Multiples sclerosis in India.

Abstract

The chosen subject of discussion for this supplement of Annals of Indian Academy of Neurology is multiple sclerosis and related disorders in India. It is the initiative of the President, Dr. Arabinda Mukharjee, and comes at a time when a lot is happening in the field in general and in our country as well. From a time when early Indian practitioners of neurology wondered about the existence of multiple sclerosis in India, perceptions have changed much in recent years. While India still appears to be a low-risk zone for multiple sclerosis based on our geographical location, cases are seen regularly in all parts of India, rural and urban. In the absence of robust epidemiological data, it is very difficult to have accurate perceptions of the incidence and prevalence of multiple sclerosis in India. Increasing numbers of neurologists and the uniform availability of diagnostic tools such as magnetic resonance imaging have helped increase the detection and diagnosis of cases. On the other hand, the possibility that the incidence is increasing cannot be denied, and this has been shown to happen in other Asian countries, such as Japan. From the initial documentation of Indian patients with demyelinating disease, it was thought that the clinical pattern tended to be somewhat different in India, the optic nerves and spinal cord being affected more often: the “Asian MS.” Recent clinical and radiological studies on large cohorts of Indian multiple sclerosis patients have confirmed that their clinical profiles are similar to those seen in other parts of the world. The concept of Asian MS has given way to the recognition of neuromyelitis optica (NMO) as a distinct disease spectrum, and information is now available about NMO among Indians. The antibody detection rates in NMO spectrum disorders have increased in India, probably as test methodologies have improved. With the availability of tests throughout the country, the differential diagnosis between multiple sclerosis and NMO has become easier and therapies have improved. The increasing role of vitamin D in the causation of immunological disorders assumes importance in India, as large sections of the population are deficient in vitamin D, for unclear reasons. This issue of Annals of Indian Academy of Neurology covers some of these aspects. Singhal, our senior neurologist with long-term experience in treating demyelinating disorders, gives an overview of multiple sclerosis in India with comments on local therapy issues. Bhatia et al. present information on the epidemiological and genetic aspects of multiple sclerosis in India. As can be seen, the available reports are few, and there is a clear need for multicenter efforts spread across the country. There are two papers on NMO. Pandit, with her special expertise in this condition, covers many aspects of the disease in India, and Biswas and Mukharjee deal with the therapeutic aspects of NMO. As radiology forms the mainstay of the diagnosis, Katdare and Ursekar discuss this important aspect of diagnosis in modern times, covering differential diagnosis. The subject of therapy for multiple sclerosis is presented in two parts. Coles discusses the conventional and the newer agents in the treatment of multiple sclerosis and Shah discusses the symptomatic therapies. Surya gives an overview of the rehabilitative measures for these diseases, an aspect that requires much attention in our local situation. As can be seen from these papers, the diagnostic aspects of the disease have improved in India, but challenges face us in terms of the availability and affordability of therapies. As many Indians still bear medical expenses out of their own pocket, the feasibility of purchasing medicines becomes remote. There is a clear need for efforts toward subsidizing the drug costs and, possibly, evolving locally suitable treatment paradigms. The Multiple Sclerosis Society of India is an active and vibrant organization. Initially started in Mumbai, it now has many branches throughout India, and volunteers are involved in rehabilitation and counselling work, arranging medical camps, and spreading awareness. Having been associated with them for over two decades, I have witnessed their dedicated work. Support from neurologists and cohesive work with such organizations can further the documentation of data on multiple sclerosis and create a stronger platform for the sufferers.