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Apr 12 2022 MS Living Well Podcast: Aging and Multiple Sclerosis

Image: Maria Lupan on Unsplash

Our immune systems become less robust as we age. With an autoimmune disease such as multiple sclerosis, a weakened immune system can lead to less relapses and active MRI lesions.  However, many people living with multiple sclerosis develop progressive disease with worsening physical and cognitive disability as they age. Strategies to live better with MS as one grows older are shared.

The vast majority of treatments for multiple sclerosis have been studied in people 55 years of age or younger. However, 46% of people living with MS are older than age 55.  New studies are answering important questions about MS treatment in older patients. At what age, can treatment safely be stopped without risk of relapse or worsening disability? Safety concerns such as serious infections, cancer risk and immunization responsiveness in older MS patients on immunosuppressive treatments are addressed.

Season 4 MS Living Well podcast is sponsored by Octave.

Barry Singer MD, director of The MS Center for Innovations in Care, interviews:

Bianca Weinstock-Guttman MD

Bianca Weinstock-Guttman MD is a Professor of Neurology at the Jacobs School of Medicine & Biomedical Sciences in Buffalo, New York. She is the Director of the Jacobs MS Center for Treatment and Research since 2002. Dr. Weinstock-Guttman competed a fellowship in neuroimmunology at the Cleveland Clinic. She serves as executive director of the New York State Multiple Sclerosis Consortium.

John Corboy MD

John Corboy MD is a Professor of Neurology at the University of Colorado Denver, School of Medicine and Co-Director of the Rocky Mountain MS Center.  Dr. Corboy did his undergraduate, medical school, and Neurology training at the University of Pennsylvania, and completed his postdoctoral fellowship at John Hopkins. In 1997, he founded the University of Colorado Multiple Sclerosis Center, and has built it into a multidisciplinary group offering state-of-the-art care and research to MS patients.

 

Mar 29 2022 MS Living Well Podcast: Diet & Multiple Sclerosis

Photo: Louis Hansel on Unsplash

Trying to figure out the ideal diet for multiple sclerosis? Two of the leading experts on diet and multiple sclerosis share our current understanding based on the latest research. Diets reviewed include intermittent fasting, Swank diet, Wahls protocol and Mediterranean diet. The role of the gut organisms, called the microbiome, on immune health explained.

In-depth information highlighted how certain foods affect people living with multiple sclerosis. Specifically dairy, gluten, polyunsaturated fats, fruits, vegetables, salt, vitamins and supplements are covered.  Dr. Ellen Mowery and Dr. Ilana Katz Sand also discuss how they counsel their own MS patients on diet.

Season 4 MS Living Well podcast is sponsored by Octave.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Ellen Mowry MD

Ellen Mowry MD is a Professor of Neurology and Epidemiology at Johns Hopkins University. Dr. Mowry also co-directs the Johns Hopkins MS Precision Medicine Center of Excellence. She completed her undergraduate degree Georgetown University and medical school at the University of Rochester. After finishing her neurology residency at the University of Pennsylvania, she completed a fellowship in multiple sclerosis and master’s degree in clinical research at the University of California San Francisco. Her research focuses on environmental factors that influence the risk and prognosis of multiple sclerosis.

Ilana Katz Sand MD

Ilana Katz Sand MD is an Associate Professor of Neurology at the Icahn School of Medicine at Mount Sinai and on staff at the Corinne Goldsmith Dickinson Center for MS in New York City. She attended college at University of Pennsylvania and medical school at Columbia University College of Physicians and Surgeons. She completed her neurology residency at Columbia University followed by a fellowship at Mount Sinai and joined the faculty at Mount Sinai following completion of her fellowship in 2013. One of main areas of her research is the role of diet in MS.

Jan 25 2022 MS Living Well Podcast: Multiple Sclerosis: Cause & Cure

EBV or Epstein-Barr virus causes MS based on new research. Image: iStock

The Epstein-Barr virus (EBV) causes multiple sclerosis based on a new monumental study in young adults serving on active duty in the US military.  The risk of developing MS increased 32-fold after infection with the Epstein-Barr virus. EBV causes infectious mononucleosis, spreads through saliva and infects B immune cells.

