto-immune disorder, in which the body’s immune system attacks its own tissues, has chances of relapse despite treatment. “The frequency has increased from 2.5 cases per year to 24 cases per year, which translates to 5 to 6 cases every month,” Dr Chandra said.
For instance, he received a case where a 35-year-old woman suffered temporary loss of vision in the left eye back in 2003. Later, the right eye was affected too. Treatment was given and she regained her eyesight partially.
“However, symptoms such as weakness in the legs followed. In 2019, she was unable to even get out of bed to go to the washroom, let alone go to work or perform domestic chores. She suffered seven episodes of multiple sclerosis between 2003 and 2009. She now needs support to walk and has lost vision in the right eye completely now,” he added.
Dr Netravathi M, Additional Professor, Department of Neurology, NIMHANS, said,” Awareness on early diagnosis and treatment is increasing. In a week, I see anywhere between three to 10 patients, while 3-4 years ago, it was only 1-2 patients per month. Multiple Sclerosis can happen to women prior to marriageable age and sometimes even immediately after marriage. It is devastating and affects her career and family.”
“We saw 186 patients between January 2015 and July 2018. Of them, 74 patients were aged between 21-30 and 48 in the age group of 31-40 years. Females accounted for 60% of the patients,” Dr Netravathi added.
Dr. P R Krishnan, Neurology consultant at Fortis Hospital said, “The numbers are definitely bigger among females and the volume of cases are increasing each year, with a new patient coming in once every two months. While researchers have not been able to find the exact causes, studies point to environmental triggers such as climate change. Hot climate works as a trigger for Multiple Sclerosis, as opposed to cold climate. Stress could also be a factor, but it is not proven concretely. Viral infections are also possible triggers that lead the body to attack its own nervous system.”
The potentially disabling disease of the brain and spinal cord has been recognized as a disability by the government, but patients are not entitled to any sustenance. While treatment costs have reduced, it is still high and unaffordable for the poor.
“Steroids are administered for treatment. There are several disease-modifying therapies available. There are injectibles to be given once or thrice a week through intramuscular and sub-cutaneous methods, respectively. Oral medication has become more popular in the last 4-5 years, which are given once or thrice a day, which cost Rs 12,000 to Rs 15,000 per month while injectibles cost Rs 12,000 to Rs 18,000 per month,” Dr. Satish Chandra said.
“Poor people cannot afford it and it is not covered by Ayushman Bharat Arogya Karnataka scheme. Even private health insurance covers only initial hospitalization therapy, but not subsequent visits when there are relapses. Only those covered by Central Government health scheme, those in Army and Railways have their treatment covered for multiple sclerosis,” he added.
The drugs, along with early diagnosis and treatment, needed to insured and exempted from tax, he felt. “Medicines cost Rs 14-15 lakhs over a period of two years. The best medicines cost Rs 20,000 to Rs 30,000 per month. While cost has reduced from what it was three years ago, it is still high,” Dr. Netravathi pointed out.
“Oral medication is popular these days as they reduce the shrinkage of the brain and are more affordable than before. Immunoglobulin and interferon injections are given. This only help control the disease, but there is no cure,” Dr Krishnan explained.