As part of the Summa Health Neuroscience Institute, Dmitri Kolychev, M.D., MS, has special interests in the Management of Stroke and Neurorehabilitation, Multiple Sclerosis and Parkinson’s Disease. He graduated from the Medical College of Georgia in Augusta, GA, followed by a Neurology residency and Vascular Neurology fellowship at Tufts Medical Center in Boston, MA. He is board certified by the American Board of Psychiatry and Neurology in Vascular Neurology, as well as the American Board of Psychiatry and Neurology in Neurology.
Scott Webb (Host):
More and more people are being diagnosed with multiple sclerosis. According to the US National Library of Medicine, the estimated number of people with Multiple Sclerosis (MS)
worldwide increased to 2.8 million in 2020. That's 30% higher than in 2013. And joining me today is Dr. Dmitri Kolychev, he's a Neurologist with Summa Health, and he's here to discuss the topic of MS.
This is Healthy Vitals, the podcast from Summa Health. I'm Scott Webb. Doctor, thanks so much for joining me today. Let's begin by learning about multiple sclerosis or MS, what is it exactly?
Dmitri Kolychev, MD (Guest)
: Multiple sclerosis is a chronic disease of the brain and spinal cord, which makes up the central nervous system. And that controls everything that we do. The exact cause is unknown, but we do know that something triggers the body's own immune system to attack the nerve fibers in the brain and the spinal cord and the inflammation of the insulating layer around the wire like nerve fibers results in an interruption of communication within the nervous system. And it also damages the cells within the brain and the spinal cord. Certain regions or parts of the nervous system are effected more frequently than other regions.
: And Doctor, do you have a sense of, we, you know, we hear, I mentioned there that the numbers are going up. Do we have a sense of why is that more and more people are suffering from MS or is that we're maybe just better at diagnosing it and diagnosing it early? What's your sense of things?
Well, I think it will depend on who you ask, but I believe that there are probably multiple factors that contribute to this growth. I think a certain degree of blame can be placed on increasing incidence of certain risk factors. Obesity, change in diets, maybe vitamin deficiencies, maybe smoking. Also we do diagnose MS earlier.
The criteria for definite multiple sclerosis have been determined and we incorporate laboratory and certain imaging findings that compliment our clinical decision-making process and overall enable earlier diagnosis with multiple sclerosis. I would say that rarely, lesions of multiple sclerosis can be seen on MRI imaging studies, even before the clinical symptoms of multiple sclerosis develop. For example, an MRI done for evaluation of chronic back pain and imbalance can sometimes lead to diagnosis of MS. And I also believe that community education and increased awareness of multiple sclerosis leads to more testing of patients that may be exhibiting typical signs and symptoms of multiple sclerosis.
: Yeah, I think that sounds right. And I'm sure things like this podcast, just, you know, having conversations, getting the word out, educating people, especially when it comes to the signs and symptoms. So you mentioned the clinical signs and symptoms. Let's go through them. What are the signs and symptoms that an average person, maybe of average risk should be on the lookout for?
: Well, I think everyone's experience with MS can be different, but it can present with symptoms of tingling or numbness, weakness, or memory problems. Mood changes, gait imbalance is common. Some people experience electric shock-like sensations that may occur with certain neck movements, especially bending the neck forward. They're usually described as a sense of shock or vibration. I heard it described as somebody hitting a wooden pole with a baseball bat. But occasionally optic neuritis or inflammation of the optic nerve can cause pain behind the eye and subsequent vision loss, which may be temporary or partial. Many patients complain of problems of fatigue with exposure to heat.
All of these problems can be temporary or permanent. Symptoms can vary. And depending on the amount of nerve damage on which nerves are affected. Most people, 80% or more that are initially diagnosed with MS, will have a relapsing remitting disease course. One day they'll experience an attack of new symptoms that usually last two weeks or months. And these attacks are followed by periods of time when symptoms have improved partially or completely. And a small percentage of people present with gradual loss of function and gradual onset of disability rather than distinct attacks. And this clinical course is usually seen in the progressive form of multiple sclerosis. Some people with severe MS may lose the ability to walk independently while others may experience long periods of remission without any new symptoms.