Alberto Ascherio MD DrPH from Harvard T.H. Chan School of Public Health shares on the podcast his group’s recent findings published in Science.  Epstein-Barr virus treatments in clinical trials reviewed including vaccination studies with the goals of stopping disease progression and preventing MS from ever occurring. The impact of vitamin D, smoking and childhood obesity on the risk of developing multiple sclerosis is reviewed.

Howard Weiner MD, Harvard Professor of Neurology, Director and Founder of the Partners Multiple Sclerosis Center, details the genetic risk factors for developing multiple sclerosis such as human leukocyte antigen (HLA) and risks of passing the disease onto children.  The role of gut organisms, known as the microbiome, in both potentially causing multiple sclerosis and protecting people with the disease is explored. Strategies for a multiple sclerosis cure are highlighted.

Barry Singer MD, Director of the MS Center for Innovations in Care, interviews:

Howard Weiner MD

Howard L. Weiner MD is the Robert L. Kroc Professor of Neurology at the Harvard Medical School, where is has been on faculty since 1976. He is the Director and Founder of the Partners Multiple Sclerosis Center as well as the Co-Director of the Center for Neurologic Diseases at the Brigham & Women’s Hospital in Boston. In 2007, Dr. Weiner received the prestigious John Dystel prize for Multiple Sclerosis Research awarded by the American Academy of Neurology. He is also a film writer, director and author. Dr. Weiner is the author of “Curing MS.” His latest book is “The Brain Under Siege: Solving the Mystery of Brain Disease, and How Scientists are Following the Clues to a Cure.”

Alberto Ascherio MD DrPH

Alberto Ascherio MD DrPH is Professor of Epidemiology & Nutrition at the Harvard Chan School of Public Health. Dr. Ascherio obtained his medical degree at the University of Milan in 1978. He practiced medicine and public health in Latin America and Africa for several years and then moved to Boston, where he received a doctoral degree in epidemiology from Harvard in 1992 and then joined the faculty.  His research group focuses on identifying causes, risk factors and biomarkers of susceptibility and early diagnosis of multiple sclerosis including key research on Epstein-Barr virus and vitamin D.

Season 4 MS Living Well podcast is sponsored by Octave.

 

Nov 27 2021 COVID-19 & MS Treatment: The Long Game

Image: Rawpixel

Omicron variant of the SARS-CoV-2 virus that causes COVID-19 is now taking off in South Africa with scattered cases already in Europe. With over 30 mutations to the spike protein on the surface of the virus, unanswered questions arise. Will the vaccines still be protective? Is this version of the virus more infectious and more lethal? Africa was vulnerable due to only 6% of the population being vaccinated due to global health disparities.

People living with multiple sclerosis deserve highly-effective therapy, which has been shown to prevent future physical and cognitive disability. Many of these medications that prevent the autoimmune attack on the brain and cervical spine are immunosuppressive. Under normal circumstances, the benefits generally outweigh the risks.  During the COVID-19 pandemic, individuals on immunosuppressive MS disease-modifying therapies have had to be extra careful to avoid infection and may be at risk for more serious COVID-19. It’s been a substantial sacrifice for them; missing out on some family gatherings, limited time with friends, remote work or high-risk exposure at work and avoiding critical exercise at classes, gym or the pool. Anxiety and depression in the MS community has been very high during the pandemic.

Sacrifice for 2 years is hard enough, but what if COVID-19 doesn’t go away? COVID-19 could stay around as an “endemic” disease. The best case scenario is that enough people become vaccinated (with regular boosters) or infected naturally that there will be a dramatic decrease in cases over the coming years. An influenza A virus H1N1 caused the 1918 Spanish flu, killing 50 million people globally. Influenza viruses are still around, resulting in 20-60,000 American deaths annually.  However, flu vaccines are not nearly as protective as COVID-19 vaccines and new and emerging treatments for COVID-19 are quite effective.

