In this brief review of what’s new in MS, a detailed review of new therapies available to people with MS is beyond the scope of this article. The pharmacologic therapies are detailed in the National Multiple Sclerosis Society website https://www.nationalmssociety.org/What-is-MS. The non-pharmacologic advice and options available to people with MS are detailed elsewhere on this site.
THE OLD PRINCIPLES REMAIN THE SAME
1. BE PICKY ABOUT THE DIAGNOSIS
A patient should actually make sure they have MS by going to an MS center. Diseases like Neuromyelitis Optica Spectrum Disorder for years were thought to be a variant of MS, but now we’ve known for over a decade that NMOSD is its own disorder, with its own treatments. And another demyelinating disorder, Anti MOG Antibody disease, has its own course and treatment approach. These disorders leave their own unique footprints on modern MRI scans, and it’s important that a modern scanner be used for the diagnosis and followup. And advances are being made every year in the field of neuroimaging. 3T is the modern standard for MRI field strength for imaging patients with MS. And 7T is on the way to some centers across the country. But most importantly, your Neurologist must be able to use the tools she or he has available to help make decisions about your care. The old saying “It’s a poor carpenter who blames the tools” applies to Neurologists who care for people with MS.
2. CHOOSE THE RIGHT MEDICATION FOR THE TREATMENT OF MS
The new era of more powerful drugs affecting the immune system has led to challenges (as in those presented by the Covid pandemic) as well as new opportunities for people living with MS. An interesting editorial by Granziera et al appeared recently in JAMA Neurology. (Time to Change the Current Clinical Classification of Multiple Sclerosis_ JAMA Neurology Feb 2023) This article challenges the traditional classification of MS into Relapsing Remitting MS and Progressive MS. The article discusses the concept of PIRA (Progression Independent of Relapse Activity), and the need to consider MS as a disease that is progressive from the beginning, as defined by changes is newer high resolution MRI markers not available previously. Tur JAMA 2023 Association of Early Progression Independent of Relapse Activity With Long-term Disability After a First Demyelinating Event in Multiple Sclerosis
Thus, the concept of NEDA, or No Evidence of Disease Activity, may need a closer look, given these new MRI markers and the newer, more powerful drugs available to people living with MS. The proviso still remains, that if a medication is more effective at suppressing the immune system, that medication will make a person more vulnerable to infectious disease.
But in a “normal” environment, or at least one that can be controlled to some extent, the “old” concept of “treat early, treat hard with a powerful drug,” may have acquired new meaning for people living with MS. The concept of induction therapy, with methotrexate or cyclophosphamide, for the treatment of MS has been around for decades, and so hitting MS hard in the beginning is still a good idea.
3. DON’T BLAME EVERY SYMPTOM A PERSON LIVING WITH MS HAS ON MS.
People with MS get pinched nerves, sleep disorders, and other neurological diseases just like everyone else. So always maintain a questioning attitude about a new symptom in a person living with MS. Is that symptom due to MS, or is it caused by something else? A urinary tract infection or a pinched nerve. And the gut bacteria are known to be increasingly involved in many types of immune system disorders, so which bacteria are there, and what we feed them plays an increasingly important role in therapy, with an autoimmune protocol diet always being worth a try, in addition to the drug you and your doctor decide is the right one for you.