¶ Intro / Opening
Another informational remote.
🎵 Music
Featuring conversations with our physicians and other healthcare providers. Here's Melanie Clinton.
For a person living with MS. Physical wellness can involve so much more than just disease and symptom management. My guest today is Dr. Janadha Avasarala. He's a neurologist with a specialty in MS at UK Health. Dr. Avasarala, I'm so glad to have you with us. We're talking about a really great topic. Tell us what is MS for the people that really don't understand what this is.
¶ Understanding MS: Causes, Symptoms, and Diagnosis
Right. Thanks for having me. Um, multiple sclerosis is a chronic neurological disease of the brain and the spinal cord and it typically affects young individuals and more so women than men. Um, and that's how, you know, one would look at it as a disease.
Do we know what causes MS? Is it an autoimmune disease, doctor? Is it something that if you have family history of autoimmune, tell us a little bit about that?
So MSC is an autoimmune disease, like you pointed out. Um, it's a disease driven by B cells and T cells, which are part of the immune system. Um and a person who has another immune disease can have M S as an additional, I guess, disease affecting the brain or the spinal cord, although it is not necessary to have other diseases.
uh on top of M S. Uh but it does um also go along with, like I said, other autoimmune diseases. To your question about whether family members who have other autoimmune diseases uh and therefore the person of interest with MS would be influenced by other autoimmune diseases in the family is debatable but uh somebody who has a family member with MS obviously has an increased risk of multiple sclerosis. Now keep in mind this is not uh an inherited disease. It's not inheritable.
uh the risk goes up if some of the family members as in um you know, a sibling or parents having the disease or sometimes, you know, a twin having multiple sclerosis and the risk of this other twin who is unaffected, the risk of disease goes up. So
Then let's talk a little bit about diagnosis and symptoms because some of the symptoms might mimic other diseases and it can be hard to diagnose it completely, can't it? Tell us what might someone experience? And at what age might they experience some of those symptoms?
Right, right. Um, so the symptoms can vary. Um, so let's talk about symptoms. So like I said, it could be optic muitis or it could be weakness in your limb. Or it could be a person has weakness in his legs or her legs. It could be a bladder symptom. Sometimes it's sensory, which means tingling and numbness that is persistent.
um that lasts let's say more than a couple of days for example and doesn't go away and it's spontaneous in its onset. I mean it just pops out one day and it just pops up. It's not as if something triggers it. I mean heat can worsen and heat can also bring on a symptom. But typically when the symptoms present, um To your question about confusion in why there is a misdiagnosis or why there is an overlap with other diseases. Uh this is because there are so many neurological diseases
that MS can overlap with. So so for example somebody has acutely sudden onset, for example, some facial tingling and numbness and there is arm weakness or leg weakness That can be part of a stroke, for example. Or for example, something you know, in the setting of somebody who has let's say history of Lyme disease and that person has symptoms that may mimic multiple sclerosis, the question becomes, is this Lyme disease or is this MS? How do we know which is which?
So something that also mimics multiple sclerosis, other diseases like sarcoidosis, vasculitis for example, and other the many, many diseases that produce similar symptoms and it's hard to separate because there's a lot of overlap And one has to be cautious in giving out a diagnosis because there is a strong element of misdiagnosis. And patients also get treated um, you know, for a diagnose, for a presumed diagnosed that I have, and that's that can be an issue as well.
¶ Advances in MS Treatment
So if you do diagnose it, and this is such a big topic, we could really talk about it all day, what is the first line of defense and treatment? Is it about managing the symptoms, managing the medications? Tell us a little bit about treatment.
So treatment um has come a long way. The very first drug uh in terms of F D A approval for multiple sclerosis began in nineteen ninety three there were injectable therapies um that were first introduced into the market and then came the oral medications and now we just uh ballooned into uh much more sophisticated medications that also includes intravenous preparations
uh called monoclonal antibodies. Um and we also have um bone marrow transplantation as part of the therapy that is beginning to uh you know, rise up to uh uh you know you know, it has the potential I guess to become mainstream but it's a few years away, obviously maybe it's a decade away, ten years away and you know, it's tough to estimate that. But Um, MS therapies have come a long way and uh to answer your question about
you know, is it symptom management or is it um trying to uh halt the progression of the disease? Most of the drugs currently that we have in the market and there are two new medications that have also been introduced for uh disability related um concerns with MS Uh most of the drugs uh treat the neuro inflammation. So they treat the inflammatory components.
