Preventing Multiple Sclerosis from progressing to long-term disability

India struggles with a high prevalence of autoimmune diseases that eventually lead to chronic illnesses in approximately 5% to 8% of the country’s total population. Among these, Multiple Sclerosis (MS) is an illness identified by chronic autoimmune activity where the body’s immune system mistakenly attacks the central nervous system’s protective nerve fibres and their surrounding myelin sheath.

Due to intermittent relapses coupled with vague presentations, MS has a high risk of being misdiagnosed, especially at its early stage. Early symptoms such as difficulty in walking, numbness in limbs or blurry vision in one eye, are often attributed to either stress or vitamin deficiency, delaying diagnosis. Diagnosis and management of MS rely heavily on the timely recognition of the patient’s current symptoms. Even mild relapses of MS can cause irreversible nerve damage. If diagnosis and treatment are delayed, the disease can silently progress, which compromises long-term neurological health.

Challenges in India

In India, delayed diagnosis remains an ongoing challenge. Limited awareness, uneven access to neurological care and geographical restrictions contribute to a delayed diagnostic journey for many patients. The Indian Council of Medical Research has set up a National MS Registry, but its on-ground application remains limited. Reported figures likely undervalue the actual number of cases; estimates indicate 7-10 individuals per 1,00,000, meaning there are over 1 lakh patients living with MS in India, of whom only a few are correctly diagnosed.

Eventually, a person who does not receive treatment for relapsing-remitting MS can end up developing secondary progressive MS (SPMS). The attacks on the patient’s own nerves create a cycle that causes neurodegeneration of the patient. A simple feeling of numbness can turn into a permanent disability such as paralysis, blindness, and/or cognitive fog. Modern studies like explain that unchecked relapses leave a trail of microscopic scarring (sclerosis) causing loss of nerve fibre.

Breaking the cycle

However, the progression of the disease (from the beginning of symptoms to a disability) is not a foregone conclusion. With the advancement of modern therapies used to treat MS, this cycle can be broken. This can be accomplished if the diagnosis of MS is made early and proper therapy is used before relapses occur. Therapy will help reduce the number of times a patient relapses during their disease course, and will also slow or stop the accumulation of disability. Patients are encouraged to start taking preventive medication at a point in time that will decrease their chances of reduction in abilities or becoming unable to work.

Advancements in medicine today have allowed for treatment of multiple sclerosis and other autoimmune diseases before any damage has been done to the body’s ability to function. Compared to the old ‘escalation’ approach today’s High-Efficacy Therapies (HETs) have revolutionised care. Patients are now able to reach the stage of ‘No Evidence of Disease Activity’ (NEDA). Globally, a strong shift towards adapting the use of HETs is recognised in the disease course for suitable patients.

It is now up to our medical professionals to educate the general public, identify the symptoms of multiple sclerosis and other autoimmune diseases sooner, make informed decisions about treatment as soon as possible, and encourage members of the community with MS to prevent the impacts of this disease as far as possible. When MS is treated proactively, patients gain the ability to not only manage their condition, but to maintain their goals, jobs, and overall quality of life.

(Dr. Deepak Arjundas is a neurologist at Mercury Hospital, Chennai.deepak.arjundas@gmail.com)