Total costs of MS varied widely across countries for which studies have been conducted but are substantial in all countries. The total (prevalence weighted) average annual cost per person with MS in 2007 (based on existing studies from 15 countries) was $41,334. Over a lifetime it is estimated that the average financial cost of MS in high income countries is more than $US 1.2 million per person. Loss of employment, or early retirement, is considered the single largest cost factor contributing to this financial cost.
Costs of MS
Types of costs were divided into three broad categories: direct, indirect and intangible costs, with the view to understand more fully the kinds of costs that MS demands of the individual and society.

Direct costs
Direct costs are those incurred by the individual or society as a direct result of the disease. In the report these costs were divided into medical and non-medical subcategories and cover everything from visits to neurologists to the costs of installing wheelchair ramps at home, and the value of care-giving provided by family, friends or professional carers. The responsibility of caring for the person with MS often falls on those closest to him/her and this can affect the carers’ ability to work. Often carers are forced to work shorter hours in order to care for their loved one, or increase working hours to compensate for their loss of income. For carers it is essential that employers are understanding, supportive, and flexible where possible to enable carers to continue working in order to support those who cannot work themselves. Direct costs accounted for 26% to 87% of the total costs of MS

Indirect costs
Indirect costs, which accounted for 13% to 74% of total MS costs, are those costs which are related to MS but cannot be attributed directly to the disease itself. Loss of work is often the most costly contributor to the overall cost of MS since the average age of onset of MS is 29.2 and can dramatically affect or curtail the working life of the individual. The symptoms of MS, which can include physical disability, fatigue, cognitive impairments, transportation difficulties and speech impairments, can make finding and retaining employment difficult especially where employers do not support the changing needs of the employee.

The costs incurred can include short-term and long-term absence from work during periods of relapse, reduced working hours, changing the type of work to a less physically challenging and stressful nature (often at a lower pay), and early retirement.

Intangible costs
Intangible costs are those costs that are often most difficult to measure and can include changes to the quality of life of both the individual and his/her friends and family. In the 13 studies that were analysed with relation to quality of life, several patterns emerged. Firstly, the impacts on physical functioning are larger than those on social functioning or mental functioning, and secondly that physical quality of life deteriorates as the disease progresses over time. Significant impacts on social and mental functional were also found over time. These studies show that a diagnosis of MS does not necessarily affect the ability of the individual to engage socially or mentally, but that physical engagement may be the biggest barrier to activity that the individual faces – especially in the early stages of the disease. With this in mind, it is important that employers offer a variety of solutions to make work more accessible to those with physical disabilities.

You can read the full article here

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Introduction

Multiple sclerosis presents in various ways and subsequently shows variable disease courses. If we knew early on what the disease course for Multiple Sclerosis would be then we could better target the medication in each individual case. To date it has been unpredictable right from disease onset but, knowing the disease course is of crucial importance in guiding treatment.

Now “The Department of Neurosciences” at Cardiff University has recently been looking into factor H as a biomarker for multiple sclerosis and the findings are promising.

Effective and accessible biomarkers are needed in order to stratify (separate into groups) patients and inform treatment. The team at Cardiff University decided to look into factor H as such a marker. Regulator factor H, has recently been implicated as a biomarker in other chronic inflammatory central nervous system conditions. Could it identify or predict specific pathological processes and outcomes in multiple sclerosis?

Method

They measured factor H in blood serum from 350 patients with multiple sclerosis classified according to disease course and relapse status. Controls were found for variables including disease duration, age, gender, disability and treatment. I have decided not to go into the full method in this document as the details will be somewhat turgid to the average reader. However, the findings are fairly clear and very encouraging.

Results

1) Factor H levels were significantly higher in progressive disease compared to controls and relapsing patients. Thus factor H levels were capable of distinguishing secondary progressive from relapsing remitting disease (excluding patients in clinical relapse)

2) Acute relapse was also associated with temporarily increased factor H levels compared to stable relapsing disease.

3) In clinically stable patients, factor H levels remained constant over 1 year but in patients in transition from relapsing to progressive disease, factor H levels significantly increased over a period of 2 years. This is a crucial point as the transition between relapsing and progressive signals the need for therapy change.

