World Multiple Sclerosis Day: Voices of Strength, Stories of Hope

The Unseen Struggle That Demands Global Solidarity
World Multiple Sclerosis (MS) Day is observed on May 30 every year to show support for those whose lives are disrupted by the most unpredictable disease. Living with multiple sclerosis means battling pain, constant fatigue, and frequent prejudice. This year, the MS Society of India and the global campaign are focused on encouraging people to share their stories, raising awareness, and helping those with MS feel seen and supported (1^✔ ✔Trusted Source
World MS Day

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The Growing Footprint of MS Across the World

MS affects an estimated 2.8 million people worldwide, making it the most common disabling neurological illness among young adults internationally, after trauma. Europe and North America still have the highest number of cases, although new cases are emerging across Asia, particularly in India, as diagnostic technologies improve.

Worldwide Data says,

• MS affects people as young as 15 and as old as 60.
• Women are diagnosed with multiple sclerosis (MS) two to three times more frequently than men.
• Prevalence ranges from over 100 per 100,000 in Canada and Scandinavia to less than 10 per 100,000 in parts of Asia and Africa (2^✔ ✔Trusted Source
  Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment
  
  Go to source).

Etiology: When Genes, Triggers, and Immunity Collide

When the immune system attacks our own cells, primarily those in the central nervous system (CNS), multiple sclerosis results. Their primary target is the myelin sheath, which is the protective coating of nerve fibers, and what triggers this immune attack?

• Genetic susceptibility: Especially the HLA-DRB1*1501 gene
• Epstein-Barr Virus (EBV): A near-universal link in MS patients
• Vitamin D deficiency: More common in countries with less sun exposure
• Smoking, childhood obesity, and gut dysbiosis (imbalance in the gut microbiome) may play contributory roles

Several factors may contribute to MS, and experts are working to understand the connections between lifestyle, infections, and immune system responses (3^✔ ✔Trusted Source
An Overview of the History, Pathophysiology, and Pharmacological Interventions of Multiple Sclerosis

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Pathophysiology: When the Brain’s Defenders Become Its Destroyers

When T-cells reach the brain through the blood-brain barrier, they release chemicals that start a cycle of damage. In the process of attacking myelin, the immune system damages nerve cells by causing inflammation and demyelination.

Disease Mechanism:

• Reduced myelin covering in nerves reduces the rate at which signals travel through the brain.
• These axonal damages remain permanent.
• Further, sclerotic plaques appear in the brain and spinal cord, visible on MRI scans

MS Types:

1. Relapsing-Remitting MS (RRMS)—Unpredictable attacks followed by periods of remission (85% of initial cases)
2. Secondary Progressive MS (SPMS)—A gradual worsening over time
3. Primary Progressive MS (PPMS)—Steady progression from the start (10–15% of cases) (4^✔ ✔Trusted Source
   Educational Case: Multiple sclerosis
   
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Diagnosis: The Search for Silent Signs of MS

MS is very hard to diagnose. There are many similarities with other brain disorders, and symptoms might show up now and then. Experts look at the McDonald Criteria, which has standards from clinical exams, X-rays, and laboratory results, to diagnose MS properly.

Diagnostic Tools:

• MRI images: Identify brain or spinal lesions
• Lumbar puncture is done to look for oligoclonal bands, which can signal that there is inflammation in the CNS
• This type of test is used to measure how quickly nerves respond.

Knowing early can slow the disease, which is why finding out more on these awareness days is important (5^✔ ✔Trusted Source
Multiple sclerosis

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Treating MS: A Multidisciplinary Mission

There is no specific cure for multiple sclerosis (MS), but an early diagnosis could change the course of the disease into a manageable one. The primary goal of the treatment aspect is to

• Reduce the frequency of relapse and simultaneously reduce its severity
• Delay the disease progression and disability
• Improve the quality of life for patients and their daily functioning.

MS treatment relies on a combination of disease-modifying therapies (DMTs), symptomatic management, acute relapse care, and rehabilitation strategies. The management plan is adjusted according to how severe and what type of MS the person has.

1. Disease-Modifying Therapies (DMTs):

Disease-modifying therapies (DMTs) help correct abnormal immune responses, reduce inflammation, and prevent further damage to the nervous system. They are especially beneficial for people with relapsing forms of MS.

Injectable Medications:

• Interferon beta-1a and 1b help reduce inflammation and regulate the immune system to prevent over activity.
• Glatiramer acetate mimics myelin, so the immune system targets it instead of the actual myelin sheath.

Oral Medications:

• Fingolimod prevents immune cells from leaving the lymph nodes and entering the central nervous system.
• Teriflunomide reduces the number of activated immune cells involved in MS.
• Dimethyl fumarate activates the Nrf2 pathway, protecting against oxidative stress and inflammation.

