Abstract This paper examines eight journalistic articles depicting research and case studies analyzing the epidemiology of Multiple Sclerosis (MS). This in-depth analysis will explain the history and prevalence of the disease, and its impact on our society, along with a critical exploration of primary, secondary and tertiary interventions for MS along with its problematic relations with regard to the Healthy People 2010 objectives. The Epidemiology of Multiple Sclerosis: An in-depth Study Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system which continues to be on the increase throughout the world.
A horrible and unpredictable disorder that can vary in presence from benign to partial disability to completely catastrophic as transmission between the brain and other areas of the body becomes interrupted and confused. With the onset of MS, the body’s own auto-immune system attacks the protective layer of myelin surrounding the spinal cord. Over time, lesions and scar tissue form replacing the myelin layer and thus disrupting the neurological network of nerves that go between the brain and the spinal cord (Lucchinetti et al, 2002).
Over the past 100 years, approximately 300 studies have been conducted on subjects diagnosed with this debilitating disease ranging from prevalence, risk factors, degree of severity, and possible preventions (Kurtske, 2006). This paper will focus on the problems associated with MS beginning with a medical analysis, studying prevalence and incidence, intervention and the diseases’ importance and effect within the health community. Multiple Sclerosis Research Description and Diagnosis.
Multiple sclerosis is an often times disabling disease which attacks the body’s central nervous system which includes the brain, spinal cord, and optic nerves. Symptoms may range from being quite mild with little impact on the physical well-being of the patient to a slight numbness felt in the limbs. Or can be very severe, devastating paralysis and can include a complete loss of sight. The progressive nature, degree of severity, and even the specific symptoms of MS are impossible to predict as they vary from person to person (Williams et al. , 1995).
With MS, the human body’s own defense system attacks the myelin, a fatty substance that surrounds and protects the nerve fibers located throughout the central nervous system. In fact, the nerve fibers themselves can also be damaged by this constant attack. The damaged myelin forms scar tissue, called sclerosis, hence the disease’s name. When any part of the myelin sheath or nerve fiber becomes damaged and/or destroyed, the nerve impulses which travel to and from the brain and the spinal cord are disrupted or obstructed, producing the various occurrences of symptoms (Williams et al. , 1995).
People with MS typically experience one of the four courses of the disease, each one of which might be mild, moderate, or severe. Relapsing-Remitting Multiple Sclerosis (RRMS): persons with this particular type of MS experience sharply defined attacks of worsening neurologic function (Zorton et al. , 2003). These attacks, which can be called relapses, flare-ups, or exacerbations, are usually followed by partial or complete recovery periods called remissions, during which disease progression discontinues. Approximately 85% of people are initially diagnosed with this course of MS (Zorton et al. , 2003).
Primary-Progressive Multiple Sclerosis (PPMS): is a course of the disease characterized by the slowly worsening neurologic function from the very beginning having no real or distinct relapses or remissions (Zorton et al. , 2003). The rate of the disease’s progression may vary over time having an occasional plateau and even temporary, though minor, improvements. Approximately 10% of people are usually diagnosed with this course of Multiple Sclerosis (Zorton et al. , 2003). Secondary-Progressive Multiple Sclerosis (SPMS): this stage of the disease usually develops following an initial occurrence of relapsing-remitting MS (Zorton, et al., 2003).
A secondary-progressive disease course develops in which the disorder steadily worsens, and may be with or without the occasional flare-ups, the minor recoveries, or plateaus (Zorton et al. , 2003). Progressive-Relapsing Multiple Sclerosis (PRMS): a fairly rare stage of MS (5%) where people will experience a steadily worsening disease from the very beginning with clear attacks of worsening neurologic function consistently throughout the entire progression. They may or may not have some recovery following these relapses, but the disease usually continues to progress without any remissions (Zorton et al., 2003).
MS affects those inflicted with the disease for the rest of their life; however it does not appear to decrease their life expectancy. Prevalence and Incidence The global disbursement of Multiple Sclerosis can be sorted into three groups consisting of high, medium, and low frequency (Kurtske, 2006). High frequency areas are those with a prevalence rate of 30 or more per 100,000 people, comprise most all of Europe including Russia, Cyprus, Israel, Canada, and all the 48 contiguous United States, as well as New Zealand and south-eastern Australia (Kurtzke, 2006).