of the disease primarily and address the disability to a degree. But now there are two new drugs, Mavenclad and Mazan which are designed for secondary progressive multiple sclerosis uh management and these drugs are targeted towards trying to prevent worsening of disability. So whether you treat the inflammatory component or the the disability aspect of the disease
Um, one has to be reminded that these medications do not represent a cure. So the the goal is to stop the disease in its tracks and hold the patient in the functional status with which he or she presents to the doctor. So a person who is walking and presents to me, for example, with multiple sclerosis, I want her to keep walking
twenty, twenty five years from now, meaning the time of the the diagnosis. So the goal is to keep the patient exactly in the physical status with which he or she presents to the doctor. Um although ideally patients want to get back to their basic health status and it may you know may or may not happen in the near future, but uh the primary goal as it stands now is to help the patients remain stable.
Then tell us, doctor, how's the treatment of MS at UK different from other places in Kentucky?
Well, I mean, uh, being a university center we have uh typically we give every medication that is prescribed at any launch. medical center, we have infusions, we have uh uh the latest I guess drugs that are given at any large center. So for example, if you take Stanford um university or picket place, you know, Johns Hopkins, what they give is what they give h what we give here. Um in the private world uh is this being replicated, I guess
uh if there are MS experts in the area which uh I believe there are in Louisville, they might be doing, you know, similar uh I guess approaches. But we at UK have what the rest of the world does. Pretty much what the the rest of the country, the rest of the world does, is what we do. We also have some clinical trials that we are enrolling in, so we are pushing boundaries as far as new medications are concerned. and um I guess, you know, trying to introduce tomorrow's medications, tomorrow's
medicines that would probably be approved in a few years. We also have clinical trials for those type of drugs at UK.
¶ Lifestyle and Wellness with MS
How exciting and what a time to be in this field, Doctor. As we wrap up, research has shown that healthy diet and exercise ongoing preventive care can really help overall health for patients with MS. Speak about really your best advice, but about living a healthy lifestyle, managing expectations, whether they be public perception or mental health or exercise. Tell us a little bit about the lifestyle for someone with MS and what you tell people every day.
Right, right. So um excellent questions all. But I think what I tell my patients is the following. Yeah, of course, like you said, we have medications now. We probably have almost close to twenty or between twenty and twenty two medications now F D A approved uh just for multiple sclerosis. So you know, from nineteen ninety three up until now, there's been a quantum leap in terms of medications that we are able to give. Number one. Number two
lifestyle swimming is the best way to go if you want to be active. In multiple sclerosis with rise in body temperature when a person exercises, even one degree rise in core temperature can have uh an adverse effect on patient symptomatology. So um worsening of symptoms or a new symptom might pop up. So swimming is the best way to do it because the water is cooler and on the person's uh body and then it helps
uh take away the dissipate the heat. Um as far as diet is concerned, uh the usual uh I guess advice that I give is to make sure that the heat no salt and low fat, you know, typically it's almost like a cardiac diet, if you will. What you would tell a cardiac person is what infamous person would do. Um, need a lot of fiber, obviously, keep the balls healthy.
Uh, drink plenty of fluids, make sure that you have no a person doesn't have bladder issues, uh, because bladder issues can be part of MS. So we want to keep them away. Um, and then you know, uh make sure that the patient uh so depression sometimes and fatigue can be issues as well. So we treat them and um you know, if need be and also
getting a good night's sleep. And so general um health related concerns and topics would be how will we tailor uh each person's uh I guess But my theme is to also tell them to check the national MS Society website, uh, because there's lots of information on diet, exercise, well being and also other health groups and uh
you know, who have similar issues and so forth. So these days everything, you know, on the social media, uh, you know, one can be active. There are apps obviously. Galore, uh, can also help patients and uh Uh like I said, you know, if somebody wants to exercise, I tell them again and again to try and enroll themselves in a swimming class or a swimming um exercise program to keep themselves healthy and active.
Well, it's great information. Doctor, thank you so much for coming on, sharing your incredible expertise and explaining this all so very well to us. That wraps up another episode of UK Healthcast with the University of Kentucky Healthcare. Head on over to our website at ukhealthcare.uky.edu for more information and to get connected with one of our providers.
If you found this podcast informative, please share with your friends and family on social media and be sure to check out all the other interesting podcasts in our library. I'm Melanie.