The Rising Global Burden of Multiple Sclerosis: Insights from the Atlas of MS

Broadening the Genetic Horizon: A Global Perspective on Multiple Sclerosis

Multiple sclerosis (MS) is a complex immune-mediated neurodegenerative disease that disrupts the central nervous system, impacting millions globally. In recent years, significant advancements in disease-modifying therapies (DMTs) have improved life quality for many patients, yet a cure remains elusive. The need for high-quality epidemiological data continues to be critical for better understanding of disease risk and informing healthcare policies aimed at addressing the needs of MS patients. This blog post will highlight key findings from the 2020 report "Rising Prevalence of Multiple Sclerosis Worldwide: Insights from the Atlas of MS, Third Edition," authored by Clare Walton and colleagues

Global Prevalence and Rising Trends
As of 2020, an estimated 2.8 million people worldwide live with MS, marking a notable increase in prevalence from previous years. This figure corresponds to approximately 35.9 cases per 100,000 people globally. The rising trend is consistent across all regions, with prevalence rates increasing by 50% since the last edition of the Atlas in 2013. This upsurge is attributed to several factors, including improved diagnostic techniques, better access to healthcare, and increased awareness of the disease.

Countries in Europe, the Americas, and the Eastern Mediterranean reported the most significant increases, with the Americas showing an 87% rise in prevalence. In contrast, regions such as Africa and Southeast Asia, where MS prevalence has historically been lower, also witnessed growth in case numbers but on a smaller scale.

Pediatric MS: A Growing Concern
One notable development in MS research is the increasing recognition of pediatric-onset MS. While once considered rare, MS is now diagnosed in children at a much higher rate than previously documented. The Atlas of MS reported over 30,000 pediatric cases in 2020 across 47 countries, a significant increase from the 7,000 cases reported in 2013. This highlights the importance of developing tailored treatments and support mechanisms for younger populations affected by MS.

Regional Variations in MS Incidence and Prevalence
Regional analyses of MS prevalence reveal considerable geographic variation. Europe, with a prevalence of 142.81 per 100,000, leads the world in terms of MS cases, followed by the Americas, where prevalence stands at 117.49 per 100,000. On the other hand, regions like Southeast Asia and Africa report much lower prevalence rates of 8.62 and 8.76 per 100,000, respectively.

These variations are likely due to a combination of genetic, environmental, and socio-economic factors. In wealthier nations, the availability of advanced diagnostic tools and healthcare services enables earlier detection, while in lower-income regions, underreporting and lack of resources hinder accurate data collection.

Methodological Improvements in Data Collection
The third edition of the Atlas of MS incorporated several methodological enhancements aimed at improving the accuracy and consistency of the data. These changes include the explicit definition of key terms in the survey, the introduction of a confidence tool to assess the reliability of data sources, and the use of imputation techniques to fill gaps in missing country data. These efforts have provided a more accurate global picture of MS, though significant gaps remain, particularly in regions like Africa, where data quality and availability are still suboptimal.

Challenges and Future Directions
Despite the improvements in data collection, challenges persist. A key limitation of the Atlas is its reliance on country representatives to report data, which can lead to variability in reporting standards. Furthermore, there are still significant gaps in data from lower-income regions, particularly with respect to incidence and pediatric-onset MS cases.

Moving forward, the authors of the Atlas recommend several actions to address these gaps. These include the need for systematic, validated data collection, particularly in lower-income countries; prioritizing the collection of incidence data; and incorporating variables such as race, ethnicity, and pediatric MS in surveillance efforts. These steps are essential for understanding the global landscape of MS and for ensuring equitable access to care and treatment.

Conclusion
The third edition of the Atlas of MS provides invaluable insights into the global burden of MS, highlighting the rising prevalence of the disease and the critical need for more comprehensive data collection. As the number of MS cases continues to rise, particularly in regions previously thought to have low prevalence, efforts must be made to close the gaps in knowledge and improve access to healthcare resources. This report calls on policymakers, healthcare professionals, and MS organizations to use the data to inform research, advocate for better care, and ultimately improve the quality of life for individuals living with MS worldwide.

Reference:
Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., ... & Baneke, P. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Multiple Sclerosis Journal, 26(14), 1816-1821.