Multiple sclerosis can have severe implications for individual protection assurance, says Lisa Allcock
Multiple sclerosis (MS) was first described in Holland by a 14th century physician. It is a disease in which the nerves of the central nervous system - brain and spinal cord - degenerate.
Myelin, which provides a covering or insulation for nerves, improves the conduction of impulses along the nerves and is important for maintaining the health of the nerves. In MS, inflammation causes the myelin to degenerate and eventually disappear. Consequently, the electrical impulses that travel along the nerves decelerate.
Late in the disease, the nerves themselves are damaged. As more and more nerves are affected, a patient experiences a progressive interference with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memory.
Genetic factors
Although yet unclear, it is thought that genetics may play a role in MS. Eskimos and African Bantu do not usually develop MS, while Native Indians of North and South America, Japanese and other Asian groups have a low incidence.
The general population has less than a 1% chance of ever contracting MS. The chance increases in families where an immediate relative has the disease. Therefore, a brother, sister, parent, or child of a person with MS stands a 1-3% chance of developing MS. Similarly, an identical twin runs a 30% chance of acquiring MS whereas a non-identical twin has only a 4% chance if the other twin has the disease. These statistics suggest that genetic factors play a major role in MS. However, other data suggests that environmental factors also have an important role.
Symptoms of MS may be single or multiple and may range from mild to severe in intensity and short to long in duration. Complete or partial remission from symptoms occurs early in about 70% of all MS patients. Visual disturbances are often the first symptoms of MS, but they usually subside. A patient may notice blurred or double vision, red/green distortion, or sudden blindness.
Commonly, muscle weakness leading to difficulties with coordination and balance is noticed early. Muscle spasms, fatigue, numbness, and prickling pain are also common symptoms. There may be a loss of sensation, speech impediment, tremors, dizziness, or occasionally hearing loss. Generally, 50% of patients experience mental changes such as decreased concentration, attention deficits, some degree of memory loss, or impairment in judgment. Other symptoms may include depression, manic depression, paranoia or an uncontrollable urge to laugh and weep, known as laughing-weeping syndrome.
As the disease worsens, patients may experience sexual dysfunction or reduced bowel and bladder control. Heat appears to intensify MS symptoms for about 60% of patients, and relief is found in cold baths or swimming. Pregnancy seems to reduce the number of attacks.
Due to the broad range and subtleties of symptoms, MS may not be diagnosed for months or even years after the onset of symptoms. Physicians, particularly neurologists, take detailed histories and perform complete physical and neurological examinations. If patients have minor complaints but no definite clues of MS or abnormal examinations, they may be diagnosed with 'possible' MS. Further testing helps to diagnose 'probable' or 'definite' MS.
Magnetic resonance imaging (MRI) with intravenous gadolinium or magnetic resonance scanning (MRS) help to identify, describe, and date lesions in the brain, known as plaques. Another electro-physiological test called evoked potentials, examines the impulses travelling through the nerves to determine if the impulses are moving normally or too slowly. Finally, examining the cerebro-spinal fluid that surrounds the spinal cord may identify abnormal chemicals or cells floating in the brain or spinal cord that suggest the presence of MS.
Progression
Collectively, these three tests strengthen the diagnosis of MS. If criteria for definite MS are not met, the patient is diagnosed with probable MS. Definite MS is diagnosed when the patient's age is within the range for MS, at least one attack affecting more than one organ has occurred or there has been a progression of symptoms over a long time, and the MRI or MRS, cerebro-spinal fluid abnormalities, and evoked potentials suggest MS.
Drugs known to affect the immune system have become the primary focus for managing MS. Initially, corticosteroids, such as prednisolone, were widely used. However, since their effect on the immune system is non-specific and may cause numerous side effects, corticosteroids now tend to be used to manage only sudden, severe MS attacks.
Since 1993, medications that alter the immune system, such as 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; alpha, beta, and gamma. All interferons have the ability to coordinate attacks on viruses, slow or halt the development of immune cells, and regulate the immune system.
Lisa Allcock is life and disability underwriter at Scottish Equitable Protect
Statistics
About 250,000 to 350,000 people in the US have MS. Approximately 2,500 new cases of MS are diagnosed in the UK each year. It is one of the most common neurological disorders in young adults, and is usually diagnosed between 20 and 40 years of age. MS has, however, been diagnosed as early as age 15 and as late as age 60.
MS is twice as likely to occur in Caucasians as in any other group. For example, the incidence of MS is uniformly low in Japan, against a much higher risk in Western Europe and North America. Women are twice as likely as men to be affected by MS earlier in life. Later in life, the incidence of the disease in men and women is almost equal. MS afflicts one in 700 people in the US.
The following are statistics from various sources about hospitalisations and MS:
n 16,411 of hospital consultant episodes were for MS in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 90% of hospital consultant episodes for MS required hospital admission in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 31% of hospital consultant episodes for MS were for men in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 69% of hospital consultant episodes for MS were for women in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 23% of hospital consultant episodes for MS required emergency hospital admission in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 13.9 days was the mean length of stay in hospitals for MS in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n Four days was the median length of stay in hospitals for MS in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 46 was the mean age of patients hospitalised for MS in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 86% of hospital consultant episodes for MS occurred in 15-59 year olds in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 2% of hospital consultant episodes for MS occurred in people over 75 in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 37% of hospital consultant episodes for MS were single day episodes in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
n 104,557 of hospital bed days were for MS in England 2002-03 (Hospital episode statistics, Department of Health, England, 2002-03)
Sources
www.mssociety.org.uk
www.curesearch.com
www.medscape.com
www.neuroguide.com
www.nejm.org
www.healthatoz.com
Underwriting implications
A 'possible' or 'definite' diagnosis of MS in an individual will have implications on all protection/ disability benefits an insurance provider may offer.
For example, dependent on the nature, symptoms and progression of the disease, life cover may be offered at an increased premium or not offered at all. However in the assessment of critical illness (CI) cover, where MS is a specifically named benefit under the CI definitions, it is highly unlikely that any insurance provider would offer CI cover to any individual who has been diagnosed with MS or possible MS.
With regard to total permanent disability and waiver of premium options often associated with protection policies, these will either be declined depending on the individual's symptoms and severity of the disease or MS will be specifically excluded. Income protection would also be declined.