The high frequency groups are bordered by areas of medium frequency having prevalence rates of 5-29 per 100,000 people. These medium frequency groups are inclusive of the majority of Australia, the southern Mediterranean, Russia from the Urals into Siberia, the Ukraine, South Africa, and a large area of the Caribbean and South America (Kurtzke, 2006). All other geographic areas of Asia, Africa, Venezuela and Colombia are the low frequency groups with prevalence rates under 5 per 100,000 people.
Several national surveys in Europe lend evidence to a geographic clustering of MS, being stable over the course of time, but can also be diffused as well (Kurtzke, 2006). This is geographic clustering is also found in the United States. In Multiple Sclerosis, there now appears to be an increasing female preponderance of the disease. The United States has a clear predetermination for Caucasians; however other racial types have a geographic prevalence at comparatively lower levels (Kurtzke, 2006).
An interesting finding has come to light that immigrants from low-level incidents areas who migrate to high-level areas before they reach the age of 15, become as susceptible to MS as those who are native to the high-level area (Multiple Sclerosis: Hope Through Research, n. d. ). Interventions Because of the nature of the disease, MS intervention prior to onset is impossible. In the past, primary, secondary and tertiary interventions involved only passive applications of symptom relief.
Today, aggressive treatments even during periods of remission are the preferred intervention methods being employed (Noseworthy et al, 2000). Global management of RRMS includes treating the underlying disease process, decreasing particular symptoms, managing flairs, and helping the quality of life for both patient and family (2000). Until recently, there were no pharmacologic drugs that were proven to change the underlying pathophysiology of MS.
Fortunately there are now three immunomodulating biologics approved in the U. S. for the treatment of RRMS, as well as a recombinant interferon beta-1a agent (Rebif®) available for use in Europe, Canada, and Australia (Lucchinetti et al, 2002). In addition, mitoxantrone (Novantrone®), an antineoplastic drug, has been the one agent approved by the US Food and Drug Administration for the treatment of progressive MS (2002).
Effects on the Health Community Although MS is not specifically named on the Healthy People 2010 Focus Areas, it is a disease which, due to the prolonged and protracted affliction, has a considerable impact on the Medical Community and Government funds (Healthy People 2010).
Because early and continued intervention is key in controlling the disease, its progression, and the quality of life for both patient and family, all facets of the Medical, Health, and Government communities should work together to continue research, studies, and treatment developments to reduce and eventually prevent the progressive nature of MS. Treating a patient as quickly and aggressively as possible during early detection will greatly lessen the financial burden placed upon these institutions while increasing the overall health of the community. Although MS is not a communicable disease, there are genetic links to its occurrence.
Combine this with its apparent increase in its prevalence, Multiple Sclerosis detection, diagnosis, and intervention should be specifically named as one of the Healthy People 2010 or 2020 Focus Areas. Conclusion Multiple Sclerosis (MS) is a chronic autoimmune disease which attacks the central nervous system through demyelination of the spinal cord. It continues to be on the increase throughout the world and is characterized as an unpredictable disorder that can vary in presence from benign to partial disability to completely catastrophic as transmission between the brain and other areas of the body becomes interrupted and confused.
This paper delved into the problems associated with MS starting with a medical analysis, studying prevalence and incidence, intervention and the diseases’ importance and effect within the health community. Although MS is not a prevalent disease in comparison to cancer or heart disease, it is none the less significant causing catastrophic and debilitating symptoms that can lead to astronomical medical costs to the individual, the community, and the nation as a whole.
The reason for these costs are that although the disease is chronic, it does not affect the life expectancy of those afflicted and thus the annual costs to the United States runs in the billions of dollars. More research into pharmaceutical drug therapies that slow down or place the affected individual’s auto-immune system into remission are needed in order to ease the symptoms of MS and thus reduce the overall costs associated with fighting the flares and out-breaks of the disease.
References Healthy People 2010. Objectives and Goals. (2005).
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