Multiple sclerosis (MS) is a disease that affects the central nervous system. Each person can be affected differently by the disease, with different symptoms that depend on which areas of the nervous system are affected.
Dr. Carolyn Bevan discusses how The Northwestern Medicine Multiple Sclerosis Program offers cutting-edge and compassionate care for patients with MS.
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Understanding Multiple Sclerosis
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Learn more about Carolyn J Bevan, MD, MS
Carolyn J Bevan, MD, MS
Carolyn Bevan, MD, MS, is a board-certified neurologist at Northwestern Memorial Hospital and assistant professor of neurology (MS/neuroimmunology) at Northwestern University Feinberg School of Medicine. Dr. Bevan specializes in patients with inflammatory diseases that affect the brain and spinal cord. Most common conditions she treats include multiple scoliosis, neuromyelitis optica, neurosarcoidosis, myelitis, and autoimmune encephalitis. She holds her medical degree from Dartmouth Geisel School of Medicine and her masters of science degree at the University of Southern California. After completion of medical school, she pursued her fellowship from the University of California San Francisco and finished her residency at Columbia University. In addition, Dr. Bevan has participated in several observational studies in MS, peer-reviewed publications and abstracts. She is also a member of the American Academy of Neurology and National Multiple Sclerosis Society.Learn more about Carolyn J Bevan, MD, MS
Transcription:
Understanding Multiple Sclerosis
Melanie Cole (Host): Welcome. Our topic today is understanding multiple sclerosis, and my guest is Dr. Carolyn Bevan. She’s a neurologist specializing in multiple sclerosis at Northwestern Memorial Hospital. Dr. Bevan, let’s start with a working definition for the listeners. What is MS?
Dr. Carolyn Bevan (Guest): Sure and thank you so much for having me. Multiple sclerosis is a chronic disease where the immune system attacks the myelin, which is the insulated covering of the nerves in the brain and spinal cord. So these attacks cause inflammation and leaves scars in the brain and cord and we can see those on an MRI, and people with multiple sclerosis have neurologic symptoms that can affect their vision, weakness, sensory stuff, balance, bladder, all sorts of things.
Melanie: So then tell us, do we know the cause and also who’s at greatest risk? Are there certain risk factors? Is there a genetic component? So speak about the etiology a little bit and the risk factors.
Dr. Bevan: Sure so we know that multiple sclerosis is a disease that more often affects younger people, so the average age at diagnosis is in the mid-30s and we know that for the most common kind of MS, which is the relapsing kind of MS, women are more often affected than men. There is a small genetic risk with multiple sclerosis; however, the risk gene for multiple sclerosis are really common in the general population, and we know for example that even in monozygotic twins, so twins that have exactly the same DNA, the risk of a twin getting MS, if one of the twins has MS, is only 30%. So that means that there is a big environmental piece to multiple sclerosis and we don’t exactly know what the environmental piece is. We know that some things like low vitamin D, smoking, maybe obesity early in life and possibly even the bacteria that live in our guts may be risk factors for getting multiple sclerosis but there’s no one thing that we know to be the cause of multiple sclerosis.
Melanie: And are there different types?
Dr. Bevan: There are different types of multiple sclerosis. The most common type is this relapsing form of multiple sclerosis where people experience episodes of neurologic symptoms that last for days to weeks and then kind of periods of recovery and that recovery may be complete but they may be left with symptoms from that attack and about 80% to 90% of people with multiple sclerosis have that kind of MS. Then a smaller number, so like 10% to 15% of people will have a form of progressive multiple sclerosis called primary progressive, where instead of having these episodes they have worsening from onset. Just kind of slow over a month to years, and then there’s a third type of MS where people start with a relapsing course and then over long periods of time, like 10 to 20 years after their initial diagnosis, they start to develop a progressive course and that’s called secondary progressive MS.
Melanie: One of the things we heard about over the years, Dr. Bevan, with MS is that it’s so hard to diagnose. Tell us a little bit about some of the red flags, symptoms that would send somebody to see a neurologist in the first place, and then what would you do to diagnose it? How do you figure it out?
