MS: An Unpredictable Disease That Needs More Attention

What would you do if you had symptoms of extreme fatigue, blurred vision, loss of balance, slurred speech, tremors, problems with memory and concentration, or paralysis that occurred sporadically throughout your life and potentially worsened over time? It is a crazy and debilitating thing to think of, but this is what people with multiple sclerosis deal with every day. Multiple sclerosis (MS) is a chronic neurological disease of the central disease system (brain, spinal cord and optic nerves) and is thought to be a disease in which the immune system incorrectly attacks its own healthy tissue. Over 2.3 million people are affected by MS across the globe, but because symptoms can be invisible or difficult to diagnose, the National Multiple Sclerosis Society predicts there are many more cases than accounted for.

This past month I volunteered at the MS150 – a two day, 150 mile bike ride from Houston to Austin that fundraises for the National MS Society. Anyone that races has a four hundred dollar minimum to raise towards MS. This year, they were able to raise over $10 million dollars total towards helping the National MS Society bring hope to those affected. I had heard of this race and organization in the past, but had never really pursued looking further into it. This year I decided to cheer on a fellow friend racing in it and learn a little more about MS while I was there. I was so glad I did. It was such an uplifting experience with everyone gathered and racing for a common cause. It really made me consider if there’s anything similar being done – information sharing, raising money, learning about the disease – in other countries. The U.S. is lucky to have resources to coordinate these kinds of events, but they are not the only people affected by the disease.

MS does not know country borders or only affect populations in certain nations. It is a disease that affects those across the globe. Global prevalence of MS showed greater numbers in higher income countries (>60 people per 100,000) than lower income countries (ranging from 0-20 people per 100,000) from a study done by the Global Atlas in 2013. However, these numbers could be skewed from showing the whole picture due to less lower income countries adequately diagnosing and reporting the disease. Another study, the global burden of disease study, or GBD, conducted in 1990 estimated the incidence, prevalence, duration and mortality for more than 500 different diseases and injuries. Neurological diseases, like MS, were measured in disability-adjusted life years, or DALYs. These measure the impact of a disease such as MS, on a person’s healthy lifespan. If the impact is one DALY, then it can be thought of as losing one year of healthy life free from disease and disability. This study revealed that noncommunicable diseases, including neuropsychiatric diseases like MS, had a notable impact on the health burden in all parts of the world. MS was predicted to have an increasing number of total DALYs from 2005 (1,510,000 DALYs) to 2030 (1,648,000 DALYs). This was measured out of a total of 92 million DALYs contributed by neurological disorders in 2005 and a predicted 103 million DALYs in 2030. Although the burden of MS seems small in the group of neurological disorders, it is predicted to increase and continue to make an impact.

Luckily, scientists today are researching and testing different theories to try and pinpoint the unknown cause of multiple sclerosis. A recent study published this past week points to gene expression of what’s called TOX. TOX contributes to the development of lymphocytes that attack foreign threats in the body. However, when this TOX is activated in CD8+ T lymphocytes, the lymphocytes can not hear signals from the brain telling them that the neurons they want to attack are actually healthy and not a threat. They instead attack the brain cells and eventually lead to the development of MS. This discovery is an exciting first step in understanding MS better and how to prevent it from impacting so many.

However, we are not all scientists. So what can we do to help those with MS or other noncommunicable diseases across the globe? We can start with learning, understanding and speaking out about the burden that noncommunicable diseases like MS have on our communities. In the 2013 Atlas of MS survey, it was found that there were 4.7 neurologists per 100,000 people in high income countries compared to 0.04 per 100,000 people in low income countries. The range of MS nurses was also similar and many low income countries reported having zero nurses with these specific skills and expertise. The number of MRI machines also closely matched this trend, with lower income countries having less machines available to them. Low and middle income countries unfortunately have the double burden of communicable and noncommunicable diseases. It is easy to spend so much time on infectious and communicable diseases because we see “easier fixes” to the problem such as providing vaccines, adequate hand hygiene education, and access to clean water initiatives. However, diseases like MS, while trickier to tackle, should be kept in the forefront of our minds.

The World Health Organization has an awesome chapter from a book called, “Neurological Disorders: Public Health Challenges” that hits home this point about resources (both financially and the public health workforce) being needed to help those with neurological disorders alongside communicable disease resources. It aims to provide a basis for decision making at global, regional and national levels so that resources are available for both realms of public health challenges. I believe if we’re acknowledging and advocating that noncommunicable diseases are also of public health importance – we can slowly chip away at the multitude of different global health challenges we are faced with everyday. I’ll end with a quick link to the World Health Organization’s page titled 10 facts on noncommunicable diseases. Check it out and see if there’s something new you can learn today!

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