World Multiple Sclerosis Day on May 27 :

MS, the mystery disease can strike early

By Nilma DOLE

I first heard about Multiple Sclerosis (MS) when a close friend told me that her sister died after a long battle with the disease. It came as a complete surprise because her sister was an able-bodied individual, the life of the party and there were no hereditary factors which were known that really answered the question as to how she contracted the disease.

Dr. Hithaishi Weerakoon

This made me realise how fragile life is and how we shouldn't ignore early warning symptoms because even though the exact cause for MS is not fully understood, it is important to seek help soon.

Also known as Demyelinating disease, Multiple Sclerosis is an illness that affects the brain and spinal cord, hampering the immune system.

The disease is more prevalent among women than men where those in the 30 to 40 age group are seen to be stricken with MS.

However, in the Western world, there are patients in their 20s who have been affected. Even though it is not hereditary, if you have an MS patient in the family, it might be worrying but it's best to check you and your relatives every six months to be on the safe side.

The problem is that research is going on about what causes MS and how it can be brought on. Most doctors cannot determine why a perfectly normal person could go from a healthy individual to a MS patient.

In medical terms, MS is caused when the myelin sheath which is the protective covering that surrounds nerve cells is damaged making the nerve signals slow or stop. This type of nerve damage is caused by inflammation which happens when the body's own immune cells attack the nervous system. The problem is that it can spread from the brain to the optic nerve, affecting the spinal cord.

Some experts say that environmental factors can cause it but the most common thought is that a virus or gene defect, or both, are to blame but this is not the exact reason. Symptoms vary from on patient to patient as the gravity of the illness including the severity of each attack can be different.

Episodes can last for days, weeks, or months and they cross with periods of reduced or no symptoms (remissions).

If you have a recurring fever, take frequent hot baths, sun exposure, and stress, you will be prone to, can trigger or worsen attacks and it is common for the disease to return (relapse). In some patients, it might be a fatal accident or a calamity that would make them go and check their medical condition and more often than not, it becomes too late. Fatigue is a common and bothersome symptoms as MS progresses where it is often worse in the late afternoon.

Since nerves in any region of the brain or spinal cord may be at risk, patients with Multiple Sclerosis can have symptoms in many parts of the body. The muscle symptoms include loss of balance, muscle spasms, numbness, mobility problems, coordination problems and trembling or tremors in the legs.

When it comes to bladder and sexual problems, constipation and stool leakage can occur at different intervals. When it affects the eyes, the patient can see anything from double vision to having eye discomfort, uncontrollable rapid eye movements and vision loss.

Other symptoms include lack of attention, memory loss, poor judgement, reasoning problems, depression, dizziness and balance problems. The problem in checking if a patient has MS is the fact that it can be similar to symptoms as other nervous diseases but more checks are needed to rule out if a patient has the disease.

In checking if a patient has MS, an eye examination is done to check any defects, a Lumbar puncture (spinal tap) for cerebrospinal fluid tests, an MRI scan of the brain and a Nerve function study (evoked potential test).

Unfortunately, there is no treatment for the condition but therapy and physiotherapy have been shown to reduce the onset of the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

There are a number of medications that are used to treat any of the MS symptoms but they are expensive and have to be taken during the course of the patient's life.

In Sri Lanka, the Multiple Sclerosis Association of Lanka was set up in 2006. It is affiliated to the Multiple Sclerosis International Federation (MSIF). Philanthropists and donors help steer the cause of curing multiple sclerosis forward with a goal to help all MS patients and their families.

Speaking to the Sunday Observer was MSAL’s Founder President, Dr. Hithaishi Weerakoon who was an MS patient herself. She first noticed symptoms of MS when she was 24. Her right leg and face felt numb, as though she was ‘paralysed'. Having being diagnosed as a MS patient at 34, Dr. Weerakoon said, “I strongly feel that stress was a contributory factor to my MS condition.” She said that it is a social stigma in Sri Lanka to admit that they have MS, for it is seen as something that is like bad karma. “I feel that at present, there are 85 registered MS patients in Sri Lanka but Dr. Weerakoon puts the statistics at a higher number as most of the patients do not know that they have MS or they do not report. Dr. Weerakoon said, “Relatives of MS patients and the patients themselves shouldn't be ashamed to admit that they have the condition and seek help.

