An Epidemiological Review of Multiple Sclerosis - Coursework Example

An Epidemiological Review of Multiple Sclerosis Introduction In 1886 a French neurologist, Jean Martin described Multiple Sclerosis as a disease characterized by the accumulation of inflammatory cells distributed within the brain and the white matter of the spinal cord leading to episodes of neurological dysfunction. Further developments in research have substantiated the fact that the disease is caused by inflammation of nerves which erodes the myelin sheath, making it difficult for the transmission of nervous impulses. It is thought that the inflammation observed in MS is as a result of autoimmune response but no single microbial agent has been isolated further supporting the notion that the disease is not caused by pathogens. MS just like other autoimmune diseases show high prevalence in females than in males. During the earlier stages, MS can be described as either relapsing remitting or primary progressive MS. Relapsing remitting MS is observed in 80% of the patients and is characterized by the gradual development of symptoms or attacks for several hours or days after which the symptoms slowly dissipate. Primary progressive MS is on the other hand characterized by the relatively slow developments of the symptoms. The relapses are caused by the movement of myelin reactive T cells towards the site of infection causing inflammation and subsequent oedema in the affected region. Treatment of MS involves the use of immunosuppressive drugs for instance Mitoxantrone, Cyclophosphamide and a MHC binding protein involving the T cell receptor, glatiramer acetate. MS (Hafler, D. 2003). Epidemiology just as biochemical research has been materialistic in demystifying various aspects, trends, geographical distribution and prevalence of Multiple Sclerosis. Epidemiology simply combines the natural history of a disease, concentrating on the already available data to make calculated conclusions that can help to predict the future trends of the particular disease. Furthermore epidemiology helps in an analytical and in depth description of a disease. Epidemiology has introduced new dimensions to the study of Multiple Sclerosis, making use of aspects such as frequency of the disease which is the number of cases reported per given population. The number of new incidences reported and deaths that occur as a result of Multiple Sclerosis calculated per unit time, are also tools used by epidemiologists. These geographical distributions have been fundamental in the description of Multiple Sclerosis since they have opened doors for other empirical scientific research and comparison in terms of climate and other environmental factors. For instance research in the United States has established that female prevalence of the disease is increasing and American whites are showing higher disease prevalence. Epidemiological Review Diagnosis of Multiple Sclerosis has presented a challenge to both medical practitioners and researchers. For instance, currently there is no universal criterion for diagnosis of the disease; this is because the disease takes time in some individuals to present the symptoms. The symptoms are sometimes not exclusive to the disease. A proposed methodology that utilizes Nuclear Magnetic Resonance (NMR), which identifies lesions on the Central Nervous System (CNS) characteristic of individuals with Multiple Sclerosis, has been too generalized because individuals without the disease have also presented the same symptoms, however NMR has been materialistic in monitoring the developments of the disease. Studies carried out in the UK show the existence of a gradient in relation to the northern and the southern hemisphere. This approach has supported the assumption that the prevalence of Multiple Sclerosis increases as one move away from the equator. The results were further substantiated by a research conducted in 1950 at Limburg, United Kingdom which also showed that the prevalence of MS rose with increasing distance away from the equator. (Ford, L. Gerry, E. Airey, M. Johnson, H. Williams, D. 2009). This notion has been supported by many researchers. In the same context research has also realized that the prevalence of Multiple Sclerosis also show some racial inclination. This was established after a study in South Africa established that the number of cases observed were mostly concentrated on the immigrants rather than on the natives. (Rhys, W., Rigby, A. Airey. M. Robinson, M. Ford, H. 2009). The racial perspective has also been used to describe the disease. In other instances research has established that Multiple Sclerosis is much more vigour in individuals within the same lineage. MS has also shown increase in risk factor in relation to genetic predisposition. MS and other related autoimmune diseases have shown significant relation to a particular set of genes. The association has been observed in