Though the course of Multiple Sclerosis cannot be accurately predicted, early treatment has substantial benefits for the patient.

No permanent cure: Often patients with MS lose control over their limbs.

MEENAKSHI BHUJWALA

Group Captain Prabal Malaker (Retd.) is a 53-year-old retired officer of the Indian Air Force. Prabal was commissioned as a fighter pilot in 1977.

As a qualified flying instructor, he was responsible for training novice and beginner pilots. His flying skills also mean that he was employed as experimental test pilot, and flew practically every aircraft in the Air Force inventory. From MIGs, Jaguars and Mirage jets into large transport carriers like the Avro and AN-32 were his life.

Life seemed to be going well until August l998. Then things changed drastically. He was diagnosed with the progressive form of the disease multiple sclerosis (MS). MS is a disease not many people are aware of, especially in India.

MS is an inflammatory, chronic, and degenerative disorder that affects nerves in the brain and spinal cord. Many characteristics suggest an “auto-immune” disease where the body attacks its own cells and tissues, which in the case of MS is myelin. This is the fatty substance that surrounds and insulates nerves and facilitates the transport of nerve impulses. The symptoms begin to appear as the myelin is gradually eroded.

MS happens far more commonly in women than in men; you may recall “Guru” in which Vidya Balan is diagnosed with MS and is confined to a wheel chair. Such disabilities with MS are common: almost 50 per cent of patients will experience some form of physical disability within the first 15 years, particularly if left untreated.

The exact causes of MS are unknown. It is a chronic inflammatory disease but what triggers the immune system to turn against its own body is still unknown. Current researchers think that MS may be caused by combination of several factors.

One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process.

Diagnosis can be quite difficult since the symptoms mimic that of other conditions such as visual disturbance, tingling or sensations, loss of control over their limbs. In such cases patients often tend to visit an ophthalmologist, general physician or an orthopaedician, whereas a neurologist would be the appropriate specialist. This is because neurologists follow certain guidelines for the diagnosis of MS, which are critical. The MRI of the brain is one important test for the diagnosis.

Like diabetes, hypertension, Alzheimer’s, and Parkinson’s, there is no permanent cure for MS. However, there are facets of the disease that have recognised treatments and can be very effective. These include:

People suffering from MS experience acute attacks that lead to hospitalisation resulting in loss of work hours and leading to added anxiety. During acute attacks, steroids are commonly given to help reduce inflammation at the site of new “demyelination” and control those attacks, but steroids are not the ideal solution owing to their long-term harmful effects. Though, the current favoured steroid regimen is methyl-prednisolone given intravenously in high doses, it is believed that the use of steroids may not have any effect on the long-term course of the disease. Other Disease Modifying Therapies (DMTs), such as modern biological medicines, also exist and are used to reduce the severity of the attacks and improvethe quality of life of patients.

There is no permanent cure for MS as yet. With the exception of the chronic progressive form of MS, there are certain drugs like DMTs that are known to slow down the disability progression and improve the quality of life of the patient suffering from ‘Relapsing-Remitting’ form of MS.

These DMTs include biological interferon beta products and products containing glatiramer acetate. However different patients respond differently to these medicines. Patients need to consult their neurologists to find the most appropriate therapy. In addition medicines available help reduce muscle spasticity and antidepressant medications may be helpful for mood or behaviour symptoms.

A number of these new drugs that have been approved for use in MS , have some effect on the frequency and severity of exacerbations and the number of lesions as seen on MRI, though the effect on progression of disability remains unclear.

Physical therapy, speech therapy, occupational therapy, or similar forms of therapy may also be helpful. This may improve the person’s outlook, reduce depression, maximise function, and improve coping skills. A planned exercise programme early in the course of the disorder helps to maintain muscle tone.

A healthy lifestyle is encouraged, including good general nutrition. Adequate rest and relaxation helps to maintain energy levels. The patients should avoid fatigue, stress, physical deterioration, temperature extremes, and illness to reduce factors that may trigger an MS attack.

One of the major fallouts of being diagnosed with MS is the psychological effect, particularly when the patient is in the prime of life. This is because there isn’t any proven cure and so the patient often suffers severe bouts of depression. Therefore it becomes essential that the heart rules over the mind.
Support Groups

The Multiple Sclerosis Society of India (MSSI) is the only charitable non-profit voluntary organization for MS in India. MSSI has eight chapters all over India and recently launched its website ( http://www.mssocietyindia.org) to help patients find the relevant resources and information on MS by providing programmes and services that help people with MS and their families move their lives forward.

Though it is tough to accurately predict the course of MS for any individual, there is substantial evidence to showcase the benefits of an early treatment for MS. The initial years give some indication about how the disease will continue. Organisations like the MSSI along with companies such as Biogen Idec are working together on creating a brighter future for people living with MS.

Although Prabal’s career came to a halt in spite of being cleared for promotion (by being placed in a non promotable medical category), Prabal’s training as a fighter pilot has made him even more determined to fight the disease. Today he stands tall on his ‘three feet’ (walking stick included) and continues to keep fit by exercising with weights, stationary cycling, stretching exercises and swimming. A self-confessed ‘foodie’, Prabal enjoys checking out all the latest restaurants in town. “You live life just once, so live to the fullest,” he says.

The writer is Joint Secretary, All India Governing Council, MSSI.

Symptoms

MS is a variable condition. Symptoms depend on affected areas of the patient’s central nervous system. With no set pattern, symptoms can vary dramatically between patients and even within the same person, the symptoms can vary from time to time and can change in severity and duration. There is no typical MS. Though there are symptoms common to many people, no person will have all of them. Common symptoms include:

Fatigue: A debilitating kind of general fatigue, which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of the most troubling) symptoms of MS.

Visual problems: blurring of vision, double vision (diplopia), optic neuritis (inflammation of the optic nerve that may cause a complete or partial loss of vision).

Balance and co-ordination problems: loss of balance, tremor, lack of co-ordination, weakness particularly in the legs and walking, spasms,

Altered sensation: tingling and ‘pins and needles’, numbness (paraesthesia)

In addition, a patient suffering from MS can experience loss of bladder control, particularly during activities such as exercise, coughing, sneezing or laughing loudly.

The history of MS goes back to 1868. Jean-Martin Charcot, a professor of neurology at the University of Paris (often regarded as the father of neurology), examined a young woman with a tremor that he had never seen before. He noted other neurological problems including slurred speech and abnormal eye movements. After she succumbed to the disease, examinations revealed scars or “plaques” on her brain. Today these lesions are known to be characteristic of MS.