Dr. Bevan: So you’re right that MS can be very tricky to diagnose, and MS is a clinical diagnosis first, and what I mean by that is the most important thing that should make a person think about MS are certain symptoms and certain things that we see on the neurologic exam, and so today we are all so focused on different fancy labs and images but at the end of the day, we first and always have to listen to our patients first and understand the symptoms that they’re going through and then do a very careful neurologic exam, and then based on that, then we kind of do the next steps, which is getting MRIs and blood work and sometimes even a spinal tap or a lumbar puncture. So the symptoms that people may have with multiple sclerosis, one of the most common ways that people presented was something called optic neuritis where you may lose vision in one eye with some pain on eye movement that kind of maybe colors look a little bit different out of that eye. It happens over a period of days and then usually gets better. So that’s one way they can present. Often people develop double vision or trouble with balance or coordination. Another type of symptom may involve the spinal cord, and that symptom usually consists of weakness or numbness that’s usually more on one side than the other. Sometimes people may have trouble walking or trouble with their bowels or bladder, and then there are other symptoms that people with multiple sclerosis may deal with that are a little less specific for multiple sclerosis like things like fatigue for example, trouble with their memory, concentration, or attention. So there are a lot of symptoms and many of them are not specific for multiple sclerosis, so that’s why we have to put the whole picture together.
Melanie: So since multiple sclerosis is not curable, correct? It’s mostly about managing the symptoms, managing or slowing down the progression. There’s so many promising new therapies. Speak about how it’s treated and managing the many medications that someone with MS might have to take. What do you tell them about dealing with it day by day?
Dr. Bevan: Yeah so you’re right there are a lot of medications and a lot of different types of medications that we use to help a person with multiple sclerosis. The one category of treatment is the preventive therapies and we call these the disease modifying therapies. These therapies change how the immune system works. They prevent relapses and they prevent new lesions from forming on the brain MRI. There are many different kinds of them. Most of them are approved for relapsing multiple sclerosis. There are injectables, there are pills, there are IV infusion, and they all have different efficacy and different safety profile. So that’s one category. These therapies do not reverse the symptoms though of attacks that people may have had in the past, so there is another important category of treatment, which is the symptomatic treatment, and so people with multiple sclerosis may have nerve pain, they may have spasms, they may have bladder problems, fatigue and we have many different treatment options to just help them manage those symptoms. That’s always important to remember that prevention isn’t the only part of multiple sclerosis. And then there’s another category for people who are having relapses, so like you said there’s not a cure and some of our more modern disease modifying therapies are very effective, but nothing is 100% effective, so even people on these modifying therapies may still experience attacks and some of those people experiencing attacks may require treatment with drugs called corticosteroids, most commonly Solu-Medrol by IV for very short courses of three to five days just to help speed up recovery from attacks, so that’s a different category of treatment, and of course we always emphasize diet and lifestyle changes, so exercise, nutrition and general self care are so important for people with multiple sclerosis, and then also we have our future goals for treatment. So this is – of course we want better treatment for people with progressive multiple sclerosis and we also want to develop strategies for remyelination and repair.
Melanie: Is that where you see the future going? Give us a little blueprint of where you see the future because, as you’ve discussed Dr. Bevan, the different medications and modifying the disease course, there’s injectables and there’s orals, there’s infused medications and it’s a lot to take in. It’s a lot for people to try and understand where do you see the future going for this?
Dr. Bevan: It is so much information to take in, and I think that is one of the biggest challenges of helping a person with multiple sclerosis who is newly diagnosed. It’s just taking in all of the information at hand. I think right now we have some very highly effective treatment for relapsing multiple sclerosis, but we have just such few options for people with progressive multiple sclerosis and I think that is a very important goal of the future, and I think we are getting there. There are promising trials that suggest that there are medications in the pipelines for people with progressive MS that may provide some meaningful benefit, and the other part of it is reversing the damage that has already been done. Whether that’s by stimulating the stem cells that we have in our bodies to help repair or rewrap myelin around those nerves or finding other ways to reroute around areas of injury so that people with multiple sclerosis can have less symptoms and better function and better quality of life, and of course the goal then future that we all hope for one day is a cure.
Melanie: Certainly and it’s such great information. Dr. Bevan wrap it up for us. What you would like people who have MS or listeners who know someone or have a loved one about looking forward to the future and your best advice for living that healthy lifestyle even with MS.
Dr. Bevan: So multiple sclerosis is a disease that affects people who are young who have families and careers and we live in a time where there is so much hope. So even though it can be an overwhelming thing to be diagnosed with multiple sclerosis, there are so many options for treatment and for management so I would encourage people who are living with multiple sclerosis to reach out to a neurologist and allow themselves to rely on the support and love of their family and friends as they deal with this diagnosis, but there is a lot of hope now and I think the goal that we all have is to support people with multiple sclerosis to live their best life and fulfill all the goals that they have regardless of their diagnosis.
