New drugs give real hope to MS sufferers

Multiple sclerosis affects up to 7,000 people in Ireland, many of whom may benefit from new treatments, writes RONAN MCGREEVY

The case of Marie Fleming has focused attention on the condition known as multiple sclerosis (MS).

Ms Fleming (59) is in the advanced stages of the illness and, in court appearances, has given harrowing testimony about the way the disease has devastated her life. Ms Fleming’s desire to be allowed to die by assisted suicide is now the subject of a Supreme Court appeal which will have major implications for euthanasia in Ireland.

When the public thinks of irreversible, chronic conditions that can lead to paralysis, MS is often an illness that comes to mind, but the picture is complicated.

MS is an autoimmune condition where the immune system interacts with the central nervous system. The system works by transmitting electrical signals around the body through axons which is like the copper wiring of a cable. Surrounding that is the insulation called myelin.

If the myelin gets damaged, the nerve signals round the body get damaged. In MS, for reasons that are not clear, the immune system attacks the central nervous system thinking that some of the protein in the myelin are foreign bodies.

“That happens in waves and this results in the neurological disability because the nerve cannot transmit the electrical signal,” explained Prof Orla Hardiman, a consultant neurologist at Beaumont Hospital and the leading authority on the disease in Ireland.

The disease is common in Ireland affecting between 5,000 and 7,000 people, higher than the European average of one in 1,000.

The reasons countries such as Ireland and Scotland have such high rates is not certain, but it may be genetic and/or related to the absence of sunlight and the resulting lack of Vitamin D.

A recent study found significant differences in rates of MS between Donegal and Wexford.

Severity of condition

Prof Hardiman said Ms Fleming would be “quite unusual” in terms of the severity of her condition. She said roughly a third of people with MS have little or no disability, another third have moderate disability and a smaller proportion of the rest have severe disability.

She believes those figures may well be dated as new treatments have come thick and fast in recent years leading to real hope for sufferers.

The conventional treatment is steroids which dampen down the immune system but can also lead to side effects including osteoporosis, diabetes and obesity. They also do not treat the disease itself or halt its progression.

When Prof Hardiman started out in the 1980s there was no disease-modifying treatment for MS, but such treatments have come onstream with increasing rapidity in recent years.

Beta-interferon and Glatiramer acetate are effective in reducing the number of relapses for those with the relapsing-remitting form of the disease, the most common type.

In recent years, a number of other drugs have come on the market. Tysabri, the great hope of the Irish-based pharmaceutical company Elan, was even more effective. Unfortunately, it also led to a condition called PML, a viral infection in the brain. The number of people getting this drug in Ireland has been capped because of the costs.

The latest big development is Gilenya, which is taken in tablet form. It reduces the number of white cells that make the autoimmune response. There are minor side effects.