Ask the Expert: Bruce A. Cohen, M.D.

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What areas of MS–related research do you think are especially promising?

I’m interested in finding the right therapy at the right time for an individual who has been diagnosed with MS. I’m interested in learning what causes or triggers MS or relapses in certain people, and why some people with MS have milder courses than others. This would help us figure out whether to intervene with strong drugs early.

How does someone with MS choose a disease-modifying drug?

It is crucial to be well informed and to talk with a physician you trust, because there are a lot of considerations. If I had a way to predict whether a person was going to have a mild or highly aggressive form of MS, that would help with the decision, but the course of disease is very difficult to determine at the outset. It’s important to consider the risk-benefit profile you and your physician are comfortable with, your tolerance for side effects, and what your goals are for managing the disease. Convenience is another factor to take into account—for example, a drug that's administered by infusion may require you to take time off from work.

What can people with MS do for their emotional well-being?

MS makes some of the activities of daily life more difficult and leads to more fatigue. It is helpful to have a solid family support system, as well as support from other people, and to not be socially isolated. Also, maintaining a healthy lifestyle can maximize opportunities to be independent.

What can those with MS do to improve their situation at work?

In most cases, it is easier if people at work know that you have MS. But some individuals may prefer not to disclose this information. It may help to have a buddy who can cover for you if you need to take a rest or make frequent visits to the bathroom on account of bladder problems.

What about pregnancy and MS?

Two-thirds of people with MS are female and the peak incidence is during childbearing years, so one of the questions I’m most frequently asked is: Can I get pregnant? Pregnancy is somewhat protective against symptoms and relapses, at least while you’re pregnant. But you may need to discontinue your medications or use them with caution during pregnancy, depending on which ones you take.

What breakthroughs do you hope to see down the road?

I’d like to see a cure. I’d like to see MS go the way of polio. But that will require a better understanding of the disease. And our success with the medications we already have is going to make it harder to justify doing a trial that includes a placebo, even for a drug that may turn out to be a revolutionary breakthrough.