Jaime Lewis (Host): ​Multiple sclerosis affects over 2.8 million people worldwide, yet many people don't fully understand what this complex neurological condition really is. Here to guide us through the fundamentals is Dr. Ann Cabot, a neurologist with Elliot Health System. Dr. Cabot brings deep expertise in neurological conditions and is dedicated to helping patients and families understand and navigate their MS journey.

This is Elliot Health Talks. I'm your host, Jamie Lewis. Dr. Cabot, welcome to the program.

Dr. Ann Cabot: Thank you so much for having me. It's so fun to be here today.

Host: Well, let's start at the very beginning. Can you explain what multiple sclerosis is in simple terms for our listeners?

Dr. Ann Cabot: Well, yeah, of course. I'd love to make it simple, but honestly, MS is a very complicated disease. So, it is an autoimmune disease, which means the body's own immune system identifies the myelin in the central nervous system as foreign, and then it creates an inflammatory response. So when we tell patients they have an autoimmune disease, that's part of it. And then, there are lots of different autoimmune diseases, and this one in particular focuses on the myelin. Now, the myelin is in the central nervous system, so that's the brain, the optic nerves, and the spinal cord, and it covers all the nerves. So, what happens is there's this autoimmune inflammatory response that attacks the myelin, it can break it down, then there's this period of recovery. But patients may have symptoms referable to those different attacks, wherever they might be in the central nervous system.

Host: And I'm curious, what are those common symptoms that a person might notice?

Dr. Ann Cabot: They are different and unique for almost every patient. So, some of the more common symptoms that we see are things-- you know, especially things that get your attention when you're a patient are especially things like vision. So, some patients might have some double vision or they might have eye pain and blurring of vision.

Another common presenting symptom may be numbness or tingling in the extremities, maybe it starts minimal numbness and tingling. And over some period of time, it may creep up and go up from the feet up to the knees or up to the abdomen. But there are a whole host of different, more subtle symptoms that patients can get that we can certainly dig into a little more later.

Host: Well, I'm wondering also about family history. Is this something that's passed down genetically or can it affect anybody?

Dr. Ann Cabot: So, they've done a lot of research as to what may cause MS. And to be honest, we still don't have an exact pathway. We know a whole lot about different risk factors, and one risk factor is genetics. So like in the general population, the risk of getting a MS is 0.5%, but if you have a parent or, you know, a sibling with MS and your risk is about 1%. So, it definitely increases the predisposition to MS. So, that's a very important question. It's one of the questions, especially a lot of parents ask. "If I have a diagnosis of MS, am I going to pass this on?" And it's not like that direct hereditary type of pathway. It's more of a predisposition that's slightly higher.

Host: Okay. Okay. Well, if somebody suspects that they might have MS, or they're wondering if they can get some more information about it, how does a doctor actually diagnose it? What should the patient expect?

Dr. Ann Cabot: Really, it's all about the types of symptoms a patient is experiencing and then, sitting down with the patient and getting a really good history. So, digging into like, "Well, tell me what, when, where, how. Like, how did your symptoms start? What does it feel like to you?" So, that's really our first step in evaluating patient's symptoms.

The hard part about MS is really the symptoms can be so myriad. You know, sometimes patients have fatigue, which can be caused by so many different medical conditions that it's not very specific. Cognitive issues, again, really hard to pin down. Something like a vision change is a little easier for us because we can sometimes see it or quantify that a little better.

if a patient's having weakness or spasticity, that can also help us when we're trying to figure out where that problem is coming from. So then, what we do is if we're suspicious of the diagnosis of MS, then we'll do some additional tests. One of the first tests that's very helpful for us is imaging. So, we use MRI, and we can get MRI of the brain and the spine to look for, depending on the patient's history and their exam, where we might want to do that MRI. And then, if that's suspicious for MS, there are other tests that we need to do. We need to rule out other diseases. We don't want to tell someone they have MS when they may have something else. So, we do our best to rule out other diseases. And we might also do a lumbar puncture.

So, the things that we really do to help patients confirm a diagnosis is history, exam, imaging with MRI, and labs and lumbar puncture. So, those are really what's in our basket to help us diagnose patients.

