Awareness is the key!, Health News, ET HealthWorld


By Dr. Varsha A. Patil

Mumbai: Vinay Rajput (name changed), a cheerful 25-year-old from Mumbai, whose first symptoms of the disease were blurred and double vision, for which he visited an ophthalmologist. He was then referred to a neurologist, who diagnosed him with multiple sclerosis (MS). After initial treatment with steroids, his vision recovered completely, but he suffered two more attacks (relapses) while on moderate efficacy disease-modifying therapy (DMT). Over the next four years, his walking became even more difficult and he had to drag his left leg and foot and lost his balance while walking. Later, Vinay was started on a highly effective therapy, given to him as an intravenous infusion every six months. His symptoms have gradually improved, and so has his gait and confidence. He has completed his HR MBA and is now looking for a job. While medications have improved her physical symptoms, her so-called 'hidden symptoms' such as fatigue or blackouts force her to change jobs frequently, because employers don't know what MS is! Her parents and the neurologist treating her are very eager for her to overcome all her challenges.

Vinay's case takes us through the typical journey of a patient suffering from MS, from diagnosis to treatment. What is noteworthy is the challenges one may face in various spheres of life while living with MS. Awareness from society is of utmost importance to deal with this chronic neurological disease.

What is MS?

MS is a chronic inflammatory demyelinating disorder that affects the central nervous system. It affects young people, with women being affected twice as often as men. It is usually diagnosed between the ages of 20 and 40. According to the Atlas of MS (3rd edition), more than 2.8 million people suffer from MS worldwide. In India, about 1.5 lakh people suffer from MS. Although these seem to be crude estimates derived from about 75 reporting countries, 'Every five minutes, someone somewhere in the world is diagnosed with MS!'

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MS is the most common disabling neurological disorder affecting young people. It affects the brain, spinal cord and optic nerves. Symptoms vary depending on the part of the nervous system affected. In some people the disease can be mild; while in others it can be progressively worse with disability over time. The disease is rarely fatal; most people have a normal life expectancy. While there is no cure for MS, treatment can ease symptoms, prevent further relapses and improve quality of life.

What are the relapsing and progressive forms of MS?

MS can be broadly classified into one of three types: relapsing-remitting multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS). The RRMS types are characterised by periods of recovery followed by episodes of new or worsening symptoms (relapses). Progressive forms of MS (PPMS or SPMS) are more disabling forms, where disability can get worse without any improvement. Of the different subtypes, RRMS is the most common subtype (80-85 percent), while PPMS accounts for around 15 percent.

How are relapses treated and what advances have been made in therapy?

An acute attack of MS (relapse) is often treated with steroids which help reduce inflammation and lead to full recovery in most cases. However, if the attack is severe, therapy such as intravenous immunoglobulin (IVIG) or plasma exchange may be needed.

After treatment of the acute attack (which is often the first attack), the most important aspect of the treatment paradigm is detailed discussion with the patient and family. Shared decision-making includes education about the disease, its impact on social and personal life, the various disease-modifying treatments (DMTs) available, and its impact on fertility and reproduction (especially in young women).

While earlier options for DMT were limited to injectable drugs (interferon) or oral drugs (dimethyl fumarate and teriflunomide), there has been a major breakthrough in MS therapy with highly effective MS therapies. There are many options available for RRMS, however, only a few drugs are useful for the treatment of PPMS and SPMS.

What are targeted monoclonal antibodies?

There are several highly effective MS treatments available worldwide. Fortunately, many of these treatments are now available to Indian patients as well. Notable among these are monoclonal antibodies directed against CD20 such as rituximab (used off-label), ofatumumab and ocrelizumab (the latter two FDA-approved). These antibodies target a type of immune cell called CD20-positive B cells that play a key role in the disease. These treatments, which can be administered via injection or infusion, aim to reduce damage to the myelin sheath surrounding nerves, which is commonly associated with MS relapses. With a decade-long strong track record of safety and efficacy of molecules like ocrelizumab or rituximab, these have emerged as the preferred choice for MS treatment (in select patients), providing relief and convenience with a twice-a-year dosing schedule.

Recently, three treatments were added to the World Health Organization's (WHO) List of Essential Medicines on July 26, 2023: rituximab, cladribine, and glatiramer acetate. A new section has been created on the list that underscores the importance of treatments for MS. “By increasing access to disease-modifying therapies in low- and middle-income countries, this decision promises to transform the lives of countless individuals who have long struggled to access adequate MS treatment,” said Dr. Mara Tintoré, President of ECTRIMS.

Importance of awareness:

In a developing country like ours, there are many barriers ranging from delay in diagnosis to delay in starting DMT (either due to reluctance of patients or cost constraints). The key to effective treatment for MS is a patient and his family being informed about all the treatment options available along with their side effects, efficacy and safety. Apart from treatment, other important aspects of treatment are physiotherapy, occupational therapy, pain management and addressing the so-called 'hidden symptoms' (which include fatigue, pain, anxiety, depression, cognitive disturbances and bowel and bladder symptoms).

This article is written by Dr. Varsha A Patil, Consultant Neurologist based in Mumbai.

Disclaimer:

The information provided is for educational purposes only and is not a substitute for the medical advice of your doctor. Roche makes no representations regarding any treatment action or drug application through this educational effort and therefore shall not be liable for any direct or indirect damages arising therefrom. Please consult your treating physician for any further advice and treatment.

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  • Published on May 29, 2024 at 10:00 AM IST

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