Speakers' abstract
Co-morbidity in MS
Duddy M, Consultant Neurologist, Royal Victoria Infirmary, Newcastle
People with multiple sclerosis suffer from the same diseases as the general population. However, some conditions seem to occur more frequently than chance alone would dictate. It is possible that one disease may lead to the other or that both are associated with a common cause. It has been hoped that studies exploring these links may shed light on the nature of MS but results have been inconclusive and contradictory. The case that MS is an autoimmune disease is supported by some studies showing an increase in the incidence of other autoimmune diseases (especially thyroid disease) in people with MS or their relatives, but other studies have failed to establish a link. As many other autoimmune diseases are obviously associated with each other in individuals and families, the fact that MS appears to behave differently challenges its place as a "conventional" autoimmune disease.
Several diagnoses are more commonly made in people with MS and are likely to be consequences of the MS disease process and/or the resulting disability. Depression is common and may result from MS plaques in certain key areas or as a reaction to the diagnosis or increasing disability encountered. Epilepsy appears to be over-represented in MS and can occur early or late in the disease. Osteoporosis is commoner in people with MS and may predispose to fracture. People with MS experience a lot of pain, not all of which is directly attributable to central, MS-related mechanisms. As a group, people with MS have more infections than the general population (urinary tract infections, chest infections, cellulitis), presumably as a complication of disability. Conversely, the role of infections in triggering MS continues to attract interest but remains controversial. Interestingly, people with MS seem to have lower rates of ischaemic heart disease, myocardial infarction, hypertension and chronic obstructive airways disease. There are also some studies suggesting a lower incidence of certain cancers in the MS population.
Aside from any consideration of causal links, the presence of MS has an effect on the manifestations of other conditions, and has implications for their treatment. In treating concurrent diseases, especially where surgery or anaesthetic are involved, there are often concerns of adversely affecting the person's MS. This session will seek to discuss the ways in which MS is linked to other diseases, considering both theoretical and practical issues raised.