individuals within the same familial origin with MS, Hashimoto’s thyroiditis, Crohn’Vitiligo and diabetes mellitus. This trend was realized after a French study involving 357 consecutive patients was conducted. (Zorzon, M. Zivadinov, R. Nasuelli, D. Dolfini, P. Bosco, A. Bratina, A. Tomassi, A. Locatelli, A. Gazzatto, G. 2003). Attempts to describe the ever elusive etiology of MS have also been significant especially when concentrating on the risk factors involved. MS is an autoimmune disease that affects the most basic component of Central Nervous System (CNS). The disease triggers the immune system to destroy the myelin sheath which plays a significant role in the transmission of nervous impulses from one neuron to the other. The CNS largely depends on control and coordination, and in the instance that it is compromised, a significant amount of cognitive aspects are also compromised. There is a significant achievement in the epidemiological study of Multiple Sclerosis in that its distribution within populations is properly defined. As explained earlier the distribution of the disease can be defined in various perspectives, this includes the geographical distribution, the racial distribution and the gender distribution. In terms of geographical distribution, it has been established that the prevalence of Multiple Sclerosis increases away from the Equator. One of the most studied aspects of Multiple Sclerosis is the geographical distribution, studied as a function of prevalence and in which there are over 300 recorded results. The results have been extensively used to describe the disease. For instance the global description has led to three distribution zones of high, medium and low frequency. The high frequency areas include regions with the rates of prevalence exceeding 30 for a population of 100,000. High frequency regions have been found to cover a significantly large part of Europe, The United Sates, New Zealand and part of Australia. Areas of medium frequency are the regions whose prevalence range from 5 to 29 cases for a population of 100,000. The areas include South Africa and South America, large part of Australia, the Caribbean Islands and the southern part of the Mediterranean basin. The rest of the world which includes other parts of Africa and Asia fall under the low frequency regions. The discoveries were made after an analytical study of the geographical distribution. Migration trends have also been relevant in studying of the distribution of multiple Sclerosis. Research on migrants has established that the age of adolescent is important for retention of the disease. For individuals above the age of 15 there is a significant retention of the risk of developing Multiple Sclerosis (MS) of their birth place. However for the individuals who migrate at an age below 15, it is observed that they acquire to a lower degree the risks of their new homes. The same trend was also observed in South Africa, taking into account the age factor, where it was realized that individuals who migrated at an age lower than 15 had lower risk of MS as compared to individuals who migrated at an age of 16 and above. . (Williams, R. Rigby, S. Airey, M. Robinson, M and Ford, H. (2009). There exists another aspect of this trend which applies to those who migrate from low frequency regions to high frequency regions. Research has established that for those individuals who migrate from low frequency to high frequency regions, in fact increase their risks of developing the disease, irrespective of whether they migrated at childhood or during adolescent. Research reveals that in some instances the prevalence of MS of migrants might even surpass the one of natives. From the findings a conclusion was therefore arrived at that the risk of developing MS ranged from the age of 11 years to the age of 40 years. The evidence so far collected suggests that MS is mostly acquired at the early adolescent age characterized by various phases occurring between the onset of the disease and the onset of the symptoms. Young children are rarely at risk. Although the actual causes of MS still remain unknown, studies have shown that environmental factors play a significant role. Published evidence implies that the probability of monozygotic twins of developing MS ranges from 25% to 30% as compared to 2% to 5% in dizygotic twins. Migrant studies in South Africa also indicate that MS is mostly prevalent in immigrant with low cases being reported in natives from diverse races. However the research did not consider other factors such as the ease with which individuals could access health care services and if his could be a contributing factor. The research took into consideration factors such as age and realized that the estimated prevalence for English speaking individuals born in South Africa were much higher than those individuals who spoke Afrikaans. This data indicated that there existed a decreasing risk of