She looks like any other youthful woman. Her eyes are bright, but tinged with anxiety as she worries about the future. She has suffered for the past eight years, and, despite her brave smile, will go on suffering till the end of her life. "At first, I noticed that my hands were trembling. I thought I was tired. Afew days after that, I couldn't hold anything – it would just fall down," says Shereen Ahmed. Like many other Egyptians, when they feel ill, they put it down to tiredness or stress. Shereen was the same; her job as an architect is a demanding one and that what was making her feel so exhausted. Then something happened to alarm her. "I was walking down the street to work one morning, when my legs simply stopped working," she recalls, with fear in her eyes. "I couldn't walk and I cried to other pedestrians to help me. They carried me to a taxi, which took me back home." Then she went to a neurosurgeon who referred her to a radiologist, who made her a resonant X-ray. When the results came out, he told her parents: "You must take her to hospital. It's already too late." "In the hospital, they gave me a dose of cortisone. That made me feel better and I could walk again," she told The Egyptian Gazette. Shereen, 32 and unmarried, didn't know that it was only a temporary improvement. Six months later, she was at a friend's wedding party when she collapsed on the dance floor. "I went again to the doctor, who told me that I would never be like other young women because I had an illness which cannot be cured," Shereen said at a seminar, while filling in a form, at the top of which was written: ‘Cairo University League against Multiple Sclerosis. Please write down your name, gender, age, phone number and when you first contracted MS, as well as the medicines you have been taking. You are not alone. We will help you'. She continued: "No-one told me I had MS, not even the physicians. But I've been learning all about it over the past eight years." To raise Egyptians' awareness about multiple sclerosis (MS) and to mark World MS Day today, the Sawy Cultural Centre in Zamalek last week held a seminar organised by the Cairo University League against Multiple Sclerosis. It was attended by dozens of people, most of them patients themselves. MS is a disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. Disease onset usually occurs between the age of 20 and 45, and it is more common in females. "This disease is also common globally. According to the latest statistics, there are as many as 2.5 million people worldwide infected with MS. Around 10,000 cases are discovered every year," says Dr Mona Abdel-Fattah, a professor of neurology at Qasr Al-Aini Hospital, affiliated to Cairo University's Faculty of Medicine, one of the Middle East's top medical faculties. In the US, she adds, around 400 new cases are discovered each week. However, in Egypt, according to her, the problem isn't so severe. "In Egypt, 1.4 per cent of the population suffer from MS," she explains, quoting a study made by professors at Qasr Al-Aini, depending on a sample from all of Egypt's 29 governorates. According to Dr Mona, symptoms of MS usually appear in episodic acute periods of worsening (called relapses or attacks), in a gradually progressive deterioration of neurologic function, or in a combination of both. MS relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above one and a half per year. Some attacks, however, are preceded by common triggers. Relapses occur more frequently during spring and summer. Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse. Stress may also trigger an attack. Dr Mona adds that the person with MS can suffer almost any neurological symptom or sign, including changes in sensation, muscle weakness, difficulty in moving; difficulties with co-ordination and balance; problems in speech or swallowing, visual problems, fatigue, acute or chronic pain, and bladder and bowel difficulties. Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common. Most likely MS occurs as a result of some combination of genetic, environmental and infectious factors. Epidemiological studies of MS have provided hints on possible causes for the disease. Theories try to combine the known data into plausible explanations, but none has proved definitive. "Around 80 to 85 per cent of the patients have no relatives infected with the disease," Dr Mona stresses, as she pauses to talk to patients in wheelchairs or on crutches. According to her, the chance increases in families where a first-degree relative has the disease. Thus, a brother, sister, parent or child of a person with MS stands a 1 to 3 per cent chance of developing MS. "However, an identical twin runs a nearly 30 per cent chance of acquiring multiple sclerosis, whereas a non-identical twin has only a 4 per cent chance if the other twin has the disease," Dr Mona adds. Shereen and other MS sufferers want the public and the Government with its health representatives to give more attention to the disease and to them. The problem is that interferon, used to treat this disease, costs LE7,000 per month, where the salary for the average Egyptian is only around LE500 per month. "Of course I can't afford this, so I have to use Cortisone, although it's very bad for the health," shereen explained. In the US since 1993, medications that alter the immune system, particularly interferons, have been used to manage MS. Interferons are protein messengers that cells of the immune system manufacture and use to communicate with one another. There are different types of interferons, such as alpha, beta and gamma. All interferons have the ability to regulate the immune system and play an important role in protecting against intruders, including viruses. Each interferon functions differently, but the functions overlap. The beta interferons have been found useful in managing MS. Interferon beta-1b (Betaseron®) was the first interferon approved in the US to manage RR-MS in 1993. "Please write your name or even just your initials in the application you have, in addition to your gender and age. We can give these details to the Ministry of Health, so it can get an idea of the number of MS sufferers there are in Egypt," Dr Sherif Hamdi, the President of Cairo University League against Multiple Sclerosis, told patients. "We hope the Ministry covers the cost of treatment and provides patients with health insurance," he added, while watching them fill in their forms with weak, trembling hands.