There is help available but people don't use it preferring to accept fate and die an early death.” She said, “As a patient myself, I ask people to be more open-minded, speak about the disease, have a forum, share their stories with others and help others like them take control of their situation.”

Treatment is available in Sri Lanka that includes the disease-modifying drug Interferon and steroids for relapses but again both are highly expensive.

“The Health Ministry has promised to help MS patients by bringing the same quality drugs at a reasonable cost but the burden of the expense of the drugs has been difficult to bear,” said the doctor. She said that they depend on the generosity of donors to help steer forward the cause of helping MS patients because this is a condition that is predicted to affect more people in the future as a result of leading busy lifestyles.

In Sri Lanka, reflexology, yoga, Feng Shui, Tai Chi, massage and meditation, or a combination of such therapies, under medical supervision have shown some benefits that could prevent permanent disability.

This year, MS day in Sri Lanka will be held with a special event at the Baptist Church, Colombo 7 starting at 9 am.

“We are having the Colombo event on June 2 and the Kandy event on June 16 so we welcome people to attend the MS day activities to understand more about the disease,” said Dr. Weerakoon.

Besides commemorating the MS day, there are bi-monthly programs held at the MASL office at 144, Vipulasena Mawatha, Colombo 10 with talks by neurologists too.

Discussions with physiotherapists and other service providers, are very helpful to people with MS symptoms. Patients are given an opportunity to talk about their problems and share their feelings and experiences and more information and research on MS is given.

Wherever possible, assistance is provided for the purchase of drugs and needed equipment. Dr. Weerakoon said, “We want people with MS to get the most out of life and hold their heads up high with dignity. ”

References courtesy Multiple Sclerosis Association of Lanka

Look away to avoid pain during an injection

Health professionals commonly say, “Don't look and it won't hurt” before administering an injection, but is there any scientific basis for the advice? A group of German investigators has found that, in fact, your past experience with needle pricks, along with information you receive before an injection, shape your pain experience. Their research is published in the May issue of Pain.

“Throughout our lives, we repeatedly experience that needles cause pain when pricking our skin, but situational expectations, like information given by the clinician prior to an injection, may also influence how viewing needle pricks affects pain,” says Marion Höfle, a doctoral student in the research Multisensory Integration group.

While watching video clips showing a needle pricking a hand, a Q-tip touching the hand, or a hand alone, study participants concurrently received painful or non-painful electrical stimuli applied to their own hand. The clips were presented on a screen located above the participants’ hand, giving the impression that the hand on the screen belonged to them.

Participants reported that their pain was more intense and unpleasant when they viewed a needle pricking a hand than when they saw a hand alone. In addition, observing needle pricks increased the unpleasantness of pain compared to viewing Q-tip touches. The findings were paralleled by enhanced activity of the autonomic nervous system, as measured by pupil dilation responses. This demonstrates that previous painful experiences with needles enhance unpleasantness of pain when viewing needle pricks.

Situational expectations also influenced perceived pain intensity. Prior to the stimulation, participants were told that either the needle or the Q-tip clip was more likely to be associated with painful than with non-painful electrical stimulation.

The researchers found that presentation of clips that were more likely to be associated with pain lead to higher pain intensity experiences than the presentation of clips that were less likely to be associated with pain. This shows that expectations regarding the painfulness of medical treatment influence the intensity of pain that the treatment ultimately produces. Taken together, the study reveals several important findings. “Clinicians may be advised to provide information that reduces a patient's expectation about the strength of forthcoming pain prior to an injection,” Höfle notes. She said that, “because viewing a needle prick leads to enhanced pain perception as well as to enhanced autonomic nervous system activity, we've provided empirical evidence in favour of the common advice not to look at the needle prick when receiving an injection.”

