Episode 88. Multiple Sclerosis with Ernest Butler
Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).
Environmental and genetic factors play a role in the aetiology with a higher incidence of multiple sclerosis identified in patients living north of 40 degrees (north of Beijing and including much of Europe Russia the northern parts of the United States and Canada) or South of 40 degrees (Tasmania) raising speculation about the role of ultraviolet light and vitamin D. MS is 15 times more likely when a 1st-degree relative is affected and concordance with monozygotic twins is about 25%. Obesity, smoking, high intake of dietary saturated fats and Epstein-Barr virus have also been implicated.
Despite the distressing nature of this neurodegenerative condition many treatments are evolving to manage both acute episodes (steroids, plasmapheresis) and to prevent further damage (from Interferon beta and Glatiramer acetate to Ocrelizumab, Natalizumab and Stem cell therapy amongst others).
To guide us through this complex subject we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has a major clinical expertise in the management of multiple sclerosis amongst many other acute and chronic neurological conditions, please join me in this conversation with Ernie.
References:
Assoc professor Ernie Butler: Frankston neurology.com.au
www.ninds.nih.gov , Multiple sclerosis : Hope Through Research
www.sciencedirect.com , Multiple Sclerosis-an overview
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.