Multiple sclerosis - another step forward
Multiple sclerosis, or MS, affects about one in 1,000 people in the UK - but judging by the worried faces in my consulting room over the last 20 years, many times that number go through the agony of thinking they've got it. Other incurable conditions of the nervous system like motor neurone disease, or MND may be fifty times less common, but can be equally devastating - and yet I've never heard a patient mention MND as their worst case scenario for their symptoms. Yet it seems we all fear MS - hardly a week goes by without a patient coming in with numbness or tingling and a look of terror on their face.
Why does MS hold such horror? Perhaps it's because it strikes so young - the average age at diagnosis is just 32 years old. (1) Perhaps it's because the most common form of MS, the 'relapsing remitting' variety which 85% of sufferers have, means you're always waiting for the next disabling attack. Small wonder that up to half of sufferers experience depression. (2)
Although much research has been done into MS, in some ways it's still a bit of a mystery. We know it can run in families - having a parent with MS increases your risk from one in 1,000 to one in 50. (3) We're fairly sure it's an autoimmune disease - your body's immune system, which normally protects you against disease, turns on itself and attacks the protective sheath around some of your nerves. We don't think inheritance entirely explains the different rates in different UK countries - between 100 and 140 per 100,000 in England and Wales, about 170 in Northern Ireland and as high as 190 in Scotland. In some of the Scottish islands it's even higher - perhaps as much as four times higher than in England. (4) Some researchers believe that lack of the 'sunshine vitamin', vitamin D, may play a part, and believe far more of us at risk of deficiency should be taking a supplement of 20 micrograms (800 IU) a day.
But there is hope for people diagnosed with MS today. Doctors no longer wait for relapses to occur and treat the symptoms then. There is increasing understanding that 'disease-modifying' treatments, designed to slow down the progression of the disease, should be given at an early stage. More established agents, such as various kinds of interferon, are given by injection and cut the average number of relapses by 30-40%. Glatiramer (Copaxone®), also given by injection, cuts the risk of relapse by about a third. Several other treatments have been developed in recent years, including Campath-1H® and mitoxantrone, both given by intravenous drip. These dramatically reduce aggressive or very active MS, but do have potentially serious side effects, so are reserved for cases where other treatments have failed.
The last few days have seen a new drug licensed in the UK for the treatment of MS, this time a tablet. Called Tecfidera®, its license is for treatment of the most common relapsing remitting form of MS. In studies, Tecfidera® cut the rate of relapse by half and the rate of progression of disability by 38% over two years compared to 'placebo' treatment. Not all treatments work for everyone, so having a new option which is licensed for a wide number of people with MS is an important step. Overcoming MS is a long march, but we're moving forward.
1) The Multiple Sclerosis International Federation. Atlas of MS 2013 - UK data. 2013
2) Multiple Sclerosis Society. MS Essentials for people living with MS - Living with the effects of MS.
3) Multiple Sclerosis Society. Pregnancy and Birth. Available at http://www.mssociety.org.uk/what-is-ms/womens-health/pregnancy-and-birth. Accessed January 2014