Melanie: What a wonderful outlook you have and I can hear the passion in your voice, Dr. Bevan, for this particular disorder that you work so hard to help people with. Thank you again for joining us today and for sharing your expertise, explaining all of this because it can be quite confusing. Thanks again. You’re listening to Northwestern Medicine Podtalk. For more information on the latest advances in medicine, please visit nm.org, that’s nm.org. I’m Melanie Cole, thanks so much for tuning in.
Understanding Multiple Sclerosis
Melanie Cole (Host): Welcome. Our topic today is understanding multiple sclerosis, and my guest is Dr. Carolyn Bevan. She’s a neurologist specializing in multiple sclerosis at Northwestern Memorial Hospital. Dr. Bevan, let’s start with a working definition for the listeners. What is MS?
Dr. Carolyn Bevan (Guest): Sure and thank you so much for having me. Multiple sclerosis is a chronic disease where the immune system attacks the myelin, which is the insulated covering of the nerves in the brain and spinal cord. So these attacks cause inflammation and leaves scars in the brain and cord and we can see those on an MRI, and people with multiple sclerosis have neurologic symptoms that can affect their vision, weakness, sensory stuff, balance, bladder, all sorts of things.
Melanie: So then tell us, do we know the cause and also who’s at greatest risk? Are there certain risk factors? Is there a genetic component? So speak about the etiology a little bit and the risk factors.
Dr. Bevan: Sure so we know that multiple sclerosis is a disease that more often affects younger people, so the average age at diagnosis is in the mid-30s and we know that for the most common kind of MS, which is the relapsing kind of MS, women are more often affected than men. There is a small genetic risk with multiple sclerosis; however, the risk gene for multiple sclerosis are really common in the general population, and we know for example that even in monozygotic twins, so twins that have exactly the same DNA, the risk of a twin getting MS, if one of the twins has MS, is only 30%. So that means that there is a big environmental piece to multiple sclerosis and we don’t exactly know what the environmental piece is. We know that some things like low vitamin D, smoking, maybe obesity early in life and possibly even the bacteria that live in our guts may be risk factors for getting multiple sclerosis but there’s no one thing that we know to be the cause of multiple sclerosis.
Melanie: And are there different types?
Dr. Bevan: There are different types of multiple sclerosis. The most common type is this relapsing form of multiple sclerosis where people experience episodes of neurologic symptoms that last for days to weeks and then kind of periods of recovery and that recovery may be complete but they may be left with symptoms from that attack and about 80% to 90% of people with multiple sclerosis have that kind of MS. Then a smaller number, so like 10% to 15% of people will have a form of progressive multiple sclerosis called primary progressive, where instead of having these episodes they have worsening from onset. Just kind of slow over a month to years, and then there’s a third type of MS where people start with a relapsing course and then over long periods of time, like 10 to 20 years after their initial diagnosis, they start to develop a progressive course and that’s called secondary progressive MS.
Melanie: One of the things we heard about over the years, Dr. Bevan, with MS is that it’s so hard to diagnose. Tell us a little bit about some of the red flags, symptoms that would send somebody to see a neurologist in the first place, and then what would you do to diagnose it? How do you figure it out?
Dr. Bevan: So you’re right that MS can be very tricky to diagnose, and MS is a clinical diagnosis first, and what I mean by that is the most important thing that should make a person think about MS are certain symptoms and certain things that we see on the neurologic exam, and so today we are all so focused on different fancy labs and images but at the end of the day, we first and always have to listen to our patients first and understand the symptoms that they’re going through and then do a very careful neurologic exam, and then based on that, then we kind of do the next steps, which is getting MRIs and blood work and sometimes even a spinal tap or a lumbar puncture. So the symptoms that people may have with multiple sclerosis, one of the most common ways that people presented was something called optic neuritis where you may lose vision in one eye with some pain on eye movement that kind of maybe colors look a little bit different out of that eye. It happens over a period of days and then usually gets better. So that’s one way they can present. Often people develop double vision or trouble with balance or coordination. Another type of symptom may involve the spinal cord, and that symptom usually consists of weakness or numbness that’s usually more on one side than the other. Sometimes people may have trouble walking or trouble with their bowels or bladder, and then there are other symptoms that people with multiple sclerosis may deal with that are a little less specific for multiple sclerosis like things like fatigue for example, trouble with their memory, concentration, or attention. So there are a lot of symptoms and many of them are not specific for multiple sclerosis, so that’s why we have to put the whole picture together.