Infusion Therapies:

• Ocrelizumab targets and depletes B cells. It is used for both relapsing and primary progressive forms of MS.
• Natalizumab blocks immune cells from crossing into the brain and spinal cord.
• Alemtuzumab removes certain immune cells associated with MS and is often used in patients who do not respond well to other treatments.

While effective, some of these medications can cause side effects such as increased risk of infections, liver complications, or cardiovascular issues, so regular monitoring is essential.

2. Corticosteroids: Managing Relapses

During a relapse or flare-up, corticosteroids are often given to decrease swelling around nerves and help recovery happen more quickly.

• Methylprednisolone drug is given via IV or by mouth during a relapse.
• Children are usually in the hospital for 3–5 days.
• Even though steroids give patients prompt relief, they do not affect the final outcome of the illness.

3. Symptom Management: Improving Daily Life

Symptoms of MS range from fatigue and pain to muscle spasms, issues with the bladder and bowel, and depression. Improving quality of life depends on managing these symptoms.

Common Supportive Medications:

• Antidepressants and anxiolytics—for mood and anxiety disorders
• Antispasmodics—to relieve muscle stiffness or spasms
• Bladder control medications—for urinary urgency or incontinence
• Pain relievers and neuropathic agents—for nerve pain and discomfort
• Cognitive enhancers—for memory and focus issues

Individualized care plans help address unique symptom patterns in each patient.

4. Rehabilitation: Restoring Function and Independence

Rehabilitation helps people regain or maintain their independence when their mobility or coordination is compromised.

Multidisciplinary Therapy:

• Physical therapy—applying exercises strengthens muscles, improves your sense of balance, and reduces involuntary muscle tightness.
• Occupational therapy helps individuals find ways to do their daily routines.
• Speech therapy is used for anyone with speech or swallowing problems.
• Cognitive therapy strengthens memory, improves attention, and enhances executive function.

5. Emerging Therapies: A Future of Personalized Medicine

Experts are now looking into new and unique therapies for MS that focus on more than managing symptoms and immune activity.

Promising Advances:

• Using genetic and biomarker evidence to create a personalized approach to healthcare
• Remyelination therapies work to boost brain repair of damaged myelin.
• Hematopoietic Stem Cell Transplantation (HSCT) is a method that replaces the immune system to stop it from worsening in aggressive MS. These are designed to prevent nerve deterioration.

These new approaches give us hope that the damage can be repaired and that lasting remission might follow.

Living with MS: The Courage Behind the Condition

Beyond symptoms and scans, MS affects relationships, careers, and self-image.Fatigue may force someone to leave a job. Numbness may make parenting harder. Cognitive fog may challenge everyday conversations.

There are numerous case studies on affected individuals with MS, and one such study is on a patient named Anna, who had already been diagnosed with relapsing-remitting multiple sclerosis (RRMS) at age 35; her doctors were concerned that a different and more serious condition was behind her sudden right-sided weakness and confusion. MRI imaging revealed a large, ring-enhancing lesion—something typically seen in brain tumors or abscesses.

But this wasn’t cancer. It was a rare and challenging form of MS known as tumefactive multiple sclerosis (TMS), which causes unusually large, tumor-like lesions in the brain. These lesions are so effectively camouflaged that even experienced neurologists sometimes require a brain biopsy to confirm the diagnosis.

Anna was treated with high doses of corticosteroids, and her symptoms gradually began to improve. Her experience highlighted how MS can present in many different ways—ways that can confuse not only patients but even healthcare professionals.

This case underscores that MS is not just one disease but a spectrum of disorders. For individuals like Anna, it can mimic the very conditions we fear the most, like cancer (6^✔ ✔Trusted Source
Case Report: A Case of Severe Clinical Deterioration in a Patient With Multiple Sclerosis

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”The strongest people are not those who show strength in front of us, but those who fight battles we know nothing about.”
- Anonymous

References:

1. World Ms Day - (https://worldmsday.org/)
2. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment - (https://pmc.ncbi.nlm.nih.gov/articles/PMC10883637/)
3. An Overview of the History, Pathophysiology, and Pharmacological Interventions of Multiple Sclerosis - (https://pmc.ncbi.nlm.nih.gov/articles/PMC9888604/)
4. Educational Case: Multiple sclerosis - (https://pmc.ncbi.nlm.nih.gov/articles/PMC9284444/)
5. Multiple sclerosis - (https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274)
6. Case Report: A Case of Severe Clinical Deterioration in a Patient With Multiple Sclerosis - (https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00782/full)

Source-Medindia