Increased awareness of risk factors and symptoms among primary care physicians, prompt referral of suspected cases to specialists, and a growing armamentarium of disease-modifying drugs lead to better prognosis for patients.
Back when Patricia K. Coyle, MD, was attending Johns Hopkins School of Medicine and training to become a neurologist, she saw patients her own age being diagnosed with multiple sclerosis (MS). That stuck in her mind and instilled in her a passion for learning more about MS that continues to drive her today as professor of neurology and vice chair of clinical affairs at Stony Brook University Medical Center.
At the 2015 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Indianapolis, Coyle spoke about the diagnosis, clinical course, and long-term management of primary-progressive MS.
Although the major form of the disease is relapsing MS, Coyle said MS is the success story in neurology therapeutically. Doctors now have 12 FDA-approved disease-modifying therapies (DMTs) to offer patients. And more are just around the corner, she said.
She advised primary care physicians to remember that “All the data is saying the sooner you treat, the better, particularly for relapsing-remitting MS. To allow early therapeutic treatment, you can’t miss a diagnosis of MS.”
If there is any question of MS, she said primary care physicians need to refer the patient to a specialist for evaluation. “Before we had the DMTs, no one rushed to diagnosis. There wasn’t a cure. Without a treatment, it didn’t make a difference and would have negative implications,” she said
It’s just the opposite now. She told the audience that it is critical to make the diagnosis as early as possible to get people appropriate treatment. She believes that treating patients with a DMT at the first attack of MS is probably the optimal approach.
Coyle also said the medical community is learning more about the importance of implementing a wellness/health maintenance/vascular risk factor-controlled program. It should be viewed as a treatment for everybody for brain and central nervous system health, but particularly if a patient has a CNS disease.
Patients should be advised to pay special attention to a range of health factors and behaviors, including:
All of these actually improve brain function. Physicians should also closely monitor blood pressure, prediabetes, and hyperlipidemia.
Coyle said that there is no diet that has absolutely documented benefit in MS. But patients should probably cut down on unhealthy saturated fats and boost polyunsaturated fats, make sure they maintain an appropriate level of vitamin D level, and keep their B12 level over 400.