Melanie: So since multiple sclerosis is not curable, correct? It’s mostly about managing the symptoms, managing or slowing down the progression. There’s so many promising new therapies. Speak about how it’s treated and managing the many medications that someone with MS might have to take. What do you tell them about dealing with it day by day?
Dr. Bevan: Yeah so you’re right there are a lot of medications and a lot of different types of medications that we use to help a person with multiple sclerosis. The one category of treatment is the preventive therapies and we call these the disease modifying therapies. These therapies change how the immune system works. They prevent relapses and they prevent new lesions from forming on the brain MRI. There are many different kinds of them. Most of them are approved for relapsing multiple sclerosis. There are injectables, there are pills, there are IV infusion, and they all have different efficacy and different safety profile. So that’s one category. These therapies do not reverse the symptoms though of attacks that people may have had in the past, so there is another important category of treatment, which is the symptomatic treatment, and so people with multiple sclerosis may have nerve pain, they may have spasms, they may have bladder problems, fatigue and we have many different treatment options to just help them manage those symptoms. That’s always important to remember that prevention isn’t the only part of multiple sclerosis. And then there’s another category for people who are having relapses, so like you said there’s not a cure and some of our more modern disease modifying therapies are very effective, but nothing is 100% effective, so even people on these modifying therapies may still experience attacks and some of those people experiencing attacks may require treatment with drugs called corticosteroids, most commonly Solu-Medrol by IV for very short courses of three to five days just to help speed up recovery from attacks, so that’s a different category of treatment, and of course we always emphasize diet and lifestyle changes, so exercise, nutrition and general self care are so important for people with multiple sclerosis, and then also we have our future goals for treatment. So this is – of course we want better treatment for people with progressive multiple sclerosis and we also want to develop strategies for remyelination and repair.
Melanie: Is that where you see the future going? Give us a little blueprint of where you see the future because, as you’ve discussed Dr. Bevan, the different medications and modifying the disease course, there’s injectables and there’s orals, there’s infused medications and it’s a lot to take in. It’s a lot for people to try and understand where do you see the future going for this?
Dr. Bevan: It is so much information to take in, and I think that is one of the biggest challenges of helping a person with multiple sclerosis who is newly diagnosed. It’s just taking in all of the information at hand. I think right now we have some very highly effective treatment for relapsing multiple sclerosis, but we have just such few options for people with progressive multiple sclerosis and I think that is a very important goal of the future, and I think we are getting there. There are promising trials that suggest that there are medications in the pipelines for people with progressive MS that may provide some meaningful benefit, and the other part of it is reversing the damage that has already been done. Whether that’s by stimulating the stem cells that we have in our bodies to help repair or rewrap myelin around those nerves or finding other ways to reroute around areas of injury so that people with multiple sclerosis can have less symptoms and better function and better quality of life, and of course the goal then future that we all hope for one day is a cure.
Melanie: Certainly and it’s such great information. Dr. Bevan wrap it up for us. What you would like people who have MS or listeners who know someone or have a loved one about looking forward to the future and your best advice for living that healthy lifestyle even with MS.
Dr. Bevan: So multiple sclerosis is a disease that affects people who are young who have families and careers and we live in a time where there is so much hope. So even though it can be an overwhelming thing to be diagnosed with multiple sclerosis, there are so many options for treatment and for management so I would encourage people who are living with multiple sclerosis to reach out to a neurologist and allow themselves to rely on the support and love of their family and friends as they deal with this diagnosis, but there is a lot of hope now and I think the goal that we all have is to support people with multiple sclerosis to live their best life and fulfill all the goals that they have regardless of their diagnosis.
Melanie: What a wonderful outlook you have and I can hear the passion in your voice, Dr. Bevan, for this particular disorder that you work so hard to help people with. Thank you again for joining us today and for sharing your expertise, explaining all of this because it can be quite confusing. Thanks again. You’re listening to Northwestern Medicine Podtalk. For more information on the latest advances in medicine, please visit nm.org, that’s nm.org. I’m Melanie Cole, thanks so much for tuning in.