World MS Day 2026: How ICMR And NIMHANS Are Leading India's Fight Against Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that is a chronic condition affecting the central nervous system. It occurs when the immune system incorrectly targets the nerves' protective coating, known as myelin.

Nerves function as electric wires that relay messages from the brain to various body parts, while myelin functions as the coating that protects these wires. If the myelin is stripped off, the messages transmitted by the nerves will not reach their intended destinations because the flow of information is impaired or delayed. This results in neurological conditions including weakness, balance issues, visual impairments, and coordination problems.

MS is not among the most common neurological disorders, like headache, stroke, or seizures, but it is certainly not a rare disorder. Although MS is not prevalent in the same numbers in India as compared to other parts of the world, including Canada, which has one of the highest rates of MS anywhere, it still needs due attention.

According to a study cited by the Multiple Sclerosis Society of India (MSSI), nearly 1.8 lakh people in India may be living with MS. There have been no large-scale population-based studies to accurately establish the true incidence and prevalence of MS in India, which is why the National MS Registry is so important.

Recognising the need for India-specific data on multiple sclerosis, the National MS Registry was launched four years ago with funding support from the Indian Council of Medical Research (ICMR) and is being coordinated by AIIMS Delhi.

The National Institute of Mental Health and Neurosciences (NIMHANS) is also one of the collaborating centres with multiple hospitals across the country. The registry aims to generate India-specific evidence on the epidemiology of MS, treatment access, infrastructure requirements, insurance support, clinical research, and patient advocacy.

“This is a major step towards understanding multiple sclerosis in the Indian context rather than relying solely on Western data. The registry has already led to important publications. We are now developing a dedicated pregnancy registry at NIMHANS to support women with MS in India by helping them plan pregnancies, manage the disease throughout the process, and ensure timely treatment before and after delivery,” said Dr Netravathi M, Professor of Neurology and In-Charge of the Neuroimmunology and Neuroinfections Subspecialty at NIMHANS, in an exclusive interview with ETV Bharat.

With over a decade of expertise in CNS demyelinating and autoimmune neurological disorders, she also leads the MS and NMOSD Clinic at NIMHANS.

Excerpts from the interview:

Anubha Jain: What are some early warning signs of MS that people often ignore or misinterpret? There is a common misconception that MS primarily affects mobility in its later stages. How does MS affect everyday life beyond mobility - including vision, fatigue, mental health, and cognitive function?

Dr Netravathi: In most cases, MS first begins with minor symptoms such as numbness, fatigue, vision issues, or muscle weakness, all of which can be easily confused with stress, lack of nutrients, or any other disease, hence delaying diagnosis, allowing MS to develop further without being noticed, thereby causing damage to the brain.

The second issue with MS is late intervention in terms of taking the right treatment on time, meaning that the disease will keep developing and will cause more disability, especially related to movement, balance, coordination, and sometimes cognitive function.

Those are the two factors that contribute to disability resulting from MS, making early diagnosis and timely treatment essential for better long-term outcomes.

Anubha Jain: MS is often called an “invisible disease”. Why does MS remain under-recognised in India despite affecting many people?

Dr Netravathi: MS is no longer as under-recognised as in previous years because of increased awareness about it, along with the availability of MRIs that facilitate early diagnosis. It has become easier for individuals showing neurological symptoms to be investigated on time, including through MRIs. It is still classified as an “invisible disease” because many symptoms, such as fatigue, pain, difficulty in remembering, or issues related to the bladder, do not show themselves externally. Because individuals presenting such symptoms look completely healthy, their condition may be misinterpreted as a consequence of stress, overworking or poor nutrition, which can delay timely recognition and support.

Anubha Jain: Beyond medications, how critical are physiotherapy, occupational therapy, rehabilitation, and assistive care in improving long-term outcomes of MS?

Dr Netravathi: The function of both physiotherapy and occupational therapy becomes very crucial, especially when the disease is not detected at the initial stages or when there is a delay in its treatment. Both physiotherapy and occupational therapy are instrumental in enhancing the quality of life of patients suffering from MS.