Conclusion

Serum factor H could be an effective indicator of progression and a practical and accessible tool to split patients into groups and to predict disease course, Once we have this information we have objective evidence which can help guide therapeutic decisions. As we have known for some time, the earlier you can pick up a disease pattern the better chance of success you have with the treatment.

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Introduction

As we know Multiple sclerosis is a common neurological disease that affects 1 in 1,000 people, most commonly young women, although men too to a lesser extent. The typical disease progress includes attacks and remissions with slowly progressing disability. Current therapies can prevent the appearance of new events, but they have much less effect on disease progression and serve mainly to moderate the initial relapsing-remitting phase.

May 15th 2009 saw a new review published from Oxford University by Lars Fugger, Manuel A. Friese and John I. Bell. In it they describe the current and new approaches that can be applied to define the functional role of the known genes involved in multiple sclerosis but also point out that environmental factors have a bearing on the function of the genes.

Environmental factors

Unfortunately, these environmental factors have proved to be even more elusive than the genes. Why do different areas of the world have a different prevalence and incidence of MS ? Could this be climate? Diet ? Genetics ? Lifestyle ? Infections ? What could these infections be ? Numerous viral and bacterial infections are potential candidates such as those found in the respiratory airways and gastrointestinal or urinary tracts as they are often associated with relapses, but no single infection has been consistently associated with disease.

We do not know how so many different infections could have a role in MS and how they might interact with genetic risk factors but, it is also important to try to understand how non-infectious risk factors, such as sunlight, may interact with genetic risk factors.

Asking the questions

The biggest challenge will be to use genetic information to ask questions about the environmental factors that interact with gene pathways and contribute to disease development. The identification of the exact disease susceptibility gene does not necessarily define the pathway involved in disease development.

The insights gained from functional studies may help the study of environmental risk factors by using methodology that goes well beyond the conventional approaches of population epidemiology. The improving capacity for modelling and simulation using genetic data may lead to the identification of the additional environmental factors that interact with genetic factors to cause disease.

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There are many symptoms associated with MS which occur to a greater or lesser degree These symptoms can include:

1) Blurring or Double Vision
2) Patches of Body Numbness
3) General Weakness (usually one side of body)
4) Muscle Spasms
5) Fatigue
6) ‘Pins and Needles’ in extremities
7) Loss of Balance and Coordination

8)Cognitive (ability to think) difficulties
9) Overall Sensitivity to Extreme Heat or Cold
10) Loss of Sensation in Affected Extremity
11) Problems with urinary and bowel function

MS is a difficult disease to diagnose.

The symptoms are vague and widespread mimicking those of other diseases. This is a disease of the nervous system which damages the protective coating (myelin) around the nerve and is thought to be an autoimmune disease. As this coating is destroyed the nerves become less and less efficient at transporting messages because these messages “leak”, become weaker and more erratic. When this happens it becomes more and more difficult to control movement or certain sensory activities in various parts of the body. Which nerves are damaged and to what degree varies widely so the corresponding loss of function varies widely. Slowly the myelin can rebuild and be repaired by the body but the repair is much slower than the rate of damage.

More Advanced Symptoms include:

1) Speech difficulty
2) Loss of Sexual Desire/function
3) Paralysis

At first, Multiple Sclerosis symptoms are Episodic (off and on). The symptoms usually last 1-3 weeks, then you go into ‘Remission’ for a few months. Some individuals may have one Episode and go into Permanent Remission. Others will gradually experience Progressive symptoms. As MS Progresses, your Remission time will have Residual (remaining) symptoms from your last episode.

MS cannot be caught. It is not an infectious disease but more women are diagnosed than men with a ration of 1.7 to 1 but woman are diagnosed earlier so the sex ratio is even greater below the age of 30. Men are most likely to experience their first symptom after the age of 40 but are also more likely to have the chronic progressive type. (see “The 4 Main Multiple Sclerosis Types”)

What is the course of the disease?

This is a difficult question to answer as there is a high degree of individual variation in symptoms and speed of progression. However as a rough guide one can say that at any one time 1/3 of people with MS are experiencing no serious relapses,1/3 are having a distinct relapsing-remitting course and 1/3 are experiencing a chronically progressive course.

Furthermore 1/3 have serious disabilities and require significant everyday support and 1/3 require significant lifestyle adjustment to manage their lives.

MS is not a fatal disease in itself and the improvements in healthcare over the past 50 years for this group have seen an increase in life expectancy and quality of life.

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