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#064: Navigating MS Treatment in Turkey with Neurologist and Associate Professor Meral Seferoglu

This time I have Dr. Meral Seferoglu as an interview guest on the show and we talk about MS treatment in Turkey.

It’s always interesting to hear about other countries and how they deal with this chronic disease. I am really impressed by the number of rehabilitation days per year that a person with MS can access in Turkey. Rehab is so important to overcome the challenges of multiple sclerosis and live the best life possible. Learn more and enjoy the interview with Dr. Meral Seferoglu from Bursa, Turkey.

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Table of Contents

Introduction – Who is Associate Professor Dr. Meral Seferoglu?

Hi thank you for your invitation. I always like to listen podcast on spotify during my way to work. While I saw your LinkedIn profile also start to listen your podcast series. Congratulations for this podcast series. I think it touches many lives far from Germany. It is my pleasure to be here. I am a neurologist focusing on demiyelinating disorders. Married and have two children and a cat. I like reading books, walking, swimming and painting.

Personal motivation for your career choice?

Since my childhood, I have always enjoyed helping people. Becoming a doctor offers new opportunities every day to help people. Neurology is a field with a great need, especially in aging societies where developments are ongoing. During my neurology residency, the constantly evolving literature and complex cases fueled my excitement for this field. After becoming a specialist, I was assigned to a hospital in the eastern part of the country for two years of mandatory service. I became the only physician accessible to young adult MS patients there. And thus, my journey with MS began.

While working in this region, I maintained close contact with my mentors specializing more specifically in the field of MS. Since it was a large hospital, conducting blood tests, MRIs, and EEGs was easily accessible. After completing my mandatory service, I returned to Bursa. Upon starting work at the hospital, I observed that while neurology specialists could easily manage other neurological conditions, they were somewhat more distant when it came to treating MS. I decided to establish an MS clinic at this hospital. Additionally, I accelerated my training in MS-related studies. Now we have a small MS unit, we have outpatient clinic every day and also inpatient clinic where we do lumber puncture, plasmapheresis and an infusion room with dedicated health care workers. I am very grateful.

Prevalence and Awareness of MS in Turkey

What is the prevalence of MS in Turkey and how many people receive a new diagnosis each year?

We have 85 million population living in Turkey. In the previous studies different prevalence results found between 18 to 288 in different regions of Turkey. Recently research was conducted via Official Database of Turkey health system. As a result of the study, the number of patients with the ICD code specific to MS G35 was determined as 201,061 and the number of patients with this code entered at least three times was determined as 82,225. The prevalence of MS in Turkey was calculated as 96.4 per 100,000 and the female/male ratio as 2. The incidence of MS in 2022 was 6.2 per 100,000. Almost 5000 people diagnosed with MS every year.

How aware is the general population of multiple sclerosis in Turkey?

The level of awareness about multiple sclerosis (MS) in the general population of Turkey can vary. While MS awareness campaigns and education efforts have increased in recent years, it may still be relatively low compared to more prevalent health issues diabetes, hypertension, obesity.

In urban areas and among more educated segments of the population, there may be better awareness due to access to information through various channels such as media, internet, and healthcare services. However, in rural or less developed regions, awareness levels might be lower due to limited access to healthcare resources and lower education levels.

Every year regularly we organize awareness programs during May and a meeting with patients, families, healthcare workers at 30th of May as known world MS day. We include other specialties like rheumatology, psychiatry, ophthalmology, urology, gynecology and so many to spread the word between doctors also. We saw the great effect of these organization during years.

Overall, raising awareness about MS and its symptoms, diagnosis, and management is crucial to ensure early detection, appropriate treatment, and support for persons living with MS. Collaborative efforts involving healthcare professionals, patient advocacy groups, and government initiatives can play a significant role in improving awareness levels across the country.

Quality of Life for MS Patients in Turkey

What are some of the challenges faced by MS patients in Turkey regarding access to healthcare and support services?