MS in relation to increasing family distance. (Williams, R. Rigby, S. Airey, M. Robinson, M and Ford, H. (2009). A conclusion can therefore be arrived at MS is caused by a combination of genetic and environmental factors. The studied non genetic factors indicate that exposure to other related infections, physical and chemical agents, vaccinations, hormonal factors, nutritional habits, physical trauma, and psychological stress are the most probable aspects that may lead to MS. Further research on the genetic factors imply that MS is not caused by abnormalities in a single set of genes, but by a number of genes, this shows that MS is a polygenic disease. Therefore MS can be described as an autoimmune disease triggered when one is exposed to one or more of the mentioned environmental factors that is why the distribution of the disease can be described geographically. (Zorzon, M. Zivadinov, R. Nasuelli, D. Dolfini, P. Bosco, A. Bratina, A. Tomassi, A. Locatelli, A. Gazzatto, G. 2003). Although studies indicate that the prevalence of MS has significantly increases over time, it can also be argued that it is as a result of the studies conducted which have made the medical fraternity more conscious of the disease. Factors such as migration and climate changes have also contributed to the increasingly number of cases observed. For instance, a research conducted in Faroe Island established that up to 1999 there had been 55 cases of MS reported involving the natives. These cases were observed during subsequent epidemics occurring at an interval of 13 years with the first case being observed in 1943. It was therefore concluded that the epidemics could have been as a result of British troops who occupied the island for five years from 1940 because most of the cases occurred in the regions where the troops were stationed. (Kurtzke, J. 2008). Currently, the available treatment concentrates on alleviating the trauma associated with the symptoms as well as attempting to reverse the damages caused to the nerves by MS. In the United it is estimated that about 250,000 to 350,000 people suffer from MS. This factor places a great burden not only on the health care system but also to families and caregivers as 50% of the patients may need assistance in walking within fifteen years after diagnosis of the disease. Currently there are therapies developed to alleviate the symptoms of the disease on the short term. Long term benefits have however not been determined. The diagnosis of MS has been rather elusive; however various reliable methodologies have been developed. In the case of relapsing remitting MS which affects 80% of the patients, the signs and symptoms recur over a period of several days before stabilizing and improving in response to corticosteroids within weeks. Relapsing remitting MS usually begins at the age of 20 to 30 and has been found to be predominant in females. The risk factors involved include: sensory disturbances, unilateral optic neuritis, internuclear ophthalmoplegia, gait ataxia and neurogenic bladder and bowel symptoms among others. The symptoms greatly impair the patients both physically and emotionally making them partly or completely dependent. (Noseworthy, J. Lucchinetti, C. Rodriguez, H. Weinshekner, B. 2000). A research conducted to determine the quality of life (QOL) established that MS not only presents a burden to the patients themselves, but also to caregiver. This is because most of the patients become severely physically and cognitively impaired. The QOL of the caregiver was shown to reduce especially in countries in Europe and North America where the prevalence of the disease was higher. The conclusion therefore is that there is a strong relationship between the risk factors of MS and the health problems observed. The research realized that caregivers should be given special attention considering that they spend most of the time caring for the patience of the disease which mostly occurs for long duration of time. (Alshubaili, A. Ohaeri, J. Awadalla, A. Mabrouk, A. 2008). There are however factors that significantly prevent patients from experiencing the problems. The use of therapy has been known to alleviate the symptoms for instance the use of corticosteroids speeds up recovery from the relapses, but the effectiveness of the corticosteroids reduces with time. (Noseworthy, J. Lucchinetti, C. Rodriguez, H. Weinshekner, B. 2000). Accessibility to proper health care greatly reduces the health problems associated with MS. Environmental factors which play a significant role in the prevalence of MS relative to the equator also reduces the severity of the symptoms. The relationship between the risk factors involved and the health problems experienced show the same trend as the prevalence of the disease. Many studies have been conducted in an attempt to describe MS. The use of advanced magnetic resonance imaging (MRI) has been materialistic in studying the