Multiple Sclerosis

The Malaysian Saga

Dr Rahul Chavan, MDMedical Director, Malaysia

Outline

Introduction1

2 Prevalence

Etiology of MS3

4 Types of MS

Progress of Disease5

6 Symptoms of the Disease

Disability and its Implications7

8 Status update

Introduction: Multiple sclerosis (MS)

• Chronic autoimmune disorder affecting movement, sensation, and bodily functions.

• Destruction of the myelin insulation covering nerve fibers (neurons) in the central nervous system.

• Symptoms associated with permanent or transient nerve conduction defect

What is Multiple Sclerosis?• It is an Auto Immune Disease, where the body starts

to attack and destroy itself.• It is a life-long disease with no cure.• The disease affects those in the early to late

twenties, affecting the most productive years of their life.

• The disease is twice as common in women than in men.

• MS affects the Brain and the Spinal Cord (central nervous system) causing inflammation and ultimately leading to damage.

• If damage is severe it can also destroy the nerve/axon itself.

Background

• As damage accumulates, symptoms become more permanent and progressive disability ensues.

• As disability accumulates, the patient becomes progressively dependent on helpers, wheel chair bound and ultimately bed ridden.

• MS is a disease characterised by wide variations between patients and for the individual over time, thus making categorisation difficult.

• Currently in Malaysia about 700-800 people have been diagnosed with MS, but there are many more….

Our Evolving Understanding

• MS was considered a rare disease in Asia with the prevalence rate of only 1.33/1,00,000.

• WHO Multiple Sclerosis Atlas of 2008 describes the prevalence rate of 2.8/1,00,000 in the South East Asian region.

• Currently prevalence is considered to be between 5 to 7 / 1,00,000. (might be higher).

What Causes MS?

“Despite extensive research, we still don’t know what causes MS” (O'Connor). However they have found associations and links between many factors including genetic and environmental.

Genetic EnvironmentalSex LatitudeRacial Group Family history Migration Infections

Various types of MS and their frequency

time

Inte

nsity

and

pro

gres

sion

time

Inte

nsity

and

pro

gres

sion

time

Inte

nsity

and

pro

gres

sion

time

Inte

nsity

and

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sion

Benign MS Relapsing–remitting MS

Secondary progressive MS Primary progressive MS

15 % 45 %

30 % 10 %

Progression of Disease

Number of lesions

RRMS SPMSPre-clinical

Continuing Nerve damage

DisabilityRelapse

Most Common symptoms of MSSymptoms are variable and depend upon the location of

the damage within the brain

10 Year Disease Progression, if untreated!

Pat

ient

s pr

ogre

ssin

gto

SP

MS

(%

)

1Kappos L, et al. Neurology 2006;67(6):944–953; 2Weinshenker BG, et al. Brain 1989;112(Pt 1):133–46;

*An incidence cohort, 10 years after the onset of disease.2

†A cross-sectional cohort of patients 11–15 years after onset of RRMS.3

50%

58%

70

60

50

40

30

20

10

0

Natural historydataset 1*

Natural historydataset 2†

The Disability• 15 years after disease onset 15% of MS patients need technical

aids for walking and 29% use a wheelchair- Physical & functional impairment.

• During the first 10 years after diagnosis 50–80% are out of work- Socioeconomic & psychosocial impairment.

NormalNo disability, few signs

Minimal disability

Mild disability

Needs assistance to walk

Wheelchair,some steps

ReducedMobility

Bedbound

Wheelchair,no steps

Death

Is disability inevitable?

• As mentioned, there are numerous different paths that MS can take.

• Although MS as a disease is much feared, the prognosis in general is not as poor as commonly thought”.

• 5-20% of all patients will develop benign MS, and another 33% will have little to no disabilities allowing them to live independently while not in relapse.

• 33% of MS patients will have a severe disability.

The Situation so far

• MS treatment was funded by Medical Social Welfare Funding till January 2014

• This support has been withdrawn• There were 30 patients without any treatment• Of the total patients, we have managed to secure

funding for 12 patients• However there are still many patients without any

access to therapy• We would like to work with Rotary Club Johor to

come up with a way to provide these patients access to treatment

Our Commitment

Public Forum

MS Walk

MS Society Malaysia

MS Awareness Treasure HuntObjective: Increase MS awareness among public and bonding session for MS patients and care giver.

Patient Gathering Objective: reach out patient in East M’sia to show support that they are not alone.

Thank You