The Current Position

Multiple Sclerosis is the most common of the neurological disabilities, striking about 160 in every 100,000, and it has a high impact on those affected with a long progress from diagnosis in early adulthood often leading to loss of ability to work and earn an income and ultimately serious disability several decades later. We can recognise it, and to some extent relieve the symptoms and perhaps slow the progress, but we otherwise do not know what causes it, we do not know the mechanism that leads to inflammation and damage in the nervous system and for any individual we cannot predict the progress of the disease, of how relapses will affect the patient, because the episodes of inflammation can crop up anywhere in the nervous system.

There are many puzzles. Twin studies show that there are genetic factors contributing to the likelihood of MS, but that is not the whole story because only a few twins of sufferers progress to MS themselves. Furthermore, there are multiple genetic markers associated with MS: no single gene is predictive. It is an autoimmune disease and MS sufferers are more likely than average to have other autoimmune diseases and vice versa. Presumably there are environmental triggers, but we do not know what they are - though smoking appears to impair the immune system and raise the risk of contracting MS. Recent research also suggests that gut microbiomes may have some influence - but it is too early to be sure how this will develop. For some reason it is also more common in females than males and also among those living in high latitudes - perhaps there is a connection with vitamin D levels?

The Future

In spite of our lack of understanding of causes and mechanisms, there has been steady progress on treating symptoms, mainly through improvements in anti-inflammatory drugs, which can reduce the rate at which permanent damage occurs in the nervous system. Unfortunately, the more effective drugs also have the most serious side effects (such as immunological suppression raising the risk of other infections - and even cancer). Doctors and patients therefore still have difficult choices to make: does one go for the more aggressive treatment as early as possible, hoping to stave off the progressive phase of the disease for as long as possible (accepting the risks) or start with gentler and safer treatments, reserving the more effective but riskier drugs for a time when the disease gets worse?

Dr Harding provided us with a fascinating and information packed lecture, and the audience showed their involvement with the topic through many interesting questions.

Date: Wednesday, 13 Nov 2019
Dr Katharine Harding
Royal Gwent Hospital
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