In our country, since health insurance is comprehensive and extensive, patients can easily access hospitals and physicians. There are more comprehensive healthcare centers in major cities. Reports for medications for MS patients are issued at tertiary level hospitals, which are university and research hospitals. In this context, patients from smaller cities may need to travel to regions where these comprehensive hospitals are located. Like everywhere in the world, the remote access systems developed during the Covid process seem to provide convenience in this regard. In this way, patients can have their routine check-ups done locally and prefer to visit large hospitals only for necessary consultations.

Which cultural stigmas or misconceptions exists surrounding MS in Turkey?

In Turkey, MS is often surrounded by some cultural stigmas and misconceptions. Many people in Turkey have limited knowledge about MS, leading to misconceptions about its nature. This can result in people believing that MS is contagious or always leads to severe disability. Although rare, the belief that MS is a barrier to pregnancy can lead to people with MS being isolated from society and becoming more cautious in forming or maintaining relationships. Persons with MS may also face social stigma like discrimination in workplace. There is a strong perception that MS inevitably leads to severe disability even though between MS patients. While diagnosed with MS they always have to change job or fired. MS can be mistakenly perceived as a psychological rather than a neurological condition. This can result in patients not receiving appropriate medical care and support.

How do cultural beliefs and attitudes affect the treatment and management of MS in Turkey?

Due to cultural beliefs, some individuals might prefer alternative or traditional treatments over conventional medical therapies. There can be misinformation about the effectiveness of treatments available for MS. This can result in the use of ineffective treatments and a lack of adherence to medically recommended therapies which can exacerbate the disease.

Cultural beliefs about illness and disability can influence the level of support people with MS receive from their families and communities. In our culture there is always strong support from families.

It is very important to adress these stigmas and misconceptions and to increase public awareness about MS. Educating people on the nature of the disease, and promoting a more supportive and inclusive society for those affected by MS may reduce these wrong believes and attitudes

Access to Treatment and Support Services

What types of MS treatments, therapies, or interventions are more commonly recommended or accessible in Turkey (e.g., certain types of DMTs, aHSCT, rehab)?

In our country, it is possible to access almost all treatments used for MS. Prednisolone and plasmapheresis treatments can be applied for relapse management. Disease-modifying therapies are administered stepwise in accordance with health regulations. First-line therapies include interferons, glatiramer acetate, teriflunomide, and dimethyl fumarate. Second-line therapies include fingolimod, cladribine, natalizumab, and ocrelizumab. Third-line therapies include ocrelizumab and alemtuzumab. Stem cell therapy is applied in a few centers with special approval from the health regulations. Siponimod and ofatumumab treatments are also expected to become available in a few months.

Are there any specific laws or regulations in Turkey that protect the rights and promote the well-being of individuals living with MS?

Since our healthcare system is comprehensive, treatments are covered by the government. Persons with MS generally do not face issues in accessing treatments. Additionally, young male persons diagnosed with MS before the age of 20 are exempt from obligatory military service. I think this is an important right. The healthcare system provides individuals with MS the opportunity to benefit from 90 days of physical therapy and rehabilitation services each year. Municipal services in many cities also offer MS patient associations the right to use social facilities. For example, in Bursa, MS patients can use the municipality’s swimming pools and gyms for free on certain days and hours of the week. Municipalities may also provide discounted fares on public transportation.

Social Support and Coping Mechanisms

How do MS patients in Turkey cope with the challenges of living with the condition?

MS patient associations play a crucial role in providing social support. Almost all the associations have MS specialized doctors, nurses, physiotherapists, psychologists as a member of the association supporting activities. These associations often organize events and activities, creating a sense of community and offering emotional support. Also, there are social media accounts and pages of MS patients.

What role do social support networks and community resources play in supporting MS patients in Turkey?

