In Australia over 33,300 people and globally nearly 3 million people are living with MS. MS costs the Australian government / healthcare system approximately $2.5 billion per year. MS is often diagnosed between the ages of 20 to 40, and affects females more than males; 3 out of 4 diagnosed with MS are female. In Australia, 1-2 Australians are diagnosed with MS every day.
What is Multiple sclerosis (MS): The immune system attacks foreign invaders such as viruses and bacteria, and eliminates them effectively from the body. However, in the event of autoimmune diseases, one of which is MS, the immune system mistakenly attacks itself. In MS, immune cells, attack the myelin sheath. The myelin sheath is a fatty material which protects and covers the nerves to allow communication signals between the brain and the rest of the body. In MS, this myelin sheath is attacked by immune cells (called, demyelination), leaving parts of the nerve fibres exposed, and as such, there is loss of nerve impulse / transmission between the brain and the rest of the body. Eventually, this can cause permanent damage (scarring) or deterioration of the nerve fibres, in some people.
What causes MS: There is no single cause of MS, however a combination of genetic factors and environmental factors are triggers which contribute to the development of MS. In addition, age, being female, family history, race, low levels of vitamin B, low levels of vitamin D, genes, obesity, other autoimmune diseases such as type-1 diabetes, pernicious anaemia, psoriasis, thyroid disease, and exposure to certain toxins and chemicals, including tobacco smoking. Climate also contributes to MS, as it’s been noted that those living in Canada, NZ, USA, south-east Australia, and Europe have higher incidence of MS. Further, certain infections have been linked to MS, in particular, Epstein-Barr virus (EBV), and similarity sequences have been found in EBV virus proteins and in the myelin sheath, hence, triggering an immune response to EBV viral proteins, could trigger cross reactivity leading to the immune system attacking self-myelin sheath proteins with similarity sequences (regions). However, in such situations, the genetic make-up of the individual is crucial as only certain genetic codes (called MHC) are involved in autoimmune disorders. So, a combination of genetic codes of an individual (MHC), and viral infection, can lead to MS in some people.
What are the symptoms: Symptoms, severity and the duration varies between individuals. The symptoms range from asymptomatic to chronic symptoms which do not go away and get worse. In severe cases, there is loss of motor function, loss of hand and arm function, inability to walk, loss of sensation, vision changes and changes in cognition. Some of the common symptoms include numbness or tingling in one or more limbs, lack of coordination, vertigo, fatigue, slurred speech, and mood disturbances.
Disease Course: There are different types of MS. (a) Relapsing-remitting MS is the most common disease course. Individuals often experience new symptoms or relapses ranging from days to weeks followed by partial or complete improvement leading to remission which can last months or even years. (b) Secondary-progressive MS affects about 20-40% of those with relapsing-remitting MS. Such individuals eventually develop steady progression within 10-20 years from onset of disease, affecting gait and mobility. (c) Primary-progressive MS is a gradual onset and steady progression of disease with no relapses.
Treatment options: There is no cure for MS. However, certain interventions are used to help with disease management. These are categorised as follows:
- Disease modifying medications: As MS is an autoimmune inflammatory condition, disease modifying medications suppress the immune system and help with symptoms and slow progression of disease. Medications include interferons (Avonex, Betaseron, Rebif), glatiramer acetate (Copaxone), sphingosine-1-phosphate receptor modulators (Fingolimod, Gilenya), dimethyl fumurate (Tecfidera), and monoclonal antibodies (Natalizumab, Ocrelizumab, Alemtuzumab), all with the aim to reduce inflammation and slow progression. In those who relapse, short term corticosteroids (methylprednisolone) are used to reduce inflammation and speed recovery.
- Physical therapy: This helps in strength building, flexibility, coordination, and mobility. Exercise programs tailored to patients with MS such as hydrotherapy, aerobic exercise, can improve immune function and decreases inflammation. Gait training, balance training, stretching, core strengthening, assistive devises, breathing exercises are all used to improve disease outcomes and improve quality of life.
- Occupational therapy: Helps MS patients to improve their ability to undertake daily activities. This includes muscle exercises to manage muscle weakness, coordination, and gait issues. Fine motor skills to improve hand strength are used to help with writing, use of utensils and coordination. Fatigue management, use of assistive devises to undertake daily tasks and, psychosocial support.
- Diet and lifestyle changes: Certain natural supplements such as, vitamin B and vitamin D can be beneficial and improve symptoms and reduce disease progression. Positive outlook and stress management can help with overall health
- Supporting therapies: These can alleviate symptoms and improve quality of life. Examples include mindfulness, yoga, acupuncture.
- Pain management: Pain is common in patients with MS. A combination of supportive therapies, physical therapies, heat and cold therapy, massage therapy, assistive devices, lifestyle modifications and medications and used to manage pain in patients with MS.
New Emerging therapies, emerging research: Several new emerging technologies have been developed in the last few years where researchers are trying to identify new biomarkers in an attempt to diagnose MS early and start treatment to prevent disease progression. Personalised treatments are being investigated to treat individuals based on their genetic makeup and disease characteristics, as ‘one treatment does not fit all’. Understanding the gut-brain axis is being investigated as it is believed that gut changes influence brain changes and understanding this connection may lead to novel therapeutic options. Stems cells and myelin repair molecules are being evaluated in order to repair the damaged myelin sheath. Cognitive rehabilitation, epigenetics and gene expression, and advances in neuroimaging techniques are being developed for better long-term outcomes for individuals with MS. More recently, immune therapies have been tested in pre-clinical studies and in human clinical trials in an attempt to re-educate the immune system and switch damaging immune cells to therapeutic immune cells. As such, we have been developing immune therapies with our collaborators from NewDrug and University of Patras for the last 20 years, and developed several new immune modulators, all progressing towards being tested in human clinical trials.
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