Whenever we make the diagnosis multiple sclerosis (MS) for patients in our wards or clinic, there is often a sense of helplessness not just for the patient, but for the doctors too. Besides having to face the reality of being diagnosed with a chronic illness with limited treatment options, there is the added burden of affordability of treatment. The current treatments that are available in Singapore, Rebif (Interferon beta-1a), Betaferon (Interferon-1b), Copaxone (Glatiramer Acetate) and Mitoxantrone are expensive and are only partially effective and in some cases have significant side effects. Some common questions from patients in the clinic include, “Are there any new treatments for MS?” and “When will I be able to stop injecting myself and take tablets instead?”

What is Multiple Sclerosis?

Multiple Sclerosis is a chronic inflammatory condition of the central nervous system, often affecting young people, causing significant morbidity. While less common in tropical countries such as Singapore and other parts of Asia compared to countries in the West, it is a significant burden for patients who suffer from it. Worldwide, Multiple Sclerosis is thought to affect more than 2.5 million people. In eastern Asia (China, Hong Kong, Taiwan, Singapore, Thailand, Korea and Malaysia), the MS prevalence is estimated to be between 0.8 and 2 cases per 100 000. Hence we estimate that there are around 100 diagnosed cases in Singapore. Transverse myelitis (TM) is a parainfectious disorder which may be idiopathic or related to autoimmune conditions such as Multiple Scheloris or other immunological diseases.

There is currently no cure for Multiple Sclerosis. The strategies that are available modify the disease course, treat exacerbations (also called attacks, relapses, or flare-ups) and manage symptoms. There are presently 6 US Food and Drug Administration (FDA) approved disease-modifying therapies for Multiple Sclerosis. Thankfully for our patients there is a great deal of research on the therapeutic approaches being tested for Multiple Sclerosis. Of the
immunomodulatory agents which have shown promise, there are 4 monoclonal antibodies and 5 oral agents that are in the late phases of trials.

Symptoms of Multiple Sclerosis

Symptoms of Multiple Sclerosis are highly variable from person to person and from time to time in the same individual. While symptoms can range from mild to severe, most can be successfully managed with strategies that include medication, self-care techniques, rehabilitation (with a physio or occupation therapist, speech therapist, cognitive behavioural therapist, among others), and the use of assistive devices.

The National Neuroscience Institute (NNI) works closely with various medical and surgical departments and allied healthcare professionals to provide multidisciplinary care for our patients.

Cause and Risk Factors

Multiple Sclerosis is caused by an autoimmune reaction in which the body attacks the nerve tissues by mistake. Currently, the cause of Multiple Sclerosis is unknown and there is no way of predicting who might get it. Some of the risk factors that lead to someone developing Multiple Sclerosis are listed below. It is likely that a combination of genetic and environmental factors contributes to the development of Multiple Sclerosis.

Genetic Factors
Some people carry genes that make them more usceptible to Multiple Sclerosis. These could be genes that regulate immune reactions or genes that are responsible for producing components of the central nervous system.

Environmental Triggers
There may be environmental factors that trigger Multiple Sclerosis. Studies show that Multiple Sclerosis is more common in certain parts of the world. But if you move from an area with higher risk to one of lower risk, you acquire the risk of your new home if the move occurs prior to adolescence. Such data suggest that exposure to
some environmental agent encountered before puberty may predispose a person to Multiple Sclerosis.

Diagnosis

Diagnosing Multiple Sclerosis can be difficult. There is no single test to make the diagnosis of Multiple Sclerosis. The disease is diagnosed with a combination of the clinical features and diagnostic tests which may include:

• MRI scan of the brain and spinal cord
• Lumbar puncture for cerebrospinal fluid analysis
• Evoked potentials – electrical tests of conduction along a person’s nerve pathways
• Blood tests to rule out other conditions that masquerade as Multiple Sclerosis 

Multiple Sclerosis Support Group : MS CARE

For patients living with a chronic illness such as Multiple Sclerosis, it is useful to have a support network where fellow patients and care-givers may provide each other with various types of help. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others’ experiences, providing sympathetic understanding and establishing social networks. A support group also works to inform the public or engage in advocacy.

MS Care was set up in 2003 to play such a role. Some of the services provided include, a 24-hour Care-Line, arranging chaperons for hospital visits and check-ups, healthcare services at the patient’s home and regular
visits to patients and their families. MS Care is a result of dedicated work from a small group of volunteers led by Mr Derek Dunn and Ms Amelia Mok.

Since its inception, MS Care has organised both social activities where Multiple Sclerosis patients, families and volunteers gather for fun and celebration, as well as sessions to provide practical care services to help people living with MS continue to have a better quality of life. At present, MS Care is actively serving 65 patients with the help of approximately 30 volunteers.

For patients who are interested in joining the support group and volunteers keen to help, they may contact Ms Amelia Mok at info@chcsa.org.sg or 6835 9916.