Evolving landscape of multiple sclerosis in India: Challenges in the management

Abstract

Multiple sclerosis (MS) is a chronic neurological disease which often leads to disability. The complex etiology and progressive nature pose challenges in the management of patients with MS, particularly in developing countries like India. Lack of data on prevalence further complicates estimation of the magnitude of MS in India. There are various other challenges associated with management of patients with MS due to which the therapy is utilized by only a small segment of population in India. This article encapsulates the gaps and challenges in the management of patients with MS and presents suggestions and recommendations of the members of advisory boards held to discuss these challenges. The advisory board members suggested that an early diagnosis of MS and an early initiation of treatment are essential to achieve better results for tackling MS-related challenges. In addition, awareness and education about MS among people, regular training to physicians, emphasis on the use of revised 2010 McDonald criteria, and utilization of advanced diagnostic modalities in magnetic resonance imaging would help to achieve desirable as well as effective therapeutic outcomes. Further, access to an easy-to-use therapy delivery system could also be beneficial in attaining an adequate treatment adherence and related health benefits.

Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges

“…An early MS diagnosis may significantly improve long-term patient outcomes. Early MS diagnosis and therapy are critical for minimizing disability and maintaining general health in patients [ 3 ]. In the last 20 years, there has been a deliberate effort to update and improve diagnostic criteria to be employed more quickly [ 88 ].…”

“…MS is difficult to diagnose since its subtypes, pseudo-relapses, and clinical presentation vary immensely among patients [ 96 ]. Neuromyelitis optica (NMO), a kind of MSinvolving the spinal cord and optic nerve demyelination, is a severe disease affecting people worldwide, including India [ 3 ]. The McDonald’s criteria are also used to define PPMS.…”

“…It is the most common cause of non-traumatic neurological disability in children and adolescents. This motor neuron disease is most commonly diagnosed between the ages of 20 and 40, with women being diagnosed three times more frequently than men [ 2 , 3 , 4 ].…”

The Clinical Spectrum of Multiple Sclerosis in a Tertiary Care Hospital

“…Few MS studies have been performed in some parts of India [2][3][4]. Recent studies [5][6][7][8] conducted in India have demonstrated increased MS prevalence across different Indian states owing to the growth of neurology as a subspecialty and the availability of modern diagnostic tools such as magnetic resonance imaging (MRI). This finding agrees with the 2013 Atlas of MS provided by the World Health Organization (WHO) and the Multiple Sclerosis International Federation.…”