Say “multiple sclerosis” to a person and they are likely to imagine a progressively debilitating condition and a life that is spent, eventually, in a wheelchair. That is far from a certainty, however. The Froedtert & the Medical College of Wisconsin Multiple Sclerosis Clinic offers comprehensive and individualized care to change the outlook for many MS patients.
Ahmed Obeidat, MD, PhD, neurologist and MCW faculty member who is fellowship-trained in MS, responds to questions the medical community might have about MS and how the Froedtert & MCW Multiple Sclerosis Clinic treats it.
How Common Is MS?
MS is relatively common. About 1 million people in the United States live with MS, including more than 20,000 in Wisconsin. The prevalence here is medium to high. Although there is no known cause for MS, people in northern climates are more likely to have it, perhaps because of vitamin D deficiency and low exposure to UVB light. Diet and genetics are also thought to play roles as well as prior exposures to certain common viruses. It seems that it is more of the interaction of these factors than an individual effect of each.
When Does MS Occur?
It typically affects people in the prime of life — the peak ages are 20 to 40. They’re just beginning to live out their dreams and boom! They get this diagnosis. Also, women are two-and-a-half to three times more likely than men to get MS, percentages that are similar to other autoimmune disorders. It’s impactful, affecting family and loved ones as well. MS can happen any time in life after age 10 but rarely beyond 65.
How Is MS Diagnosed?
Diagnosing MS is complex and there is an art to it. The disease itself is highly variable and each patient presents differently. Since no individual test detects MS, we depend on a clinical diagnosis based on a patient’s history, symptoms, results of a brain MRI and sometimes spinal fluid analysis. We have to rule out other conditions that can mimic MS, so it takes a great deal of training and experience to make a correct diagnosis.
What Are You Looking for on an MRI That Indicates MS?
With MS, the body’s immune system attacks the protective myelin sheaths that cover nerve fibers, which produces scarring, or lesions we call scleroses. They appear on MRIs as white spots on specific MRI sequences. We look at the size, locations and morphology of the lesions to tell us whether or not it is MS. Changes caused by other autoimmune diseases and vascular disease may look similar and have to be excluded.
What Conditions Can Mimic MS?
Neuromyelitis optica, MOG antibody-associated disease, sarcoidosis, systemic lupus erythematosus and chronic infections (e.g., HIV or syphilis) are only some of the MS imitators.
How Does MS Affect the Body?
Because MS is a disease of the brain, spinal cord and optic nerves, it affects many of our functions, such as our ability to see, to move arms and legs, to walk or to maintain balance. Symptoms can appear, remit, relapse or become progressively worse. The physical impairments of MS can also impact a patient’s mental health.
How Do You Treat MS?
We have a growing therapeutic profile with more than 16 medications we can use. These often have different mechanisms of action, so finding the right medicine for the patient is a process and an art in itself. Again, experience and training come into play in evaluating a variety of factors, including the effectiveness of the medication, risks and side effects. As of 2019, our therapeutic options increased with two additional medications approved. The MS medications can reduce relapses and MRI disease activity and may slow progression of the disease. We truly tailor treatment to each patient. We also treat symptoms with other medications in collaboration with other specialists as we provide comprehensive care to our patients.
Do MS Patients Receive Treatments Other Than Medications?
Yes, definitely, and that is one of the most important benefits of our Multiple Sclerosis Clinic. We are a comprehensive care center, certified by the National MS Society. That means we address the multiple needs of typical MS patients with a multidisciplinary team of specialists. For instance, when young people are first diagnosed with MS, they may think their life is falling apart and it’s going to destroy their dreams. They can experience a very deep depression, and thoughts of suicide are common. Providing mental health help and psychology treatments are part of our comprehensive care model. We also collaborate with urology specialists who have expertise in managing the urinary issues associated with MS, such as urgency and accidents. People with MS can have mental difficulties with multitasking and information processing, including speed and short-term memory. Our Neuropsychology Department provides testing and guidance on living with these difficulties. We also have neuro-ophthalmologists who specialize in the nerves of the eye and can accurately diagnose and treat the optic inflammation that MS patients can experience. In addition, our neurorehabilitation specialists help our patients with mobility and fine motor needs, along with other needs related to bowel and bladder functions.
Are MS Patients Eligible for Clinical Trials?
Yes. Right now, we’re the Wisconsin site for one of the largest studies in the country investigating two major approaches to therapy — one with higher efficacy, the other with lower efficacy (TREAT-MS). We’re trying to answer the question of whether patients who receive the higher efficacy treatment at the beginning do better and if it is safe for them to do so. We are also the site for several industry-sponsored clinical trials. In addition, we conduct our own studies, including those addressing questions on the immunology and risk factors for MS and integrating technology in our care and assessment of people living with MS. In addition to research studies, we hold grand rounds and case conferences and welcome community physicians to participate.
What Innovative Programs Are Offered?
We are integrating the arts and humanities into our daily care of MS patients. When patients express what they’re feeling through painting, drawing, playing an instrument or writing, this is in itself a healing process. Creative expression also keeps people engaged in their treatment and gives them a sense of achievement. We constantly talk with patients about MS as part of life but not defining life. That’s an important distinction. We encourage patients to live well and live productively. Participating in the arts can provide a meaningful goal.
What Is the Outlook Today for MS Patients?
In older studies, about 20% to 50% of patients progressed to eventually needing a wheelchair for ambulation. We’re seeing less and less of that over the last few years because of new therapies, early diagnosis and a comprehensive treatment approach. Numerous people are now living with MS and you can’t even tell they have MS. Our goal is to slow the disease so there’s no apparent disease activity, no relapses, no changes on their MRIs and no progression or worsening of their disease. If someone does relapse or gets a new lesion, we don’t just observe them. We change their treatment to get them back on track. It’s a dynamic process.
What Results Are You Seeing?
We have seen great and sometimes miraculous recoveries of patients who come into the hospital with very severe cases of MS. They were on ventilators, but we’ve been able to successfully treat them with highly effective medications and utilize a team approach in the hospital and beyond. These patients are now back at home and at work. We know MS, we know immunology and we know how to treat patients safely. What has changed the face of this disease are the therapeutics, primarily medicine driven, but also the comprehensive, multidisciplinary care we provide. It is most important to diagnose MS early, begin these interventions and offer patients a more positive outlook from the start.