Social support network and patients’ associations activities have a huge positive effect on public awareness. Also, in these activities patients can share experiences, advice, and encouragement, helping them feel less isolated. By utilizing these resources and supports, MS patients in Turkey are better equipped to manage their condition and maintain a higher quality of life. Efforts to increase public awareness about MS help reduce stigma and misconceptions. Educating the public about the nature of MS and its impact can foster a more supportive environment for those living with MS.

How have healthcare providers in Turkey adapted MS management strategies to better align with cultural norms and preferences?

Healthcare providers in Turkey have adapted MS management strategies to better align with cultural norms and preferences in several ways. Healthcare providers have recognized the importance of educating patients and their families about MS, its symptoms, treatment options, and management strategies. They often take a holistic approach to patient care, considering not only the physical aspects of MS but also its emotional, social, and spiritual impact on individuals and families. Family plays a significant role in Turkish culture, though healthcare providers recognize the importance of involving family members in the care and decision-making process for MS patients. They may provide support and education not only to the patient but also to their family members, helping them understand the disease and how they can best support their loved one.

Multiple Sclerosis Management Master program

Why did you choose the Multiple Sclerosis Management Master's program offered by the Charcot Foundation?

MS physicians in Turkey actively conduct research and collaborate with international partners to stay informed about the latest developments in MS management. It was very important for me to adapt evidence-based practices to fit the cultural context and preferences of Turkish patients. Therefore, I thought that the MS master’s program offered a great opportunity for me. It happened just as I thought. I am happy to be in the first group of international MS master program.

What new or in-depth things have you already learned about multiple sclerosis that will benefit your patients?

I had the opportunity to observe that knowledge is universal and that our patients are treated under similar conditions as in developed countries. Explaining this situation to patients firsthand is very reassuring. Patients express their pleasure in learning about my observations in such a comprehensive and international program. And also, we have onsite programs in Dresden, Barcelona and Milan. These are the MS care units that works in a multidisciplinary approach. I realized that we need advanced occupational therapy units in our health care system.

How do you benefit from the international exchange with the lecturers and other study participants?

International exchanges with lecturers and other study participants offer numerous advantages. Some of the benefits include gaining valuable insights and perspectives from individuals with other cultural backgrounds, expanding our global network, and fostering cross-cultural understanding and collaboration.

Participating in interactive classes with world-renowned scientists on MS is a really rewarding experience. The international program includes participants from nations such as Italy, Colombia, Germany, and Belgium. The organization comprises not only physicians with an interest in MS, but also professionals from many disciplines such as psychologists, researchers, and biologists. This enables us to address topics connected to multiple sclerosis from several viewpoints. We have cultivated deep and warm relationships, and we miss the moments we had together.

Quickfire Q&A Session

Complete the sentence: "For me, multiple sclerosis is...."

For me, multiple sclerosis is an act of life serves an opportunity for resilience and growth, fostering strength and empathy through its challenges.

What development would you like to see in the field of multiple sclerosis in the next 5 years?

In the next five years, I would like to see significant advancements in MS research and treatment options. Specifically, I hope for; personalized treatment approaches, improved symptom management (fatigue, pain, cognition), new reliable biomarkers that is noninvasive and cheap, regenerative therapies, equal, enhanced access to care and treatments all over the World, increased empowerment and involvement of MS patients in whole process.

Farewell

Finally, what message of hope or encouragement would you like to share with the listeners?

„Dear MS patients, I wish for you to spend each day with hope and strength. MS may present challenges but remember that your resilience and determination are greater. Together, in solidarity, we can overcome every difficulty. Look to the future with hope, because science and support are advancing every day. You are strong, you are valuable”

How and where can interested people follow your research activities?

I have an Instagram and linked-in account on my name, also with our MS hospital team we have an Instagram page for MS patients: MSYolculugum

Thank you for all your efforts for MS patients and for giving us an insight into the treatment of multiple sclerosis in Turkey.

See you soon and try to make the best out of your life,
Nele

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Nele Handwerker

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I show you how to make the best of your life with MS from family to career to hobbies. Thanks to science and research, a lot is possible nowadays.

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