Revolutionized care for MS patients
There have been some dramatic improvements in recent years in the treatment of multiple sclerosis (MS), a previously intractable disease. Even though there is no cure for MS, the disease is more manageable today, thanks to better diagnostic tools and improved medications.
Multiple sclerosis is an autoimmune disease which causes the body’s own cells to attack the myelin sheath of the central nervous system, according to neurologist Matthew Pulicken, MD, of Neurologists of Cape Cod in Hyannis.
“The neurons have a myelin sheath, which helps with proper transmission of signals,” he said. “Think of it like an electrical wire with outer insulation, helping with the optimal spread of electrical signal between neurons. If the myelein sheath gets damaged (known as demyelination), the neurons will not be able to function at an optimal level, causing symptoms, depending on where the damage is happening.”
Newer MRIs are more precise and sensitive, picking up more subtle changes and often showing evidence of previous damage. Stronger magnets used for MRI makes the studies more sensitive in picking up abnormalities, he said.
The disease-modifying medications have made significant progress since 1990s, with multiple drugs available to help prevent disease progression in MS. The goal is to reduce the attacks of demyelination, and thus prevent newer symptom and disease progression, especially in relapsing remittent multiple sclerosis, the most common subtype of MS.
“In the 1990s, the disease modifying therapies used to be all injections, but starting in early to mid 2000s, pills were approved for the same purpose,” Dr. Pulicken said. “You can take the pills orally on a daily basis compared to having injections daily or weekly. These developments have revolutionized MS care.”
Once the right medication is started , neurologists like Dr. Pulicken provide follow-up care that includes regular office visits, laboratory testing and MRI testing to assess for the efficacy of the medication and monitor for side effects.
The goal with MS care is choosing the right medicine to avoid disease progression by preventing relapses, according to Dr. Pulicken.
“We also use medications to manage other symptoms that are common in MS patients, like fatigue, depression, bowel or bladder issues and pain issues,” he said.
More Aggressive Treatments
If the pills are not effective or if patients have more progressive disease, there are more aggressive treatments that can be used, like intravenous infusions.
Before coming to the Cape in 2015, Dr. Pulicken spent three years as senior research coordinator overseeing the clinical trials/research studies and attending MS clinics at Johns Hopkins Multiple Sclerosis Center. After his graduate training in Public Health, he came to Cape Cod, and is dedicated to bringing the latest treatments to his patients.
He started offering monthly infusions of the drug, Tysabri, for MS patients at the Infusion Center at Cape Cod Hospital in 2015. And he began prescribing Ocrevus, which is administered once every six months, after it was approved by the FDA in 2018.
“We provide all of the FDA-approved therapies on the Cape, be it in infusion or pills,” he said. “We did not want patients from the Cape having to travel all the way to Boston for treatments. ”
Dr. Pulicken works closely with other MS groups in the Boston area and attends quarterly meetings with the other MS doctors in the state to keep up on latest research and share ideas for the management for difficult to treat cases. The MS subspecialists in the state are members of a small group and it’s helpful to have other doctors, both in his practice and statewide, who he can collaborate with for a second opinion, he said.
The field of treating MS has seen dramatic changes over the years. The good news is that more advancements are coming.
“With MS, we are still making bigger strides with the newer understanding about the mechanisms causing the disease and newer rationale for treatment options,” Dr. Pulicken said. “There are plenty of drugs in the pipeline for multiple sclerosis. We are looking at at least one to two that may get approved in the next year, and others that are in the clinical trial phase.”