Host: Does it make a difference if you catch it earlier versus later?

Dr. Ann Cabot: Yes, definitely. So, studies show that treating MS earlier, patients have a better outcome later on. So, we do like to try to get patients evaluated early in the course of their disease. And we also know that we can get the disease wrong. So, that's another important thing. We don't want to misdiagnose someone. So if we diagnose someone and we follow them, and then it doesn't look like MS either on the imaging or by history or symptoms, then we have to go back to the basics and sort of start all over again.

Host: So if you suspect that you are in the running for MS, definitely get it checked out early.

Dr. Ann Cabot: Absolutely. And the nice thing is it's really a whole team of people that help patients. You know, patients will typically go to their primary care first with their symptoms. They're like the quarterback of your healthcare that really help guide you in where to go. And then, they throw that football to us and they'll send a referral over to Neurology.

And then, what we'll do is really start that process of evaluation. Some patients come already with imaging, they've already had an MRI or maybe they've already seen an ophthalmologist. And some patients are really starting from scratch. But it is good to have an early evaluation whenever you're having neurologic symptoms, to just make sure that you're not missing anything. It's also very reassuring for patients to get worked up to make sure we're not missing a diagnosis of MS.

Host: Well, once somebody gets the diagnosis, what are typical first steps for treatment?

Dr. Ann Cabot: Once we confirm a diagnosis, and the diagnosis, it takes a while sometimes, so we're sort of working hand in hand with the patient. And it's really important to have good communication with your doctor. So, I think that would be one important message. So, using the tools that you have to communicate are really important. A lot of us use the myChart features on your computer. You can call a nurse, you can work with your neurologist, your primary care, but just making sure that you feel educated. So, that's really the most important thing, is to get educated. And then, try to work together to figure out what is the best and safest treatment for you, because everybody's an individual. And then, what we'll want to do is figure out, you know, what other health conditions a patient has, you know, then we'll do labs to see what's safe for the patient, and then we'll initiate treatment if they have the appropriate diagnosis.

Host: before we wrap up, I'm just wanting to think about the progress in this field because I know there was a time when MS, a diagnosis meant one thing. And I think, I suspect it's changed quite a bit over the years. How has your understanding of MS changed in recent years?

Dr. Ann Cabot: Well, I'm smiling when you ask that question, because I've been doing MS for almost 25 years now, and it's absolutely, completely different. I think of the incredible research progress that's happened over the years. You know, not just in medications, but also in symptom management. The imaging just to diagnose a patient, the imaging has improved. We use a lot of advanced techniques now in imaging and the diagnosis and symptom management, even just managing patient's symptoms. So after they're diagnosed, all of that has really improved as well. Most really dramatically, in this field in particular, the number of treatment options we have for patients has dramatically increased. So, that's been really an outstanding thing.

When I think of what we used to do, you know, 20 years ago when you treat a patient and the differences today, like you just think of if I explain to a patient they had MS, now you can go online and you can go to the MS society and you can do research and you feel really connected, and there's all kinds of support groups and resources that we can give patients that are safe and healthy. Back then, we really didn't have a lot of that. So, really, it's a changing time and we've made so much progress. So, it's very optimistic and I think a very exciting field to be in because we're not done. We still have a lot to do. Like when you look at the holistic picture of MS, we still have patients who still have progression of disease despite treatments. And because it's a lifelong condition and you're really working with patients their whole lives, the disease changes as we age. So, a lot of those nuances, like the nuances of the disease, that's really where a lot of the research is right now. So, to say it's been a dramatic change in 20 years is truly an understatement, I think. It's really one of the most exciting and complicated diseases that we get to work with, and I feel very lucky to be helping these patients navigate this.

Host: Well, Dr. Cabot, thanks so much for bringing all your expertise in those 25 years of working with MS to us today.

Dr. Ann Cabot: Thanks so much.

Host: That was Dr. Ann Cabot, a neurologist at Elliot Health System. To learn more about neurological services and MS care at Elliot Health System, visit elliothospital.org and search neurological specialties. If you found this podcast helpful, please share it with someone who might benefit, and don't forget to check out our full library of health-focused episodes. Thanks for listening.