Brain Preservation Key in MS
For the nearly 2.3 million people worldwide who are diagnosed with multiple sclerosis (MS), brain health and preservation may be vital.
"Everyone's brain atrophies as we get older," says neurologist Barbara Giesser, M.D., of UCLA Health, an expert on MS who spoke to HealthCentral in a telephone interview. Brain atrophy refers to brain shrinkage and loss of neurons.
"For people with MS, the atrophy appears to be accelerated," she says. "Their brains shrink at a faster rate than those who don't have MS. The goal for everyone is to slow the process down or decrease it."
Coming Together for MS
The field of neurology now views the broader topic of brain health with a laser-sharp focus. In 2016, an elite multidisciplinary group of MS specialists came together to share expertise and develop a remarkable resource guide and consensus statement for people with the disease. It's called the Multiple Sclerosis Brain Health Initiative and its goal is to motivate people with MS to keep their brains healthy, while accessing the very best care possible for their condition — a win-win.
The overarching objective is to preserve brain tissue and maximize lifelong brain health by reducing disease activity. HealthCentral also spoke by phone to the report's lead author, Gavin Giovannoni, Ph.D., and chair of neurology, Barts and The London School of Medicine and Dentistry, in the United Kingdom.
Of the 2016 project, he says: "It got by far the most support from the international community, and it's certainly helped raise awareness around the issues."
The report celebrates the remarkable flexibility of this organ we call "the brain." As the brain is a good actor, however, it may not show that a person has MS in its very early stages. That's why the panel's consensus that "time matters in multiple sclerosis" echoes throughout the comprehensive paper.
Remember this above all, the report says: "The brain uses up its neurological reserve as it recruits new areas to help with tasks previously performed by damaged areas. Neurological reserve plays a large part in having a healthy brain that functions well."
At some point, though, the reserve gets depleted. This fact applies to everyone, not just those with MS.
What You Can Do Now
In a nutshell, the experts recommend:
1. Leading a brain-healthy lifestyle, including treating other diseases
The report says you're on your way if you:
- Keep as active as you can.
- Keep your weight under control.
- Keep your mind active.
- Avoid smoking.
- Watch how much you drink.
- Continue taking other medicines your doctor has prescribed.
Add to the above a recommendation about the major importance of diet, suggests Dr. Giesser. A December 2017 study in Neurology confirms that people with MS who eat more fruits, vegetables, legumes, and whole grains may exhibit less disability and fewer symptoms than those whose eating habits aren't as healthy.
And about those other medicines noted above: Dr. Giesser also reminds people with MS about comorbidities or other diseases occurring at the same time, such as hypertension or diabetes. The subject was addressed in a 2015 review in the Multiple Sclerosis Journal by neurologist Ruth Ann Marrie, M.D., Ph.D., of the University of Manitoba.
For help, the National Multiple Sclerosis Society prepared this article on managing MS if you have another condition.
2. A plan to monitor MS disease activity to see whether treatment is working
Keep notes about your condition symptoms, and be clear about what matters to you and those closest to you, the authors say. Understand how your doctor will monitor your MS to determine if your disease is active — relapses and disability progression are clues. If your disease-modifying therapy (DMT) isn't working, it's time to discuss switching to one that may work better.
3. Informed, shared decision-making
Feel unencumbered about sharing your hopes and dreams, goals for your career, plans for a family, and what types of treatments you can tolerate with your doctor. This is about you.
4. Urgent referral to a neurologist and prompt diagnosis
Good news: When compared to the 1980s, MS diagnosis now can occur 10 times more rapidly thanks to magnetic resonance imaging (MRI) and more astute clinical assessments. Ask for access to MRI early on.
"There's inertia and often people aren't treated actively enough," says Dr. Giovannoni. "A lot of time can be wasted across the course of the disease, and that varies throughout the world."
He cites the revision of the previous McDonald criteria for the diagnosis of MS, published in The Lancet Neurology in December 2017. "Diagnostic criteria have changed to make diagnoses easier," he says.
Given that early intervention is so important, unfortunately, say the experts, many people with symptoms don't get to a neurologist as soon as they should. Accessing an appropriate therapeutic strategy early is job one.
It's also important for health care providers to stay up-to-date on MS, says Dr. Giesser. "Locating a neurologist who's an MS specialist means they'll understand the new diagnostic criteria and can diagnose people after the first attack. That means treatment can be started sooner."
5. Early treatment with a disease-modifying therapy when appropriate
"Get the correct disease-modifying treatment early, monitor it, and change it when necessary," says Dr. Giesser. "That is the direct way to preserve the nervous system."
Especially if you have relapsing MS, studies show utilizing a DMT early may lead to better outcomes, the report's authors say.
6. Understanding the importance of brain health at all stages of the disease
"Brain health depends on how well you maintain your reserve," says Dr. Giovannoni. "If you live long enough, you're going to have cognitive impairment. Our brains were never designed to live as long as we do from an evolutionary perspective. That's why it's so important to stop atrophy and treat MS as actively as possible."
The research momentum continues as Dr. Giovannoni shares news about the results of a five-city international pilot study based around the 2016 consensus statement.
"It's leading to an app like Trip Advisor's but it's called 'MS Advisor,'" he says. "Health centers [neurology offices and clinics] can implement it by informing patients about what to expect from care. Patients can also do the same and then give 360-degree feedback about their own experiences, such as how quickly they got an MRI and treatment. We want to create two-way communication between centers and patients. We also want to make it social — to provide a tool for patients to be change agents for themselves."
Expect the app by the last quarter of 2018, he says.
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