- MNT

Viruses and bacteria cause 16 p.c. of cancers

Strictly speaking, cancer is not contagious. But a fair number of cancers is clearly caused by viral or bacterial infections: lymphomas can be triggered by the Epstein-Barr virus, which also causes mononucleosis. 

Liver cancers can be caused by Hepatitis B and C. Cervical cancers can be caused by human papillomavirus, the major reason behind the development of a vaccine against it.

For some of these cancers, nearly 100 p.c. of the cases have an infectious link - when researchers check to see if a virus or bacterium is working in the tumor or has left signs of its presence in a patient’s blood, the answer is nearly always yes.

A new paper in The Lancet takes a look at the very best data on the prevalence of infection-caused cancers and comes up with some striking numbers.

Overall, they estimate that 16 p.c. of cancer cases worldwide in 2008 had an infectious cause - two million out of 12.7 million.

Hepatitis B and C, HPV, and Helicobacter pylori, a bacterium that triggers stomach cancer, caused the lion’s share of those cases, about 1.9 million together. Eighty percent of all infection-caused cancers were in less developed regions, where vaccines and treatment for these infections may be harder to come by, and sometimes the numbers are shocking: in China, more than a quarter of cancer cases were infectious in origin. But still, a decent fraction were in the developed world, indicating that the problem hasn’t disappeared with current advances.

And because this paper only looked infectious agents that are clearly carcinogenic, avoiding those there isn’t much data on, two million cases total is probably something of an underestimate.

How many deaths from cancer are caused by these infections? The researchers didn’t have the data to answer that question rigorously, but they point out that most of the infection-caused cancers are pretty lethal.

They make a rough extrapolation from their data and estimate that of the 7.5 million deaths from cancer in 2008, 1.5 million, or about one in five, were caused by an infection.

That’s a lot of deaths from preventable causes. It argues for more work on getting existing vaccines to the populations that need them and continuing research and education on vaccines in places where they’re readily available.

- Discover magazine

How microbes and plants can prevent allergies

Bacteria are practically everywhere around us, including on and inside you, but that is in many ways a good thing. For instance, having a diverse set of microbes living on your skin might help prevent allergies.

A new study published in PNAS links two factors related to how microbes might affect our health: the observation that diversity of microbes on a person is related to the diversity of microbes in their environment, and the hygiene hypothesis, which suggests that the modern uptick in allergies and autoimmune diseases is caused by childhood under-exposure to bacteria.

For a while now, scientists have known that children living on farms are less likely to have allergies or asthma. Being around livestock means the farm children are also around a more diverse set of bacteria than city kids living in an apartment. In this new study, scientists swabbed the skin bacteria of 118 Finnish children, some who lived in rural areas and some who lived in urban areas.

They also tested the children for levels of an antibody called IgE, high levels of which indicate hypersensitivity to allergens, or what is known as atopy. Lastly, they surveyed the parents about plant diversity around their homes.

Once the researchers had three pieces of the puzzle - biodiversity in the environment, microbial diversity on the children’s skin, and whether the kids were prone to allergies - they started looking for connections.

They found that children with atopy had less diversity in their skin microbes, specifically in a class of bacteria called gammaproteobacteria. It wasn’t the number of gammaproteobacteria cells that mattered (they only make up 2.8 p.c. of the bacteria on skin) but the number of different varieties. The children with atopy also showed a lack of diversity in a specific group of plants, “uncommon native flowering plants.”

The lack of microbial diversity may well be connected with the lack of plant diversity: gammaproteobacteria are commonly found on vegetation.

To show that gammaproteobacteria could actually influence the childrens’ immune systems, the researchers took blood samples and looked at interleukin-10, a molecule that decreases the intensity of allergic responses.

One kind of gammaproteobacteria in particular, Acinetobacter, was correlated with higher levels of interleukin-10 in healthy kids. So it could be that Acinetobacter indirectly keeps the immune system from becoming overactive.

This study with Finnish children up an intriguing set of correlations between environmental diversity, microbial diversity, and allergies - how it all works remains to be puzzled out.

- Discover magazine