Multiple sclerosis [MS] is an autoimmune disease in which the body’s immune system attacks the central nervous system. While there is no known medical cure for MS, there are several treatments that can relieve symptoms and slow down the progression of this disease.

Causes and prevalence

Since the discovery of MS in the 19^th century, medical science has come a long way in terms of understanding why the disease occurs, its diagnosis and most importantly, its treatment.

The nerve cells in our brain send messages to the rest of our body. Each of these nerve cells has a protective cover called the myelin sheath. In MS, the body’s immune system attacks this protective covering. This disrupts the communication between the brain and the rest of the body resulting in a wide range of physical, mental, and even psychiatric symptoms.

Until a few decades ago, Indians were thought to be protected from this disorder as compared to their western counterparts. However, as the number and reach of neurologists have increased and with the aid of widespread MRI availability, more and more people with this disorder are now being diagnosed. This has raised the prevalence, especially in the cities, to around 3 – 5 cases per/lakh population. Surprisingly, this is still lower than the prevalence in some areas of northern Europe where almost 100/lakh suffer from this disease.

What is the reason for this selective affliction? This has been a topic of much scientific debate and the focus of several studies. It is now known that the disease is more common in countries farther from the equator. Certain other genetic factors that are beyond the realm of routine clinical testing may also be contributory. Also, MS is known to be more common in women, perhaps because they are more susceptible to autoimmune conditions in general.

Symptoms and diagnosis

The onset of this disease is usually gradual, cryptic and can mimic a host of other ailments, sometimes delaying the diagnosis for years together. Nonspecific symptoms like tiredness, tingling numbness, blurring of vision, giddiness can be challenging to interpret, but more specific symptoms such as the sudden inability to see with one eye, sudden imbalance to one side, paralysis of one side of body, sudden weakness in both legs or urinary bladder symptoms, especially in the age group between 15 – 25 years alerts the neurologist to suspect multiple sclerosis.

Just as with other neurological problems, there is no single ‘test’ to confirm multiple sclerosis; however, with the help of a combination of patient history, clinical exam, MRI imaging and spinal fluid testing, a diagnosis of MS can be reasonably made. Of these tests, MRI is especially important and indispensable to diagnose and quantify MS. Sometimes other eye tests like a VEP [visual evoked potential] study are also required.

After the diagnosis

A diagnosis of MS can be a bolt from the blue for the patient as usually the individual is in the prime of his life and the disease can have immense social, psychological and financial implications. MS doesn’t just affect the individual; it also affects their entire family. A patient usually goes through various stages of denial, anger, depression; but with family support, counselling by the doctor and self resolve, acceptance is possible.

Treatment options and costs

The basic treatment of MS is to prevent relapses or attacks, which if not prevented, can lead to permanent disability over a period of 15 to 20 years and can make the individual wheelchair bound with the need for assistance for day-to-day activities.

The treatment for MS is three pronged: disease modifying treatment, acute attack treatment and supportive treatment. Among these, the most important are medicines known as disease modifying therapies, which are small insulin-like injections taken on a weekly or daily basis for at least a year or two. These injections are patented medicines and the average cost per month is  INR 30,000 – 40,000. The neurologist helps the patient to decide which medicine to choose depending on the side effects, which are usually manageable with simple oral medicines.

In the last decade or so, stronger and apparently more effective disease modifying therapies have been invented, which are reserved for second-line treatment as they are more expensive [approximately INR 80,000 per month] and have potentially more side effects.

Smoking, lack of exercise, vitamin D deficiency and exposure to hot environments is known to increase the risk of a relapse. As the disease affects all the spheres of one’s life—profession, family, even sexual health—depression is common. It is for these unrecognised outcomes of the disease that doctors usually enlist the help of family, friends and self-help groups in maintaining a positive outlook towards the disease.

With the help of the right treatment, regular aerobic exercises, a positive outlook and supportive treatment, the battle against MS can be won and a person with the ailment can lead as normal a life as anybody.

This was first published in the February 2015 issue of Complete Wellbeing.

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What is narcolepsy?

This is chronic sleep disorder and mostly starts around adolescence; however, diagnosis usually happens several years later. Patients often fail to seek medical help even after years of excessive sleepiness, assuming that their sleepiness is not a ‘disease’ per se.

The cause of this condition is not known, though stress and genetics may have a role to play.

What are the common symptoms of narcolepsy?

• People with narcolepsy fall asleep without warning at any point in time. They may sleep for a few minutes or even up to half an hour before they awaken. They often get up feeling refreshed, but soon fall asleep again.
• They may experience decreased alertness throughout the day.
• Cataplexy, which is the sudden loss of muscle tone, is a possible symptom of narcolepsy. Cataplexy is usually brought on by intense positive or negative emotions. This is seen as slurred speech, or drooping of the head or buckling of the knees. However, not everyone with narcolepsy experiences cataplexy.
• People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking. This is known as sleep paralysis. These episodes usually last for one or two minutes and the person may not recall it later. However, many people without narcolepsy experience some episodes of sleep paralysis, especially during young adulthood.
• People with narcolepsy may sometimes also have vivid and frightening hallucinations.

How does one diagnose this condition?

Mentioning frequency of long sleep episodes, usually accompanied by any signs of loss of muscle power can help the diagnosis. A detailed health check-up along with a brain scan may be required to rule out any other possibility.

Narcolepsy is a chronic condition that can be controlled with medication. Support from family, friends, employers and teachers can help you cope with narcolepsy. If you notice that you have been sleeping for longer hours than usual, it should warn you that you could have narcolepsy. People with this condition will not just feel drowsy but will also be unable to keep themselves from falling asleep and will actually sleep for more than 15 – 16 hours.

Certain over-the-counter drugs, such as allergy and cold medications, can cause drowsiness. If you have narcolepsy, your doctor will most likely recommend that you avoid taking these medications.

How does narcolepsy affect a person?

Effect on your professional life: Since not many people know about narcolepsy, the ones suffering from this condition are simply thought to be lazy or unmotivated people. The lack of concentration brought on by this disease actually makes it difficult for people suffering from it to perform well at work or school.

Effect on relationships: The bouts of sleepiness are so strong that the person may even fall asleep during sex. Because intense emotions are a risk factor to bringing on an episode of narcolepsy or cataplexy, it may also lead to sexual dysfunction.

Effect on personal safety: It’s no surprise that people suffering from this condition are at a risk of causing harm to themselves and others, especially if they are driving or using machines or working near fire, sharp instruments and so on.

Effect on weight: People with narcolepsy are twice as likely to be overweight. Due to constant tiredness, the weight gain may be related to inactivity, binge eating, or a combination of factors.

Lifestyle and home remedies

Lifestyle modifications are important to manage the symptoms of narcolepsy. You may benefit from these steps:

• Stick to a schedule: Go to sleep and wake up at the same time every day, including on weekends.
• Take naps: Schedule short naps at regular intervals during the day. Naps of 20 minutes at strategic times during the day may be refreshing and reduce sleepiness for one to three hours. Some people may need longer naps.
• Avoid nicotine and alcohol: Using these substances, especially at night, can worsen your signs and symptoms.
• Get regular exercise: Moderate, regular exercise at least four to five hours before bedtime may help you feel more awake during the day and help you to sleep better at night.

What is the eventual outcome?

The prognosis is variable. Excessive sleepiness is almost always a lifelong problem. In some patients, cataplexy, hallucinations and sleep paralysis become less problematic over time. However, that doesn’t mean that narcolepsy needs to ruin your life. With an early diagnosis, proper medication and guidance you can live a regular life.

This was first published in the July 2014 issue of Complete Wellbeing.

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