Nearly 30% of multiple sclerosis sufferers in Hong Kong have thought of suicide, based on a survey carried out by the Hong Kong Multiple Sclerosis Society and the Neuromuscular Disease Association this year. Compared to the estimated suicidal ideation rate of 6.2% amongst those aged 15-29, these rates are extremely alarming.

“The figures are alarming... We spend most of our time explaining the illness to patients during consultation, but don’t have much chance to listen to their worries,” said Dr Richard Li, vice-chairman of the society.

Nearly 10% of patients with multiple sclerosis in Hong Kong have attempted suicide

Multiple sclerosis is an autoimmune demyelinating disease that may cause significant patient morbidity. It strikes unexpectedly between the ages of 20 – 30, the prime years of a person’s life. Consequently, many patients have trouble coping with the physical and mental burden of the disease. Visual problems, motor weakness, depression and fatigue are just a few of the multiple ailments that they may suffer from.

“Multiple sclerosis occurs at a relatively young age, when people are supposed to be fighting or working for their lives,” said Dr Stephen Cheng Wing-ho, the society’s honorary secretary. “Therefore, when they are hit with this disease, they often feel helpless.”

Apart from the burden of the disease, Li also pointed out multiple sclerosis could damage some areas that are responsible for emotions in the brain. Hence, patients might find it difficult to manage their emotions and avoid negative thoughts.

Multiple sclerosis may be severely under-recognised in Asia

Multiple sclerosis is a condition typically attributed to the Caucasian population. Currently, Hong Kong is estimated to have more than 500 patients living with multiple sclerosis. The prevalence of multiple sclerosis in Hong Kong has increased in the last decade, with 4.8 per 100,000 in 2008 to 6.8 per 100,000 people in 2015.

Dr Alexander Lau, Assistant Professor at CUHK, states that the prevalence rate of multiple sclerosis in Hong Kong has been increased by more than 40% from 2008 to 2015. Photo credit: CUHK
Dr Alexander Lau, Assistant Professor at CUHK, states that the prevalence rate of multiple sclerosis in Hong Kong has been increased by more than 40% from 2008 to 2015. Photo credit: CUHK

Meanwhile, the prevalence is lower in Mainland China, where the estimate is at 1.39 per 100,000 people. Japan has the highest incidence of multiple sclerosis in East Asia, with 7.7 per 100,000 people – with some cities within the country reporting figures as high as 16.2 per 100,000 people.

Comparatively, the prevalence is much higher in the United States, with approximately 58 – 95 in 100,000 people. However, this may be due to a lack of knowledge to accurately recognise multiple sclerosis in Asia. Consequently, this leads to a lower frequency of diagnosis; and hence, an underestimated number of cases.

CUHK launches Hong Kong’s First Pilot Integrative Medicine Programme in Multiple Sclerosis

Unfortunately, no medication is curative for multiple sclerosis. However, treatment is available to reduce the relapse rates, progression of disease and overall disability.

In Hong Kong, interferon – β is the first-line disease modifying therapy for the relapsing-remitting form of the disease. However, it is a costly drug, with some patients having to fork out up to HKD7,000 – HKD8,000 a month. Fortunately, the Hospital Authority (HA) has included this medication to the list of special drugs that are dispensed almost free of charge to public hospital patients.

Despite this effective medication, which is by far the most responsive to disease modifying treatments, multiple sclerosis patients still often experience fatigue and cognitive symptoms and these remain difficult to treat. With regards to this situation, researchers at Hong Kong’s Institute of Integrative Medicine (HKIIM) have been exploring the use of Chinese herbal therapy and acupuncture in multiple sclerosis patients since 2014.

Combining the use of western medicines, the centre aims to pool together all available resources – from neurologists, clinical toxicologists, nurses and Chinese Medicine Practitioners – in order to tackle the highly debilitating symptoms of multiple sclerosis.

“There were 20 multiple sclerosis patients who had received integrative medicine care conjointly managed by neurologists, CMPs and nurses in our clinic. Initial findings showed an improvement in fatigue, numbness and cognitive functions,’ said Dr Alexander Lau, Assistant Professor at the Department of Medicine and Therapeutics and Deputy Chief Clinician of Integrative Medical Centre. ‘If the IM approach is found to be efficacious in ameliorating the disturbing symptoms of fatigue and cognitive impairment – it might open up a novel therapeutic modality for MS. As such, patients would have chances to regain their strengths in recreation, daily routines and self-care,” he added. MIMS

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