: Yeah. And so as you say, yeah, the symptoms may vary. They can come and go. And I'm sure that all leads to, you know, people just not being sure, maybe being confused, obviously the best thing to do, if you are experiencing these symptoms, and you can't explain them, probably reach out to your primary, maybe, you know, be referred to a specialist. Do you notice any difference between men and women when it comes to symptoms?
: More women tend to be diagnosed with MS. Men, especially younger men tend to have a more aggressive disease course at the onset of symptoms.
: And any sense of why that is, or is it just one of the mysteries when it comes to MS? Like there's things we know about MS. And things that we don't. Is it just one of those sort of mysteries and it's really just speculation at this point?
: There's no precise cause. I think genetics may play into it. Certain environmental exposures can play into it. People that live in certain parts of the country, more up north are at high risk for developing a MS. So if you don't have the exact cause or why that may be.
: Yeah, why the incidence is higher in women than men. Sort of the million dollar question. I know the answer already, but it's great to have an expert on. Is MS curable?
: There is no cure, but there's many treatment options that focus on speeding recovery after an acute attack or that slow the progression of the disease. And we have medications that help us treat certain MS symptoms. There's been a lot of progress in developing new drugs to treat multiple sclerosis, new and better disease modifying therapies that slow the frequency of relapses and rate of disability formation are becoming available for this disease with every year.
: Well, let's talk about quality of life. You know, as you mentioned that there's been a lot of advances and improvements in the treatment and medications and things. So we know it's not curable. So what is life like for folks with MS, living with MS?
Well, we generally talk about involving comprehensive MS care for most patients. You use a multidisciplinary approach and expertise of many different healthcare professionals. The neurologist usually leads or guides the care, but other ancillary personnel can be involved. Physical therapy, speech therapy. If there's any certain organ systems that are affected more than others, such as the bladder, care of other physicians, specialists may be needed.
Of course there's multiple disease modifying options that are available depending on patient's preference and certain clinical characteristics. The treatment decisions can be challenging even while better disease control is achieved with increasing number of effective immunotherapies now available for multiple sclerosis. Of course, general health evaluation and vaccination status, any family planning needs to be addressed before certain treatment options are recommended to these patients. High efficacy treatments are typically offered for people that are at the high risk or very high risk for MS progression and de-escalation strategies may be offered to people that had no evidence of disease activity for some years.
And this typically involves switching to treatments that may be more safe or more convenient compared to higher efficacy treatments. We employ specific treatments to shorten duration of relapses if they occur. And like I said, there are medications that are specifically indicated for certain of the MS symptoms, including fatigue, nerve pain, gait and balance dysfunction, and general wellness strategies are employed, including changes to exercise and diet.
: Yeah, it does seem like there's a lot of things to consider when it comes to MS. A lot of questions, concerns. I'm sure that that team approach, that multidisciplinary team approach is really beneficial to patients and their families. Really educational today Doctor. Learning a lot about MS from you today. As we wrap up, what do you most want folks to know about MS and how you think you can help them?
: I think that if you're concerned or if you have some questions about MS, I usually recommend talking to your regular doctor and potentially being referred for further evaluation. We also have multiple resources that may be available in the community. I always encourage people to contact National MS Society, when I see them, they're very good at providing education for general population if it's needed, or if people have more questions.
: Yeah, that's great. You know, a lot of benefits obviously to early diagnosis and treatment and a lot of options out there. So if folks are experiencing symptoms, want them to reach out to their primaries, as you say, their regular doctors, maybe be referred for further testing. So Doctor, thanks so much for your time today. You stay well.
: Thank you for having me. Thank you.
: And to learn more about our award-winning neurological care visit summahealth.org/brain
. If you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.