What are the most common triggers for flare-ups?
We don’t really know what will bring on a flare-up, or relapse. There are certain times when they are more common—for example, during the postpartum period in the first three months after delivery, so clearly there’s something about hormones that leads to increased disease activity. Also, we know that an infection or a flu-like illness can lead to immune activation that can bring on an attack.
Researchers have tried to determine whether increased stress can set off an MS relapse, but the findings aren’t consistent. We do know that your coping abilities can affect your immune system, so at the individual level, how you handle stress matters.
Fears about losing control are a big issue with MS. How do you recommend people address that?
Everyone should eat well, exercise regularly, get enough sleep, and take good care of their health—it’s even more important with MS. If you can take control by doing more taxing or challenging tasks in the morning when energy and focus are higher, that will help you. Trying to structure your day so you don’t feel you’re at the whim of things can make a difference, too.
Does MS shorten life expectancy?
It used to, but people with MS are doing a lot better now. We have very effective therapies that control relapses and are associated with better long-term outcomes, better overall neurologic function, and less brain injury. As a result, we’re more capable of preventing deconditioning and pneumonia and better equipped at keeping people well oxygenated and hydrated, which improves health over time.
What do you wish patients with MS asked you but usually don’t?
They don’t tend to ask me why I'm recommending a medication or why they should take it. Sometimes people don’t understand that the medications we use—the disease-modifying therapies and the symptomatic treatments—are not the same. If you’re on a medication that modifies the disease course, whether it’s an intravenous infusion or a pill, it’s important to recognize that that drug is not going to make a difference in your fatigue, pain, or other symptoms. Rather, these drugs prevent the inflammation and disease activity that injure the nervous system.
What is your hope for the future of MS treatment?
In the future, I think the condition will be so well controlled that you won’t need to concern yourself so much with multiple sclerosis. In some ways, we’re almost there. If people catch MS early and get the right medications, they can do really well. Additionally, I would like to see better opportunities for repairing the damage that has already happened as a result of MS. Once we’re able to enhance repair—with remyelination (the generation of new myelin sheaths in the central nervous system), for example—we will be in a very different place. I think we’ll get there.