At some point, each person with multiple sclerosis will need to make a calculated decision with their healthcare providers about their future treatment strategy. I anticipate most people would rather adapt their lifestyle so they can continue on highly effective treatment to prevent future physical and cognitive impairment. Other people living with multiple sclerosis may prefer de-escalation of treatment, using a medication that may be less effective but less or not immunosuppressive. Induction therapy might also become more attractive with temporary immunosuppression followed by “rebooting” the immune system such as with Mavenclad or Lemtrada.  Risk factors for worse COVID-19 disease will need to be considered such as older age and other medical problems like hypertension.

The bottom line:  We will get through this challenging time together as a MS community with open communication between those of you living with multiple sclerosis and the healthcare professionals that show up in a mask everyday to care for you.

Oct 14 2021 MS Living Well Podcast: Multiple Sclerosis Clinical Trials

Image: Rawpixel

Interested in improving MS care? Participating in a clinical trial may have personal advantages and may help others in the future. Trial design discussed including whether or not a placebo (no treatment) will be used. Criteria needed to enroll in a clinical study called inclusion and exclusion criteria explained. Key elements of clinical trials outlined including multiple safety measures and informed consent.

Current clinical trials in multiple sclerosis are covered including using highly effective treatment early for someone living with multiple sclerosis. Current studies in progressive MS and remyelination shared. Compounds highlighted include BTK inhibitors, masitinib, ibudilast, simvastatin and gold nanocrystals.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Jiwon Oh MD PhD

Jiwon Oh MD PhD is the Director of the BARLO MS Centre at St. Michael’s Hospital in Toronto. She is an Associate Professor of Neurology University of Toronto. Dr. Oh’s research focuses on developing advanced imaging techniques of the spinal cord and brain for use in clinical settings. She is the principal investigator  of local and collaborative, multi-center MRI studies. Dr. Oh is the lead of the Canadian National Progression Cohort, which is focused on better understanding progression in MS.  She completed her undergraduate degree at the University of Toronto and medical school from Queen’s University. Dr. Oh completed her residency at the University of Toronto, PhD in Public Health at John Hopkins and neuroimmunology fellowship at John Hopkins.

Robert Bermel MD

Robert Bermel MD is a neurologist specializing in multiple sclerosis at the Mellen Center for Multiple Sclerosis at Cleveland Clinic. He received a medical degree with thesis honors from the State University of New York at Buffalo. Dr. Bermel completed his neurology residency training and served as Chief Resident at Cleveland Clinic. He was funded as a National MS Society postdoctoral fellow in clinical neuroimmunology and advanced imaging at Cleveland Clinic. Dr. Bermel cares for patients, conducts imaging research, and an investigator in multiple clinical trials at the Mellen Center. His current research interests focus on the identification of advanced imaging methods to evaluate and improve recovery from inflammatory demyelinating disease.

This specific episode is sponsored by Sanofi Genzyme.

 

Apr 6 2021 MS Living Well Podcast: Future Look: From Diagnosis to Tracking Multiple Sclerosis

Image: Rawpixel

Cutting-edge research is revolutionizing how multiple sclerosis is diagnosed and monitored.  The central vein sign on MRI may soon be a key way of confirming if someone has multiple sclerosis versus other conditions such as migraine, vasculitis, neurosarcoidosis and blockage of small blood vessels (from age, smoking and hypertension).

Multiple sclerosis lesions with visible dark veins inside, called Central Vein Sign. Image: Daniel Reich MD PhD

Early clues on MRI imaging are shared in people with evidence of MS prior to developing symptoms (called radiologically isolated syndrome or RIS). New imaging techniques in development visualize changes in progressive multiple sclerosis like slowly-expanding lesions and inflammatory cells called microglia.  Dr. Daniel Reich from the NIH covers additional topics from routine MRI monitoring of the brain and spinal cord to remyelination imaging.

