When a patient is first diagnosed with multiple sclerosis, there are a lot of emotions. There's a lot of things that are often running through people's minds.
The first question often is why me? Or how did this happen or what's going on? And so often what I try to do in that first visit when someone is diagnosed is to really explain what the disease is in terms that they can understand.
I also talk about things like the risk for MS. Many people have questions about if they're family members or children will inherit MS or if they should have children. And so we have many of those conversations. And so it often is a very long conversation. I usually broach initially treatments, but we usually don't have a very in-depth conversation about treatments because there's just so much going on. There are so many questions and I really want to make sure that people absorb the information.
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So we spend a lot of time just kind of going through the diagnosis, the risk factors, the things that they can do to help themselves on a daily basis. And then we kind of talk about the goals of treatment. But if possible, I usually schedule a follow-up visit within a couple of weeks and then we come back and sit down, answer more questions that they may have or that they found their family members may have. And then we also talk about treatments at that time.
I think that when we talk about treatment plans for MS, we're talking about several different things. I always tell all of my patients that there's a role medicine plays, but there's also a role that you play and there is no medicine that will remove the things that you can do to help yourself on a daily basis to live a healthy life with or without multiple sclerosis.
And I think the other important thing is that we have to set expectations. So there are many different treatments for multiple sclerosis. And the treatment landscape has changed dramatically just even in the past five to seven years. So when I started practicing, there were only about three or four treatments for MS and all of them were injection medicines where people had to basically, inject themselves with needles at home. There were a couple of medicines that were given through ivy, but they were for what we consider very severe cases of the disease.
And then about eight years ago, we had the first oral medication or the first pill approved for MS. And since that time we've had six or seven new drugs that have been approved and literally won almost every year. So there's really been a revolution in the way that we treat MS. And that's been really great for our patients because it gives them a lot of options. But also we don't have to tolerate as much disability as we used to.
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So back in the day, we used to say, well, if you had a new spot, let's try to stick it out with this medicine because we didn't have any other options. But now we have enough options that if you're having difficulty, if you're having new lesions on MRI or if you're having more disability, there are other options where we can change the medicine to try to stop the progression of the disease.
So when we talk about expectations there two things that we're trying to affect with our medications. We are trying to affect the person who has MS and then we're also trying to affect their MRIs. We do want to change or keep MRIs from changing because if MRI's change, that eventually leads to changes in the person. So MS is a little bit of a different disease because we do actually treat people or change their treatment if their test results or MRI images change.
Most of the time we say that we don't make treatment decisions based on tests, but in this case, we do. And so we're trying to affect the person in terms of we don't want them having those relapses, those episodes of symptoms that come and go. And then we don't want them having progression. We don't want them getting worse slowly over time as much as possible. So we're trying to affect the MRI and we're trying to affect the patient.
The one thing that I didn't say is that we can't affect, at least with our disease-modifying therapies, the symptoms that are already there, so we can't, with the medicines we use to treat MS, fix what's already broken, but our goals are to try to prevent new things from being broken and that's something that I spend a very long time on explaining to patients because it is very different from how we traditionally think of medicines, right?
If we have a headache, we take this medicine, we expect it to get better. If we have diabetes and we take this medicine, we expect the sugar to come down with MS. The drugs are really preventative, so if you have numbness and we start you on a disease-modifying therapy for MS, it's not going to affect that numbness. Okay? But we hopefully want to prevent you from having more numbness or numbness in different places. There are other medications that we can use to treat some of those symptoms, but we have to make sure that we're very clear about our expectations with disease-modifying therapies or people would get discouraged and stop taking their medications because of that.
I like to think of MS Treatment as a four-layer cake because I like cake and the four layers represent the different approaches that we have to treatment. So the first layer is what I call relapse management. So that's when someone comes in with that acute symptom. Let's say, Dr. Williams, "I can't see out of one eye." There are medicines that we give for those acute symptoms and usually, we give steroids. There also is another medicine that we can use and sometimes procedures, but the most common treatment in that first layer is steroids that help the acute symptom but don't help the immune system attacks.
So that's where we come to the second layer. The second layer is what we call disease-modifying therapy. And that's the medicine that really affects the immune system and helps decrease the immune system attacking the brain and the spinal cord, which causes those symptoms. The third layer of the cake is symptom management and that's where we can really affect someone's day to day life. So if someone has numbness and tingling, there are treatments for that.
If someone has difficulty with their bladder, we can treat that. There are some symptoms that we can treat very well and there are others that we don't have very good treatments for, but that's really where we can affect day to day life. And we have to make sure that we strike a balance because some of the symptom medications can worse than some of the actual symptoms of MS.
So we have to make sure that we're checking in regularly and adjusting those medications to make sure that we're ensuring a good quality of life.
And then the fourth layer of the cake is rehabilitation. So if someone has a severe relapse, they may need physical therapy or occupational therapy, speech therapy, and we use all of those other, ancillary areas of medicine to help improve quality of life.
Dr. Mitzi Joi Williams is a top neurologist and Multiple Sclerosis (MS) Specialist in Atlanta, Georgia. She received her undergraduate degree in Neuroscience and Behavioral Biology from Emory University and her Doctor of Medicine degree from Morehouse School of Medicine. Dr. Williams completed her internship and residency in neurology as well as a Clinical Fellowship in Multiple Sclerosis at the Medical College of Georgia in Augusta, GA. Dr. Williams has a strong interest in understanding and furthering research in MS in ethnic minority populations. She is a sought-after speaker and presenter and has discussed her research both nationally and internationally at various scientific meetings. She has spearheaded and participated in multiple Steering Committees and Work Groups to further research in underserved populations with MS. She also has recently increased involvement in efforts to increase diversity in clinical research and educate the community about the importance of research participation. Dr. Williams is the author of MS Made Simple: The Essential Guide to Understanding Your Multiple Sclerosis Diagnosis. Because of her passion for teaching and advocacy.
