Drs Randall Schapiro and Jeffrey Wilken provide insight into the risk factors and disease progression noted in patients with multiple sclerosis.
Ahmed Obeidat, MD, PhD: What are risk factors that can kind of affect this?
Jeffrey Wilken, PhD: Part of that question, I’m going to leave for Dr Schapiro. Let me talk about the parts that I want to address. If you read the literature, what they’re going to talk about is, as far as things that you can see in an office as a neurologist, is if you’re seeing some atrophy and more specifically central atrophy on the thalamus. But it is hard to get that though; you’d have to have a pretty good radiology department and you’d have to more than eyeball it. That is something that you read in the literature as a neurologist, and you think, “OK, atrophy.” What I, as a neuropsychologist will talk to doctors about is you really need to look at what the person’s saying to you. It’s key because if they’re saying to you, “I’m starting to have a little trouble at my job. And I’m fine physically. I have some numbness, but I’m just not doing the job as well. I’m worried I’m going to go into disability or get fired,” or “I’m not doing that well in school, at home my family says, I’m just not the same person.” Those are the people that you need to watch and see.My opinion is you want to do some kind of baseline on every MS [multiple sclerosis] patient, and follow them over time with respect to cognition. But it’s those people that I would want to have sent to the formal neuropsychological evaluation because those are the people who are maybe heading down the slippery slope as far as risk factors.
As far as MS is concerned, I haven’t read a lot about risk factors for people with MS other than comorbidities. If you are not taking care of yourself, if you’re not physical, if you have diabetes and you’re not managing it, if you have vascular issues and you’re not managing them, if you have fatigue, psychiatric disturbance, those kinds of thing, MS is a holistic disease. It is not managed by 1 person. This is managed by a team of people. And thus, if you are not taking care of the various aspects of your being, then you’re at higher risk not just with MS any condition, but if we’re talking specifically about MS, you’re at higher risk for some cognitive issues.
Ahmed Obeidat, MD, PhD: And the same to Dr Schapiro.
Randall Schapiro, MD, FAAN: I really appreciated that answer. That was an excellent answer. We classify multiple sclerosis, and everybody knows that we talk about relapsing/remitting disease. We talk about secondary progressive disease. We talk about primary progressive disease, but we also classify MS in other ways as well. And we don’t do that as much, but we talk about brain stem multiple sclerosis. We talk about spinal cord multiple sclerosis. We talk about diffuse multiple sclerosis. And we talk about cerebral multiple sclerosis. And we don’t see that as much maybe, but when you do see it, people are having problems with their memory planning, foresight, judgment, things of that nature. You know that, that person is in trouble. And if that’s one of the presenting symptoms you know that they’re in trouble.
Seizures are not a common problem in multiple sclerosis. It’s more common than the general population, but if somebody has seizures and they have multiple sclerosis you know that, that person’s likely to have some cognitive problems along the way, and you need to be cognizant of that fact. There are other things that that may lead to it. People who are depressed that can lead to the same issues, but as a more treatable type of situation. Hence, we need to look at inciting factors as well. If they’re sleep-deprived or if they’re fatigued, those are bad prognostic indicators in multiple sclerosis, and we need to treat those in terms of cognition in multiple sclerosis. But there’s no one thing that says, “Well, that person’s going to have a problem in MS,” but we get a sense of the overall picture of how they’re doing.
Ahmed Obeidat, MD, PhD: Thus, looking at the multiple factors, sleep is important-
Randall Schapiro, MD, FAAN: Sleep is really important.
Ahmed Obeidat, MD, PhD: ….As you mentioned, is very important.
Jeffrey Wilken, PhD: People do not realize.
Randall Schapiro, MD, FAAN: Fatigue is the single most common and the single most disabling symptom. And throw that on.
Ahmed Obeidat, MD, PhD: And sometimes, what we do is when we try to treat fatigue and we mess up the sleep, and when we try to treat the sleep, we mess up the fatigue.
Randall Schapiro, MD, FAAN: And then, that person’s cognitively impaired and comes off cognitively impaired. Absolutely. And drugs that we give, not necessarily the immune drugs we’re giving for treating the disease, but the drugs we give for a spasticity, the drugs we give for a bladder, the drugs we give for whatever we’re giving that for pain or whatever, happens to be able to impair cognition as well.
Transcript Edited for Clarity