With incredible medical advances, some people that were considered to have multiple sclerosis are now diagnosed with neuromyelitis optica (NMO) and MOG Antibody Disease (MOGAD).  Dr. Sean Pittock from Mayo Clinic shares how NMO and MOGAD are different from multiple sclerosis and reviews the alternate approaches to treatment including the 3 FDA-approved treatments for NMO, Soliris (eculizumab), Uplinza (inebilizumab) and Enspyrng (satralizumab).  Latest research in screening spinal fluid and blood for clues of multiple sclerosis discussed to improve diagnosis and monitoring of the disease.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Daniel Reich MD PhD

Daniel Reich MD PhD is the Chief of the Translational Neuroradiology Section of the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH).  He obtained his undergraduate degree in math and physics at Yale, PhD in neuroscience at The Rockefeller University and MD degree at Cornell.  Dr. Reich completed residencies in both neurology and diagnostic radiology and a neuroradiology fellowship at John Hopkins Hospital.

Sean Pittock MD

Sean Pittock MD is a Professor of Neurology at Mayo Clinic.  His is the Director of Mayo Clinic’s Center for Multiple Sclerosis and Autoimmune Neurology and Director of Mayo’s Neuroimmunology Research Laboratory. He earned his medical degree from University College Dublin, post-doctoral degree at the Royal College of Surgeons in Ireland followed by residency and fellowship at Mayo Clinic in Rochester, Minnesota.

Mar 23 2021 MS Living Well Podcast: Wellness & Multiple Sclerosis

Image: Rawpixel

Wellness is a proactive approach to living with multiple sclerosis. Wellness complements routine neurological care, which is often reactive to new relapses, symptoms and disease progression.  Nutrition reviewed including diets such as intermittent fasting, paleo and Wahls Protocol.  Great physical health relies on keeping up with routine cancer screenings and vaccinations. Options for protecting cognitive health and improving mental health are highlighted. Ways to improve social and spiritual connections are shared.

Successful exercise strategies presented for an array of MS disability levels.  Information given on how to balance the need for increased muscle strength with concerns of overexertion and fatigue. The role of physical, occupational and speech therapy for people with MS reviewed.  The latest and future technology explored including zero-gravity treadmills, electronic foot braces, robotic exoskeletons and implantable microstimulators.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Riley Bove MD is an Assistant Professor of Neurology at the University of California-San Francisco.  Her multiple sclerosis research focuses on hormones and digital medicine. Dr. Bove started her studies in anthropology at Harvard and then global studies on a Fulbright scholarship. She returned to Harvard for medical school and then completed her residency at Massachusetts General Hospital and Brigham Women’s hospital in Boston.  She completed a clinical research fellowship at the Partners MS Center and a Masters Degree through Harvard Medical School’s Clinical Investigator Training Program.

Ben Thrower MD is the medical director of the Andrew C. Carlos MS Institute at Shepherd Center, a leading rehabilitation hospital in Atlanta. He completed his medical degree at University of Florida and neurology residency at the University of Texas in San Antonio. Dr. Thrower is a Clinical Instructor of Neurology at Emory University and participates actively in clinical research. He serves on the board of directors of the Georgia Chapter of the National MS Society and has served on the board for the Consortium of Multiple Sclerosis Centers. In 2005, he was the first physician inductee into the Georgia Chapter of the National MS Society Volunteer Hall of Fame.

Mar 19 2021 Ponvory (ponesimod) FDA approved!

Ponvory (ponesimod) is an oral S1P1 medication which traps certain causes types of lymphocytes (a type of white blood cell) in lymph nodes and keeps them out of the brain and spinal cord.  In the OPTIMUM multicenter, double-blind trial, 1133 relapsing multiple sclerosis patients were randomized to Ponvory or Aubagio oral medication daily.  Relapses were 30.5% lower on Ponvory than Augabio.  New lesions were reduced by 56% on Ponvory compared to Auabigo.  No statistically significant difference was seen on disability progression on the 2 medications.

Risks that were higher on Ponvory than Aubagio in clinical trial included high liver blood tests, nasopharyngitis, upper respiratory infections, respiratory symptoms and increased blood pressure.  This class of medications has been associated with rare serious infections including PML and cryptococcal meningitis.  In clinical trial, the dose was increased to full dose of 20 mg over 2 weeks to reduce risk of slowing heart rate or irregular heart rate with first dose.

