Multiple Sclerosis

Photo: Canva

World Brain Day 2021 dedicated to Multiple Sclerosis

Multiple Sclerosis afflicts predominantly young, economically active people, with 32 the average age of diagnosis globally.

Multiple Sclerosis

Photo: Canva

This year World Brain Day on 22 July is dedicated to raising awareness about Multiple Sclerosis (MS), also known as the invisible or silent disease.


Pretoria neurologist Dr. Chris Retief said the disease afflicts predominantly young, economically active people, with 32 the average age of diagnosis globally.

“It is the most important cause of neurological disability in people under the age of 60.”

Retief co-authored the South African guidelines for diagnosis and management of Multiple Sclerosis.

The symptoms of Multiple Sclerosis are not always obvious.

Still, the disease can cut short the life ambitions of young, economically active people.

“However, earlier diagnosis and better access to treatment can offer a better quality of life to those affected by a disease for which there is no cure.”

What is Multiple Sclerosis?

  • Multiple sclerosis is an immune-mediated disease, one of the most common diseases of the brain and spinal cord (central nervous system).
  • It affects more than 2.8 million people of all ages worldwide, approximately 36 in 100 000 people.
  • Although the prevalence of MS in South Africa has not been sufficiently researched, the Multiple Sclerosis World Atlas 2020 estimates it at 8 per 100 000 people.
  • Multiple sclerosis is characterised by inflammation and damage to myelin, the coating that insulates and protects the nerves.
  • This inflammation typically results in episodes of neurological disability (called relapses), including visual loss, incoordination, walking impairment, weakness or paralysis of a limb, loss of sensation, loss of control of the bladder, and impairment of mental functions. Cognitive or mental impairment includes difficulties in thinking, concentration and memory.
  • The inflammation may also be mild but ongoing, resulting in mild unrecognized relapses or silent, gradual deterioration.
  • Multiple Sclerosiss also includes an assortment of “invisible” symptoms, including fatigue, pain, cognitive and emotional issues.
  • The precise trigger of inflammation is unknown, although research implicates abnormal behavior of B-lymphocytes. Epstein Barr Virus (commonly known as the cause of glandular fever), is strongly suspected of triggering the Multiple Sclerosis immune cascade, especially if contracted after childhood.

What is the impact?

Retief further explains: “Relapses are characteristic of the initial or early phase of the disease. Treatment of a relapse consists of high-dose steroids administered through a drip over a few days. Initially, the relapses actually resolve quite well, perhaps giving one a false sense of security that the disease can easily be kept under control with only steroids.”

However, if the disease is not treated more intensively, the abnormal B-cells can become clustered in the brain, resulting in chronic continuous inflammation. This is called secondary progressive Multiple Sclerosis, which leads to progressive disability.

Hence, it is vitally important to attempt to prevent or at least delay this phase of the disease.

“It is important to appreciate the concept of neurological reserve. Children and young people have enormous neurological reserve, and generally recover very well from a neurological insult such as a head injury or a Multiple Sclerosis relapse. Unfortunately, recurrent relapses and silent ongoing inflammation deplete this neurological reserve and leave the patient disabled in middle age when their professional demands and family responsibilities are greatest.
“In short: untreated Multiple Sclerosis makes a patient’s brain grow old a lot faster,” Retief said.

Multiple Sclerosis must be recognized and treated early, even if the person feels well in the beginning, he advised.

What can we do?

Retief said that 25 years ago, there was no treatment for Multiple Sclerosis, and up to 10 years ago only one tier of treatment was available.

“In 2021, fortunately, we have several treatment modalities,” he said.

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The treatments available range from immunomodulators (which change the immune system but are very safe to use), immunosuppressive medications (suppresses the immune system), lymphocyte sequestrators (prevents the abnormal B-lymphocytes from entering the brain), immune reconstitution therapies (resets the immune system for several years) and bone marrow transplantation (the immune system is eradicated, and replaced).

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