Advancements in the Treatment of Multiple Sclerosis - 2022 Update
Tracy DeAngelis, M.D. - Neuroimmunology Specialist, Neurological Associates of Long Island, PC
January 21, 2022
Over the past two decades, the field of multiple sclerosis (MS) has achieved significant milestones, particularly in advancing the understanding of disease pathogenesis and available treatments for patients living with MS. Refinements of diagnostic criteria and a revolutionary expansion of therapeutics, targeting both relapsing and progressive forms of MS, have made notable impacts on patient outcomes and quality of life. In contrast to the early 1990s, when only steroids could manage acute exacerbations, there are now over 20 FDA approved disease modifying therapies in this brimming armamentarium. Despite such advancements, there is still much work to be done to improve MS care.
Like any autoimmune disease, MS is unique to the individual. Care must be tailored specifically to each patient. Numerous factors are considered when choosing which disease modifying therapy to initiate in a newly diagnosed patient. Balancing risks, benefits and side effect profiles with patient comorbidities, safety and lifestyle concerns can be a daunting task. General neurologists, who do not have subspecialty training in neuroimmunology, look to MS specialists for critical guidance navigating this dynamic landscape. One question which often arises is whether the treatment paradigm should be one of escalation or induction. Should we start with high efficacy disease modifying therapies at onset or escalate, as needed, in response to breakthrough disease activity? While there is clear consensus that early treatment affords better long-term outcomes, more research, for example focusing on biomarkers, is needed to clarify which strategies are most appropriate for different patients.
One of the more recent trends in MS care has been a stronger integration of wellness into the concept of disease modification. Recognizing the neuroprotective impact of factors such as nutrition, exercise, stress management and sleep hygiene is exciting and long overdue. For example, increasing research shedding light on the role of the gut microbiome and its impact on MS is one of many frontiers providing insight in this area. MS specialists and their multidisciplinary teams must take time to identify the personal, psychosocial factors which create barriers to implementing wellness measures successfully. Identifying these obstacles is the first step towards educating MS patients on how to make lifestyle changes that can improve their disease course in addition to taking their medication.
Beyond recent improvements in diagnosis and treatment, the future goals of MS research aim towards remyelination and repair of central nervous system damage already sustained by the disease. Discovery of therapeutics which can reverse disability is a goal the field of MS shares with many other areas in neurology targeting neurodegeneration, such as Parkinson’s disease, stroke and Alzheimer’s dementia.
Our team of skilled neurologists, from various subspecialty training backgrounds, has extensive clinical experience treating patients with neuroimmunological diseases, including MS. In particular, Dr. Tracy DeAngelis and Dr. Richard Blanck head the Multiple Sclerosis treatment program and serve as principal investigators on several clinical research trials evaluating the safety and efficacy of novel therapeutics. Our team includes a dedicated nursing staff as well as clinical research coordinators providing the delivery of comprehensive, state-of-the-art patient care. As the field of MS continues to advance with promise of a cure, we remain dedicated to providing patients with the individualized care requisite to facing all challenges which come with fighting this disease