Mar 9 2021 MS Living Well Podcast: Anxiety, Depression & Multiple Sclerosis

Photo: Rawpixel

Struggling with anxiety or depression? Over half of people living with multiple sclerosis can experience depression and up to 40% have anxiety. Both psychological and physical symptoms that people with MS experience are explained. Causes for these mood disorders are discussed including immune inflammation in the brain, adaptation to having a chronic disease and medication side effects such as interferons and steroids.  People with depression are at higher rate of developing multiple sclerosis. In addition, depression is associated with more disability for those living with MS which may be due to not taking medications properly, smoking, not exercising and even chemical brain changes.

Therapy options explored including meditation (including mindfulness), stress reduction, cognitive behavioral therapy and virtual platforms. Prescription medication options for both anxiety and depression covered including benefits and risks including dependence. Experts share resources and hope for those living with MS with severe depression including suicidal thoughts.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Amy Sullivan PsyD ABPP

Amy Sullivan PsyD, ABPP is a board-certified, staff clinical health psychologist and the Director of Behavioral Medicine at the Mellen Center for MS Treatment and Research at the Cleveland Clinic. Dr. Sullivan received her doctorate degree at Argosy University-Atlanta, her internship at the University of Cincinnati, and her fellowship at the Cleveland Clinic in Pain Medicine. She is also the principal investigator for several clinical trials at the Mellen Center, where her research interests are focused on MS, pain, exercise and behavioral medicine.

Adam Kaplin MD PhD

Adam Kaplin MD PhD is the Chief Scientific Officer of MyMD Pharmaceuticals Inc. since December 2020.  He completed his undergraduate degree from Yale University, graduating magna cum laude, and obtained both his MD and PhD degrees at Johns Hopkins. Dr. Kaplin complete his residency in psychiatry at Johns Hopkins Hospital, where he served as the chief resident of psychiatry. He served as an Assistant Professor of Psychiatry and Behavioral Sciences at John Hopkins and the principal psychiatric consultant to the John Hopkins MS Center. He remains as adjunct faculty at John Hopkins.

Feb 23 2021 MS Living Well Podcast: Progressive Multiple Sclerosis

Mark Webb, wheelchair rugby player and Head of Communications for Shift.ms

Progressive multiple sclerosis can be a worrisome diagnosis, filled with questions about one’s personal future including independence. In this podcast, Mark Webb shares his personal story of transition to secondary progressive multiple sclerosis with brilliant humor, incredible resiliency and tenacious optimism. He explains how MS has affected his career from Euro Disney to Head of Communications at Shift.ms, a global online MS community. He candidly describes the impact of the disease on his functioning including cognition, mobility and bladder and how he has adapted to these obstacles. Mark reflects on his acceptance of progressive MS and emphasizes his motivation to make a difference for himself, his family and the MS community.

Dr. Gavin Giovannoni describes in the podcast primary progressive MS (PPMS), secondary progressive MS (SPMS) and active secondary progressive MS and whether or not these are truly different conditions. He moves beyond labels and explains that people with progressive disease, even those with limited mobility, can still be at risk of relapses affecting vision and arms. Continuing, switching or stopping disease-modifying therapy in progressive multiple sclerosis patients are covered. The impact of early MS damage, aging and ongoing, smoldering inflammation on progressive disease is described. Progressive multiple sclerosis treatments in clinical trials are highlighted including masitinib, BTK inhibitors, ibudilast, simvastatin, biotin, lipoic acid and remyelination strategies.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Mark Webb

Mark Webb is Head of Communications for Shift.ms, an online community of over 38,000 people living with MS. Mark lives with secondary progressive multiple sclerosis and first developed MS symptoms back in 1992. He’s a blog writer: One Man and His Catheters, public speaker and rugby wheelchair player. Mark lives in the U.K. with wife and 2 sons.

Dr. Gavin Giovannoni

Gavin Giovannoni MBBCh, PhD, FCP, FRCP, FRCPath is the Chair of Neurology of the Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry at Queen Mary University of London. Professor Giovannoni completed his medical training and neurology training in South Africa. In addition, he completed a PhD in immunology from the University of London in 1998.  He is particularly interested in clinical issues related to optimizing MS disease modifying therapies including progressive disease.