Though disease-modifying therapies aid in the slowing of progression of the disease in certain cases, some patients suffer functional issues, which include difficulties in walking, balancing, and performing everyday actions. In such instances, physiotherapy comes to the rescue in order to enable patients to preserve their muscular strength and improve balance, mobility, coordination, and functionality, as well as decrease stiffness and increase endurance levels. On the other hand, occupational therapy is concerned with enabling patients to perform their everyday functions more effectively, such as dressing, working, cooking, or other routine tasks, often by teaching adaptive strategies and suggesting assistive tools if needed.

Anubha Jain: How is NIMHANS contributing to improving MS diagnosis, treatment, rehabilitation, and long-term care in India?

Dr Netravathi: At NIMHANS, there has been tremendous improvement in awareness and management of MS and other autoimmune neurological conditions, which has been made possible through the autoimmune laboratory, radiology support, psychiatric services, psychological and psychosocial support and multidisciplinary care. As clinicians, our responsibility goes further than just treating them; our responsibility includes taking into consideration all the medical, psychiatric and psychosocial challenges patients face.

Our goals include patient advocacy and research. Through research, we aim to increase knowledge about such disorders and how to treat them. As far as patient advocacy is concerned, we have special clinics for MS, NMOSD, and other allied conditions so as to provide integrated care.

Moreover, we arrange periodic awareness programmes where patients meet, interact with experts, and exchange experiences. Patients benefit greatly through such activities because this creates a strong support system, helping patients feel heard, understood, and empowered.

Anubha Jain: What are the key challenges in diagnosing MS, especially in differentiating it from other neurological disorders, particularly outside major urban centres where access to specialists and advanced diagnostics is limited?

Dr Netravathi: Early awareness and proper referrals could help tremendously in treating MS patients. Initially, many MS patients tend to suffer from optic neuritis or other visual problems that make them see an eye doctor.

The second difficulty would be diagnosing and testing accurately, as the symptoms of MS resemble those of nutritional deficiency, psychiatric disorder, NMOSD, and MOG antibody disorder, where treatment methods are entirely different. The third problem will be the unavailability of specialised treatment because many MS patients have to travel great distances while dealing with high costs associated with their therapy without insurance assistance. Thus, currently, the problem is no longer how to detect the disease, but how to obtain appropriate treatment.

Anubha Jain: What policy reforms are urgently needed to address the biggest gaps in India’s MS care ecosystem?

Dr Netravathi: There exist considerable policy lacunas in relation to MS treatment, especially when we consider urban versus rural demographics and socio-economic divides. In cases where government-funded initiatives have helped those below the poverty line, the real issue seems to be that of middle-class individuals who fall short of qualifying for those programmes but cannot afford treatments. There are basically three main issues that need to be addressed through policy measures. These include making MS medication affordable and accessible, recognising the disability caused by MS and providing help to the affected individuals living with MS, and providing adequate insurance cover for their treatment needs. Addressing these gaps is essential to ensure equitable access to treatment for all patients.

Anubha Jain: Why are women more vulnerable, and can women with MS safely plan pregnancies?

Dr Netravathi: MS is prevalent among females, which is the case with many autoimmune diseases, and this occurs mainly owing to genetics and hormones. As such, this topic is particularly significant for the health of women. Having this disease does not automatically imply that one cannot conceive. Women with MS can conceive, but this must be discussed with their neurologists at the very beginning to plan it safely.

Anubha Jain: How has the treatment landscape for MS evolved in India over the last decade? Are newer therapies becoming more accessible and affordable for Indian patients?

Dr Netravathi: Twenty years ago, treatment options were extremely limited, but today most modern disease-modifying therapies are accessible in India.

The key issue now, however, is not the availability of medicine, but rather the issue of access because of high prices, poor insurance policies, and the necessity of travelling to specialised urban centres for treatment. The critical point is that there are now effective ways to control MS using modern evidence-based treatments. Although problems related to access persist, the ability to control MS and prevent disability today is much better than before.

Even though there is no cure for MS, it is getting increasingly manageable with early diagnosis and sustainable treatment.

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