Maggie McKay (Host): You may know someone with MS or multiple sclerosis. But would you know what to do if your immune system backfired? We'll find out more about that and multiple sclerosis with neurologist, Dr. Cindy Joseph.

Welcome to Putting Your Health First, presented by Health First. I'm your host, Maggie McKay. Welcome, Dr. Joseph. Thank you so much for being here. Would you please introduce yourself?

Dr. Cindy Joseph: I'm Dr. Cindy Joseph. I'm a neurologist here at Health First. I am happy to be here and to do this interview with you.

Host: Thank you so much for your time. I know as a neurologist there are many neurological conditions you must treat. Can you give me a brief overview of the most common conditions?

Dr. Cindy Joseph: Some of the common ones I see in clinic from day to day are Parkinson's disease, Alzheimer's disease, headache and various headache syndromes, post-concussive syndrome, epilepsy and seizures, myasthenia gravis and, of course, MS, also known as multiple sclerosis.

Host: Well, that covers a lot. One of the areas you specialize in treating is multiple sclerosis, as you just said. What is multiple sclerosis?

Dr. Cindy Joseph: So, MS is an autoimmune disorder. Usually, the immune system defends her body against infection and disease. However, in autoimmune disease, there is a disturbance in this, and the immune system can't differentiate between healthy and harmful tissue. In MS, the targets of this disturbance is the brain and spinal cord tissue. Depending on where the attack is, it can lead to various signs and symptoms of MS.

Host: What causes multiple sclerosis?

Dr. Cindy Joseph: So in terms of what causes multiple sclerosis, we're not exactly sure. It's unclear though why some people develop MS and others don't. It's probably a combination of genetic and environmental factors.

Host: What are the signs and symptoms of MS? And some of the symptoms, do they start to show earlier than others?

Dr. Cindy Joseph: So, some common symptoms include tingling and weakness on either side of the body, difficulty with coordination, imbalance, falls, visual disturbance and pain with eye movement, fatigue, slurred speech; and there is a symptom in MS if it affects the spinal cord when you bring your chin to your chest, you can get an electric shock down your spine, this is a pretty classic symptom of MS; urinary urgency or incontinence. And in general, MS patients don't do well with excessive heat. With higher temperatures, it can bring back old MS symptoms and signs. This is known as Uhthoff's phenomena. In terms of which of these appears earliest, it just depends on which part of the brain or spinal cord is affected first.

Host: Are there risk factors associated with MS?

Dr. Cindy Joseph: Tobacco use and obesity have been associated with MS. Vitamin D is actually protective, so places that are further from the equator where you don't get as much vitamin D has a higher risk of getting MS. There are some theories of prior infections, particularly the Epstein-Barr infection can increase your chances of getting MS. And just being in the correct age range of 20 to 50, where MS commonly attacks is a risk factor for MS. There's also a predominance in female patients as well.

Host: Are there different types of MS?

Dr. Cindy Joseph: Yeah. There's a few different types. The most common type is a relapsing form of MS. About 85% of patients who have MS do have this type. And this type of MS is characterized by periods of exacerbation, followed by complete improvement. If this form becomes more progressive in which they are exacerbations, but without complete improvement back to baseline, it becomes known as secondary progressive. The third type is known as primary progressive. What this entails is that there is a progressive decline in patients' function and as well as increased symptoms. A very small percentage, about 15% of those with MS, have this form.

Host: Dr. Joseph, how is MS diagnosed?

Dr. Cindy Joseph: So, MS is diagnosed primarily on the patient's history, so what they come into the office and tell you what their symptoms are. And then, we also use MRI to help support the diagnosis. There's characteristic MS plaques in the brain and spinal cord that we can see on MRI. Sometimes a spinal tap is done to check for certain elements, which can further help support the diagnosis.

Host: So, you've been diagnosed with multiple sclerosis. What's next as far as treatment?

Dr. Cindy Joseph: So, treatment has exploded in the last few years. MS is treated primarily through immunomodulating medications. Originally, about 20 years ago, we just had a few and they were the in injectable medications. However, over the last 10 years, there's an increase of over 20 medications or so, and we also have oral and infusions, so lots of options for MS patients. All these medications work by helping decreasing the hyperactive immune system that occurs with MS. For acute attacks or exacerbations, steroids can be used for about three to five days, and this can help speed the recovery of symptoms.

Host: I am already learning so much that I have never heard before, doctor. We're starting to hear more and more about multiple sclerosis with the recent diagnoses of actresses like Selma Blair and Christina Applegate. Is MS more prevalent in our world now than ever before?

Dr. Cindy Joseph: So, I don't think it's necessarily more prevalent than it was before, but I do think it's being diagnosed more frequently and more often. The awareness of MS has increased over the years and people have better access to doctors and healthcare, and this leads to a more prompt diagnosis. So, it's not really being more prevalent, it's more that it's being diagnosed more efficiently.

Host: And Dr. Joseph is MS hereditary?

Dr. Cindy Joseph: It's not hereditary in the sense that it's not passed on from parent to offspring or generation to generation. However, there are certain DNA mutations that could possibly increase the risk of getting MS, but it's probably this combined with various environmental factors that increases one risk of getting MS.

Host: So, is there testing available to identify genetic markers for MS?

Dr. Cindy Joseph: Unfortunately, currently, there's not. It's not typically used in day-to-day practice. We don't do that here at Health First. It's sometimes used in investigational and clinical trials, but not day-to-day in diagnosing MS.

Host: Are there medications or lifestyle changes that are recommended to be proactive against MS? I mean, you mentioned obesity and smoking, but what else?

Dr. Cindy Joseph: Yeah. There's tons of things you can do. So, some of the things you can do to reduce your chances of getting MS is keeping an optimal BMI, like we discussed; getting adequate vitamin D either through diet or just by going outside, avoiding or stopping tobacco use, exercising and eating a healthy balanced diet.

Host: How does multiple sclerosis affect someone's life expectancy and their quality of life? Is there hope for having a normal life?

Dr. Cindy Joseph: Yes, absolutely. With the current advances, the prognosis for MS can be very excellent. As previously discussed, the amount of treatments available now for MS has increased exponentially, and there's still a lot of undergoing investigational trials, so the treatments are only going to increase in the future, I think. The outlook currently is more promising than it's ever been. It's important though to catch MS early so that treatment can be started early too. This would offer the best prognosis.

Host: Is there currently a cure for MS?

Dr. Cindy Joseph: Unfortunately, there is not a cure for MS currently. The treatments we have help suppress a hyperimmune response associated with MS, but it's not really a cure. However, with all the recent advances in MS, the prognosis can still be very favorable, especially if caught early on. This is why it's important to go see your doctor if you think you have any of the signs or symptoms of MS so you can be diagnosed early and treated as early as possible.

Host: Is there anything else you'd like to add in closing that you'd like people to know about multiple sclerosis?

Dr. Cindy Joseph: Just that the outlook, you know, is very promising currently. And if you're going to have MS, right now is a great time to have it. In general, MS isn't the horrible disease that we used to think it was. There are so many different options for treatment, so many more than we've ever had before. And if you think you have any, signs or symptoms of MS to go see your doctor so you can be evaluated and started on treatment early.

Host: Thank you so much for your time and sharing your expertise on multiple sclerosis and helping us to better understand it. We appreciate it.

Dr. Cindy Joseph: Thank you. I was happy to be here.

Host: Again, that's Dr. Cindy Joseph. To find out more, or if you'd like to speak with your doctor about multiple sclerosis, schedule an appointment today at hf.org/schedule or call 321-434-3131. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Putting Your Health First, a podcast from Health First. Thank you for listening.