Dr. Andrew Chan from the Dept. of Neurology, Ruhr-University Bochum, Germany presents at the Brighter Futures for MS event held in Belgium on 12 Jan.

1. Multiple Sclerosis – an overview Andrew Chan Dept. Neurology, Ruhr-University Bochum, Germany

3. Age, disability, cognitive/psychological symptoms: implications for career, social life, society

4. Prevalence: 80-100/100.000, D: ~120.000 patientsGenetic factors (HLA, non HLA-genes…) Environmental factors (EBV?? Vit D...) ?

6. Augustus Frederick d‘Este (1794-1848) · · · · „(...) and without any thing having beendonetomy Eyes, theycompletelyrecovered …“ · „… I fell down about 5 timesfrommylegs…“ · · „thatmymakingwaterisattended withdifficulty“ „I formed a liaisonwith a Young woman – I find myactsofconnection a deficiencyofwholesomevigor (...)“

7. (Azathioprin) (IVIG)c Immunomodulatory escalation therapy 1995 vs. 2010 vs. 2011 (Cyclophosphamid) Escalation therapy Mitoxantronea Disease activity Natalizumabb oral… Beta-Interferon GA Only partial efficacy, Side effects, no cure… Basic therapy Corticosteroids Plasma exchanged Relapse treatment aChanges of these therapies at this stage of escalation not yet formally evaluated. bIn cases of ≥2 severe relapses/year it may also be used as a basic therapy. cConsidered in some European countries as second-line treatments but not indicated in France. dOption in severe, steroid-resistant relapses. MSTKG, Nervenarzt 2002 GA, glatiramer acetate; IVIG, intravenous immunoglobulin. Wiendl H et al. J Neurol 2008;255:1449−63.

8. Different point of view: physician and patients Odds ratio (95% CI) 0.01 0.1 1 10 100 More important to clinicians More important to patients Rothwell et al., BMJ 1997

9. MS and suicides: early during the disease Stenager EN et al. JNNP (92)55:542

10. Quality of life declines with disability Patients with advanced MS have a quality of life viewed by society as worse than death 1.0 0.8 0.6 0.4 0.2 0 –0.2 –0.4 Utility 0 1 2 3 4 5 6 6.5 7 8 9 EDSS status EDSS, Expanded Disability Status Scale Orme M, et al. Value Health 2007;10(1):54−60

11. Costs: largest burden on the patient Kobelt 2009. Access to innovative treatments in Multiple Sclerosis in Europe

13. Not curable, but treatable: like other chronic diseases

14. Aim of treatment: no new symptoms, no side effects

15. Patient – Physician: only one of many important relationships

16. Patients and families carry financial burden of disease