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Comprehensive Care for Multiple Sclerosis: Referrals, Resources, and Research

Mitzi Joi Williams, MD, offered her perspectives on the patient and physician roles in MS care, the need for comprehensive care teams, resources for patients, and ongoing research.

Mitzi Joi Williams, MD, board certified neurologist and multiple sclerosis specialist, and founder and CEO, Joi Life Wellness Group Multiple Sclerosis Center, sat down with NeurologyLive recently to discuss the care of patients with multiple sclerosis (MS).

Notably, she offered her perspective on the importance of utilizing a comprehensive care model for these patients. The inclusion of other clinicians and advanced practice providers can offer those with MS benefit, as is the case for many other neurologic diseases. But, Williams added, the dynamic between the patient and physician is particularly important for ensuring that both parties are playing their role in determining the best health outcomes.

Williams also shared her insight into the resources for education, support, and advocacy that she offers to patients, as well as how that process differs for younger patients with MS. She also detailed a number of areas of research and clinical development that she’s keeping her eye on in the coming months.

NeurologyLive: How important to the care process is it that your patients can get referred to, or at least speak with, additional advanced care providers?

Mitzi Joi Williams, MD: Absolutely essential. All of those things are essential. I always like to say that medicine plays a part, and my patients play a part. No medicine gets rid of the part that they play in their own health. Part of the part that they play is when we refer them to physical therapists, that they’re following through with those visits and continuing those exercises regimens. At home, if we refer them to dietary professionals, making sure that they follow up with their dietitians and nutritionists; are eating a healthy, well-balanced diet. It’s making sure that we are caring for mood symptoms—often, we make recommendations for those. But again, the patients have to follow through and see those other providers.

Those things are extremely, extremely important to having a good care plan for MS because mood and other issues affect the physical symptoms, and then the physical symptoms can be worsened, which can affect the mood again. All those things become a circle, so we can't take care of 1 without taking care of the other. It is absolutely integral to my practice to make sure that people have access to physical therapy or occupational therapy if needed, as well as psychologists and other providers, social workers to help with disability and FMLA, et cetera.

What are the resources that you tend to guide patients toward to help them better manage that home health aspect of their health?

There is a lot of information out there, and some of it is extremely great and some of it is not so great, and in everywhere in between. I usually start with directing people to very well-known advocacy organizations. I have them start with something broad, like the National MS Society, where they can get information about therapies, about diet and exercise—you get a variety of things all in 1 space, and it's all vetted by physicians and trusted partners in the MS community. It's pretty good information.

I also direct them to our other advocacy organizations, like the MS Foundation and the MS Association of America—they're often doing educational programs and webinars about different topics related to MS. Then, I also sprinkle in some recommendations about patient advocacy groups that are led by patients. For instance, MS Views and News is a patient-led organization that offers a lot of information in different seminars. We kind of start there. I also direct people to different Facebook groups or other websites that may be appropriate for them. I do a lot of work, for instance, with ethnic minority groups. There are some organizations or groups that are focused on those groups of people that patients may want to engage with.

I think the most important thing is that people engage in the MS community once they're diagnosed because certainly, having a good support team and a good medical team is extremely important. But having that group of people who really understand, practically, what the disease is like is essential to someone being able to successfully walk through their journey with MS.

Do you find that these younger millennial patients are receptive to those resources?

I find that they often will go to social media for resources and information. I would say in terms of, volunteering with those organizations or becoming active—obviously, we've been in the middle of a pandemic for almost 2 years, so it's kind of hard to see what that looks like now. But, prior to the COVID-19 pandemic, people just kind of get in where they fit in, so to speak. Some people like activity, so they were very receptive to a walk or to a bike ride. I had some people that did, like a Muck Fest. People find the spaces that they feel comfortable in and engage in those ways. But certainly, with social media, I have found it has been much more active with my younger patients. They've kind of turned to that, as a source of support versus some of the other more traditional support places.

What are some of the things you've been excited about, or you're excited to see come to fruition in MS?

I'm really excited about a lot of things that are going on in MS. I think we have, you know, several treatments that are promising. We have a new group of treatments called the BTK inhibitors, which is a different mechanism of action of any of our other therapies, and it looks very promising. I’m looking forward to some data about those and possibly will 1 or more of those getting approved.

I'm also very excited about a lot of the research that's coming out about the gut microbiome and how that may impact the things that we eat, and how that may impact MS susceptibility and risk. I think other research that's been ongoing, but we're learning more and more about, are things like stem cell research—which has been very exciting for some time—but now we're finding that people are able to refine the process and we're seeing more long-term results. Hopefully, this is something that will come to the forefront as a means of treatment in the general population because right now, it's still very experimental. We don't have good, solid pathways to send patients to get stem cell transplants when we think they're appropriate.

The other thing that I'm excited about is a lot of the work that's being focused on increasing diversity in clinical research, which is one of my passions. We have the first clinical trial focused on MS and the African American, Hispanic, and Latino communities here in the US. I'm very excited that we will, hopefully, have some results in from that trial. Also, the first national African American MS registry was created last year, and we're about to start reporting results from that. There's a lot a lot of exciting things that are going on in the field of MS, and I think that it's only going to get better from here.

Transcript edited for clarity.