Thanks to research, a clearer picture of the disabling disease multiple sclerosis (MS) is gradually emerging. Is the world closer to effective treatment for MS?
Paintings by South African artist Michelle Nigrini often display voluptuous big-bottomed pears, appetising artichokes, fish ready to be grabbed or peas so fresh that they will burst in your mouth. The life and energy in her paintings belie the fact that she suffers from multiple sclerosis (MS), and sometimes feels too tired to paint.
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She is one of more than an estimated 8 000 South Africans suffering from this disease that may ultimately lead to muscle paralysis and life with a crutch or in a wheelchair for 40% of people. The disease strikes twice as many women than men and is diagnosed primarily in young adults between 20 and 50 years of age.
MS is a progressive autoimmune disease of the central nervous system in which patches of myelin sheaths – the insulation tape that covers the long tails (axons) of nerve cells – become inflamed, swollen and detached. Due to the inflammation, the myelin is destroyed, forming a scar (sclerosis) over the axons. In the same way that electrical energy is lost when bare electrical cables are stripped of all insulation tape, damage to the myelin slows or blocks the high speed and smooth conduction of impulses from the brain or spinal cord to the muscles. This may result in the loss of functions such as movement, muscle coordination and sensation.
Problems with eyesight are often the first warning signs. Initial symptoms often include blurred or double vision or even blindness in one eye. Most MS patients also experience muscle weakness in their hands and feet and difficulty with coordination and balance. Many people experience sensations such as pins and needles, pain or loss of feeling. About half of all people later experience difficulties with concentration, attention, memory and judgment.
The progression of the disease may be unpredictable. The symptoms may be mild or severe, of long duration or short. There are at least five types of MS. In its mildest form (in 15% - 20% of cases) the symptoms are mild, do not get worse and do not lead to disability. In its most severe form MS does not include any periods of recovery or remission between attacks; the symptoms just get worse and new ones develop. Approximately 45% of people affected by MS, live normal and productive lives. In approximately 40% of people, the disease may lead to some or other form or degree of disability.
New discoveries
Currently there is no cure for this disease. Currently more than a thousand researchers around the globe are in search of answers that may result in effective treatment methods.
Some of the most important discoveries regarding MS include the following:
1. One of the biggest problems – the prompt diagnosis of MS – has been partly solved. Since initial symptoms are often vague and general, most MS diagnoses could only be confirmed after a second, third or fourth acute attack or further progression of the disease. Doctors can now detect early signs of demyelination by magnetic resonance imaging (MRI), while major strides have been made in DNA testing for early diagnosis of MS.
2. The causes of MS seem to be a combination of environmental and genetic factors. MS is more common in people from colder, Northern countries, such as Eskimos, Fins, and Eastern European Gypsies, while the Japanese and native Indians of North and South America show low incidence rates. It also seems as if a viral (or bacterial) infection acts as a trigger to activate the MS autoimmune response, leading to the inflammation of patches of myelin. Research indicates that MS will only be triggered if both these factors (and maybe even more factors) are present. This finding means that if a genetically predisposed person can avoid certain viral or bacterial infections, his/her MS might never be activated. Problem is, researchers don’t know which infections yet, but might soon know.
3. More has been discovered regarding the genetic factors. Some people are indeed genetically predisposed to MS and therefore susceptible to MS. MS is indeed more prevalent in certain families. The average South African has about one chance in 4000 of developing MS. But relatives of people with MS, such as children or siblings, have a chance of one in 100 or even as high as one in 40. The identical twin of a person with MS has a one in three chance of developing the disease. This proves the involvement of both the genetic and environmental factors. With only genetic factors at play, the chance should have been 100%, and with only environmental factors taken into account, it should have been one in 4000. It seems that a specific gene, known as SLC11A1, might be closely involved with MS and be an accurate indicator to identify susceptible relatives of a MS sufferer very early and in time for preventative steps. If this proves to be the case, this discovery also opens the doors to develop medication that will “inactivate” this gene, turning a susceptible person into a MS-resistant person, explains Cape Town geneticists and biochemists.
4. New drugs for better control of MS are emerging. Interferon beta is one of them. According to Prof. G. Modi, head of Neurology at the University of the Witwatersrand where these drugs were tested: "there is good, sound scientific evidence that the Interferon beta class of drugs reduces the risk of an attack in MS sufferers by around 40 percent”. He described it as "the best available preventative treatment at present".
5. Recent research findings indicate a strong link between iron metabolism and MS. It has become evident that iron is one of the essential components to sustain healthy myelin sheaths. It has become clear that low iron levels in susceptible people may lead to demyelination and further attacks or progression of the disease. South African researchers, as well as several groups of American and German researchers, play a crucial role in these studies. In fact, clinical trials are underway in the USA in this regard. Researchers are confident that normal iron availability in people with MS, will halt the progression of at least one type of MS, and maybe all types. Several American patients reported no relapses since they started taking iron supplementation between three and six years before. This finding might be the key to effective prevention and control of MS.
These discoveries are some of the few around the globe that bring new hope of effective treatment. Researchers are searching for more answers.
What you can do if you have MS
In the meantime, until effective treatment or prevention is available to all, there are things you can do to make your life as easy as possible:
1. Keeping as fit as possible will help the immune system, and help to establish good muscle tone, and to improve muscle strength, balance and coordination. It may also help with depression, which often accompany MS. Exercises at home or in a gym, swimming, yoga and horseback riding are recommended.
2. Eat a balanced diet. An eating plan including at least five fruits or vegetables per day, and with loads of vitamins and minerals will boost your immune system. Increase the fibre in your diet – with more whole grains and fruit and veggies) to counter constipation, a common symptom. It is best to avoid a diet high in animal fats, starvation diets, fad diets or any diet that lacks nutritional value. The research findings linking low iron levels to MS, are a clear indicator that a nutritionally balanced diet is the way to go.
3. Do proper planning at your job and in your family to facilitate and cope with changes. Some people with MS will not be able to continue with a physically demanding job, but will still cope well with an office-based job.
4. Plan your pregnancy. The lifetime risk for a child of MS parent to also develop MS is 3 – 5%. Pregnant MS mothers should note that various medications currently prescribed to treat exacerbations or fad diets may be harmful to the unborn child.
5. Get enough rest to counter fatigue, a common symptom of MS.
6. Be careful with hot tubs. Heat may cause temporary worsening of many MS symptoms. Soaking too long in hot water may cause extreme muscle weakness in some people. If you do experience heat-related worsening of symptoms, cooling down for a few hours usually will return you to your normal state. Also consider air-conditioning if you live in a hot and humid area.
One person in every twenty has an extra rib, but this happens three times as often in men as in women. Is this perhaps where the story of Adam and the creation came from?
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