progress of the disease and in keeping track of the patient’s response to treatment. Advanced MRI has helped in proper and early diagnosis of the disease and in developing treatment for the disease. The research on the QOL of caregivers established that they need special attention in terms of training because of the sensitivity and the weight of the conditions they deal in. The research proposed that caregivers should be accorded specialized psychological programme to ensure that they subsequently improve the QOL of patients. Before the discovery of Interferon there was no single therapy for tackling MS particularly in reducing the activity of the disease. However the cost effectiveness of interferon in term of the economic pressure threatened to disable the use of the drug. A study on the geographical distribution conducted has also led to interesting discoveries in terms of the genetic, gender and racial differences observed in the prevalence of MS. For instance the knowledge that the prevalence of the disease increases as one moves away from the equator led to further research that established that there is a correlation existing between vitamin D got from the sun and the prevalence of the disease. Familial studies have also established that the genetic factors are significant in the prevalence of the disease. A conclusion was therefore arrived at that MS is caused by a combination of genetic and environmental factors. Genetic studies have also established that the genetic causes are not restricted to a single set of genes but are caused by a combination of abnormalities present in a number of genes. Discussion Although MS is a relatively common ailment among the middle aged causing significant degree of disability the research by the health care fraternities is not sufficient. The quality of health and social care should be able to address some important factors. According to a journal on MS the questions that should be answered by health care and social care include: the aims of the care provided, circumstances under which the intervention of a specialist should be sought for instance a neurologist, the extent to which the current patterns in health care meets the needs of the patients and how the effectiveness of the current system can be measured and improved. The concentration so far has been on ensuring that the caregivers reduce the severity of the symptoms of MS and ensuring that the self esteem and regard of the patients is upheld. (Ford, L. Gerry, E. Airey, M. Johnson, H. Williams, D. 2009). Additional studies needed to address the health problems associated with MS is in determining the actual environmental and genetic agents and factors that cause the disease. This will help the health care system and researchers to come up with efficient and effective treatment procedure for the disease. As proposed by the research on the QOL of caregivers, it is imperative that the caregivers be accorded specialized training to equip them with the necessary expertise which will enable them to improve the quality of life of patients. References Alshubaili, A. Ohaeri, J. Awadalla, A. Mabrouk, A. (2008), Biomed Central, Family Caregiver Quality of Life in Multiple Sclerosis among Kuwaitis. A Controlled Study. Retrieved on 13th July 2009 from www.biomedcentral.com. Bager, P. Nielsen, N. Bihrmann, K. Frisch, M. Wohlfart, J. (2006), American Journal of Epidemology, Sibship Characteristic and Risk o Multiple Sclerosis: A Nationwide Cohort Study in Denmark. Ford, L. Gerry, E. Airey, M. Johnson, H. Williams, D.( 2009), J. Neurol. Neurosurg, The Prevalence of Multiple Sclerosis in the Leeds Health Authority. Retrieved on 13th July 2009 from www. www.jnnp..bmj.com. Ford, L. Gerry, E. Airey, M. Johnson, H. Williams, D. (2009), J Epidemiol Community Health, Multiple Sclerosis: Its Epidemiological, Health Care and Social Impact. Retrieved on 13th July 2009 from www.jech.bmj.com. Hafler, D. (2003), The Journal of Clinical Information, Multiple Sclerosis. Retrieved on 13th July, 2009 from www.jci.org. Kurtzke, J. (2008), Epidemology and Multiple Sclerosis, A Personal Review. Noseworthy, J. Lucchinetti, C. Rodriguez, H. Weinshekner, B.( 2000), The New England Journal of Medicine, Multiple Sclerosis. Retrieved on 12th of July from www.nejm.org. Parkin, D. Jacoby, A. McNamee, P. Miller, P. Thomas, S. Bates, D. (2000), Treatment of Multiple Sclerosis with Interferon- Beta: An Appraisal on Cost- Effectiveness and Quality of Life. JMS Pearce, New York. Rothwell, P. Charlton, D. (2009), J. Neurol. Neurosurg. Psychiatry, High Incidence and Prevalence of Multiple Sclerosis in South East Scotland: Evidence of a Genetic Predisposition. Retrieved on 14th July 2009 from www.jnnp..bmj.com. Zorzon, M. Zivadinov, R. Nasuelli, D. Dolfini, P. Bosco, A. Bratina, A. Tomassi, A. Locatelli, A. Gazzatto, G. (2003), Risk Factors of Multiple Sclerosis: A Case Control Study, University of Trieste. Read More