Multiple sclerosis: Symptoms, diagnosis and quality of life [Text on screen: Ohio State Health & Discovery Health Talks] [Music playing] [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: Welcome to Health Talks. I'm here with Dr. Tirisham Gyang, a neurologist at the Ohio State University. Dr. Gyang, we're talking about multiple sclerosis. What is it? [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: Multiple sclerosis is an autoimmune disorder that affects the central nervous system, and that's your brain, spinal cord, and the optic nerves. There's an inflammation that's targeting the coating around the nerves called myelin. [Music ends] Gail Hogan: Is this something that's hereditary? Tirisham Gyang, MD: No, it's actually not hereditary. There's a lot of different things that could contribute to a person getting MS, or multiple sclerosis. It's a combination of genetic, there's a genetic predisposition, but it's not an inheritable disease. The environment, from what we know, plays a strong role, and then for some reason there's an immune dysregulation, which we still don't clearly understand. Gail Hogan: Are there ways that people can guard against it, or are there certain things that put someone at risk? [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: There are a lot of studies right now looking at what are the things that predispose a person to getting MS. There are a few things that we know. For instance, low vitamin D levels have been associated with getting MS. Where you're born and where you spend the first 15 or so years of your life actually determine what risk you have for the rest of your life. And there are also other factors like viruses. Right now we're studying the Epstein-Barr virus to see if it is in any way associated with a person getting MS. Gail Hogan: What are symptoms? What does multiple sclerosis look like? Tirisham Gyang, MD: So, multiple sclerosis looks very different in different people. Most patients present with acute neurologic symptoms. For instance, losing vision in one eye, weakness on one side of the body, numbness, tingling, balance issues, trouble urinating. So, symptoms are very different, and everybody presents a little bit differently. And patients have these symptoms that come all of a sudden, over some time may get better, and have these symptoms over and over again. That's the most common type of MS. There's a less frequent type of MS called a primary progressive MS, where patients come in with a very slow progression of disability. Gail Hogan: Because it's different, is it hard to diagnose? [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: Sometimes it can be hard to diagnose, and I think the problem is there is no one test that tells us a person has MS. It's a combination of the clinical profile, so we listen to the patient, hear about their symptoms, we do an examination, and then the MRI scans are very important, because we look for very specific findings we call lesions or spots on the MRI that tell us if there is abnormal inflammation in the nervous system. Sometimes additional tests are done, like a spinal tap or other tests that could help to confirm a diagnosis in an individual we're considering for MS. Gail Hogan: Obviously this impacts someone's quality of life, so how do you help some of your patients manage even their day-to-day functioning? [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: So, as I said, MS has a lot of different manifestations and patients present very differently. Each patient needs to be treated as a different person, because one patient may have completely different needs from another patient. And so we need to target treatment based on the needs of a specific patient and figure out what does this patient have, and how can I individualize the care that I give to a specific patient? Gail Hogan: And it's chronic? Tirisham Gyang, MD: It is a chronic disease. Once you're diagnosed with MS, this is a diagnosis you carry for the rest of your life. Gail Hogan: So, in doing that, people do need to learn how to manage their care? Tirisham Gyang, MD: Absolutely. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: And there's a Quality of Life Clinic that is offered at Ohio State. How does that help the patient? [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: Yeah, so this is a very innovative approach to managing patients with MS. We created a new type of clinic that completely focuses on managing symptoms of MS. As a physician that takes care of patients with MS, usually when they come to the clinic, there's just multiple things to talk about. And we are able to talk about symptoms, but sometimes we don't have enough time to address all the symptoms a patient may have. And so we designed a unique clinic just to address symptoms that a specific patient has. Symptoms could range from fatigue, weakness, numbness, balance issues, falling down, sexual dysfunction, urinary issues. So, there's a wide range of symptoms a specific patient may have. And so we have a special clinic that just focuses on managing those symptoms. Gail Hogan: Who are the experts then at Ohio State who help these patients? [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: So, we have a lot of people on the team in the Quality of Life Clinic. We have a very skilled nurse practitioner and all the patients get to meet the nurse practitioner. We collect a lot of metrics and a lot of scales to decide what does each patient need, and what are the needs of a specific patient, and how can we help them? After this visit, the patient is going to be referred to other specialists, or the MS Symptom Management Multidisciplinary Clinic. In this clinic, there are multiple specialists, like a physical therapist, a pharmacist, a social worker. We get a lot of tests on our patients that come into the Multi-D clinic just to manage their symptoms. Gail Hogan: So, the first visit is just to decide what that patient needs, and it's only in one appointment. [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: It is one appointment. We collect a lot of information to decide what the patient needs. We do a thorough examination. If any blood work is needed, we order blood work. And out of this visit, we're able to decide exactly what the needs of a patient, and we make those referrals after that visit. Gail Hogan: What's been the reaction from your patients? [Music playing] Tirisham Gyang, MD: It's just been wonderful. I've sent multiple of my patients to this clinic, and I've gotten a lot of very positive feedback. When I see them in clinic, I'm able to address whatever needs they have, but sometimes we're limited With time. It's helpful to have another avenue, where all we're talking about is managing these symptoms and improving the quality of life of a patient. Gail Hogan: And it's just specifically for them. [Text on screen: Tirisham Gyang, MD Neurologist Ohio State Wexner Medical Center] Tirisham Gyang, MD: Specific for them. Each person's plan is different. Everybody is treated as an individual, with the specific needs that they have to be addressed. Gail Hogan: Dr. Gyang, thank you very much for joining us. And thank you for joining us for Health Talks. [Text on screen: Ohio State Health & Discovery Health Talks health.osu.edu] [Music fades]