Dr. Robert Fox is one of the leading researchers in this country on multiple sclerosis. He’s also the medical director at the Mellen Center at the Cleveland Clinic.
I had a chance to talk to him recently about treating patients with MS. He said it’s important to remember the therapies for MS are designed to slow the progress of the disease, not to reverse it.
Robert Fox, MD, neurologist at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic in Ohio: Oftentimes a patient will come back after being on these therapies for six months or 12 months and say, “I don’t think it’s working, I don’t feel any different.”
And what we have to convey to them is that they’re not going to feel different. They are preventive therapies. They are preventing relapses. They are preventing new lesions on the MRI. They are preventing progression of disability. And if they’ve not had any of that, then it’s a success.
I use the analogy of an aspirin to prevent a heart attack. When an aspirin is recommended, at the end of the year a patient may ask, did the aspirin work? And the question is, did they have a heart attack? And if they didn’t, we say yes.
Dr. Gupta: Let me ask you, Dr. Fox: For patients out there, can you explain what’s happening in their bodies, their brains, their spinal cords when they have MS? Not just in terms of their function, but also in terms of their mood levels, depression, things like that.
Dr. Fox: MS is a disease where the immune system gets confused and it attacks the brain and the spinal cord and the optic nerve. We don’t know why it does that, but it thinks of the brain as a bad thing and it attacks it. It’s similar to rheumatoid arthritis where the immune system gets confused and attacks the joints; but in the case of MS, it’s the brain and the spinal cord and the optic nerve.
As a result, the functions that the brain and the spinal cord and the optic nerve serve can be disrupted. And that can be a number of different ways. It can be numbness and weakness, walking difficulties, blurry vision, double vision. Also bowel and bladder dysfunction, so urinary urgency or frequency, incontinence.
There’s also things we don’t often think about, but the way we think, the way our mood is. So our mood comes from our brain, and when there are lesions from MS, the MS scars disrupt the mood circuitry. It can cause depression, it can cause anxiety, it can also cause concentration difficulties and memory difficulties. Basically anything that the brain, the spinal cord, and the optic nerve runs, can be impacted by MS.