Working to stop MS in its tracks

Working to stop MS in its tracks: On World Brain Day (22 July), work continues to diagnose multiple sclerosis (MS) earlier, provide access to life-changing treatments and improve the quality of life for those living with the condition

By Professor Tissa Wijeratne, University of Melbourne and Professor Wolfgang Grisold, World Federation of Neurology

Health, as defined by the World Health Organization, is “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity”.

Our brain health is the key to our overall health – it’s the agent for all human actions and experiences as a species.

And our brains are amazing.

The human brain consists of millions and millions of electrical wires which are known as axons which are covered with myelin that speeds up conduction.

To get an idea of how complex our human neurological system is – the length of these wires is equivalent to travelling around the Earth four times.

It’s thought that there are about eighty billion neurons that make up the human brain. There are then about ten trillion connections between these neurons which help us to read, write, watch, learn, plan, think, feel, move and solve problems on a daily basis.

But, right now, brain health is at a crossroads.

Disorders affecting the health of our brains continue to be the leading cause of disability globally. However, many of these brain disorders can be prevented by modifying our risk factors.

For example, worldwide, around 50 million people have dementia – but nearly 50 per cent of dementia cases can be prevented by taking steps that include maintaining a healthy weight, keeping away from smoking and too much alcohol consumption, as well as learning new hobbies.

If we look at strokes, there are more than 80 million people currently living who have experienced stroke – and around 90 per cent of those strokes could be prevented by addressing just over ten modifiable risk factors that include things like treatment of hypertension, increased physical activity and maintaining a healthy diet.

But there’s a lot to do to achieve these targets and save brains globally. A crucial step in changing these trends is to raise awareness of brain health.

World Brain Day was launched on 22 July 2014 as an annual, global World Federation of Neurology (WFN) advocacy campaign promoting brain health and aims to educate everyone about the importance of keeping their brain healthy.

Every year, we focus on a different area of brain health.

This year, WFN and the Multiple Sclerosis International Federation have teamed up with the aim of stopping multiple sclerosis.

Multiple sclerosis (MS) affects approximately 2.8 million people of all ages globally and someone receives this life-changing diagnosis every five minutes.

It is a debilitating neurological disease that impacts every aspect of a person’s life, with effects ranging from cognitive impairment to significant physical disability.

MS is the most common autoimmune disease affecting the brain, spinal cord and optic nerve. It’s also one of the most common non-traumatic disabling diseases in young adults, with the mean age of diagnosis at 32 years of age.

Over the last 30 years, MS has become a global disease – almost doubling in some regions and forcing some to even think about MS as a pandemic.

And there are different forms of MS. The majority belong to what is known as the relapsing and remitting form (RRMS), but other forms include primary and secondary progressive MS.

While there’s currently no single identified or agreed cause for the development of MS, it’s likely to have an immune-inflammatory basis with a possible genetic predisposition to the condition.

Early diagnosis of MS is critically important.

The primary event in MS is focal inflammatory lesions in the brain (demyelinating events), optic nerves (optic neuritis) and spinal cord (myelitis).

It is well known that MS leads to a progressive loss of axons and neurons culminating in progressive loss of brain volume and memory impairment.

But, in 2021, early diagnosis and early treatment with disease modifying therapies can almost cure this disease.

Disease Modifying Therapy (DMT or disease modifying drugs, DRDs) is a treatment that modifies how MS progresses. Some of the stronger therapies not only delay the progression and disability but can even reverse the disease.

DMTs can be prescribed as subcutaneous injections, intravenous infusions, tablets or a stem cell transplant in a recognised MS centre and work by modifying your immune system.

There are now well over a dozen excellent DMTs available in Australia to treat the relapsing form of MS.

These therapies now have an emerging new goal – to achieve ‘no evidence of disease activity’ (NEDA), which is also also referred to as freedom from disease activity.

And modern therapeutic interventions like this have led to significant reductions in relapses for many people with MS.

However, in the most recent edition of the MS Atlas, which includes data from 115 countries, there are alarming statistics outlining unmet needs, barriers and lack of access to therapeutics in many countries.

This means that nearly 70 per cent of the world struggles to offer early diagnosis and early treatment to millions of patients. While here in Australia we have access to many DMTs, these medications are still unavailable in many parts of the world.

We can stop MS by diagnosing it earlier, providing better access to life-changing treatments, and advocating for improving the quality of life for those living with MS and their caregivers.

And research is key to the success of treating people with MS. The past decades have shown an increase in research and many bench-to-bedside developments, which could and should be implemented into clinics around the world. Not only for the improvement and benefit of the patients, but to also change the concept of therapy radically.

By raising awareness of the treatments available and working with health care professionals around the world to recognise the signs and symptoms of MS, many more people can be diagnosed early and effectively treated.

First published in Pursuit Health and Medicine