A COMPREHENSIVE APPROACH TO TREATMENT EQUALS BETTER OUTCOMES FOR PATIENTS WITH MULTIPLE SCLEROSIS.
BY LAUREL DIGANGI
PHOTOGRAPHED BY THE MATTHEW SMITH
When Samantha Brown was first diagnosed with multiple sclerosis (MS) 14 years ago, she knew nothing about the disease. Frightened and confused, she consulted with a specialist who told her, “Just try to forget you have this disease and live your life the best you can.”
But that meager advice didn’t sit well with Brown, so she sought out neurologist Barbara Giesser, MD, who was at another hospital at the time. Dr. Giesser joined Pacific Neuroscience Institute at Providence Saint John’s Health Center, where she is building an MS program, in February 2020. “Dr. Giesser changed my life,” she says. “If I had listened to that first doctor, I can’t imagine how challenged I’d be.”
Dr. Giesser is an internationally recognized expert with 40 years of experience in the treatment of MS who employs a comprehensive approach to treating patients. “Our mission at PNI is to treat the whole patient,” says Dr. Giesser. “It’s not just about medication. The
state-of-the-art care for people with MS involves disease-modifying drugs coupled with symptom management coupled with lifestyle and psychological well-being.”
This multifaceted approach, which includes individualized treatment plans and encourages patients to be active participants in their care, has helped Brown, now 49, manage her disease. She also continues to live an active, productive life, which today includes regular exercise, multiple hobbies and a full-time career in technology and media.
Multiple sclerosis is a chronic, autoimmune disease that affects a patient’s central nervous system by damaging myelin—a substance that wraps around and protects nerve fibers—causing lesions on the brain and/or spine that interrupt the nerve signals. Patients with MS can experience a wide variety and range of symptoms from fatigue, muscular weakness and “brain fog” to difficulty walking and full or partial paralysis. Patients may also experience vision issues, numbness, speech problems, tremors, hearing loss or depression. Because other conditions can be mistaken for MS, Brown had a battery of tests including an MRI, evoked potential testing and a spinal tap. “An accurate diagnosis is a very important part of managing patients with MS because the earlier you start disease-modifying drugs, the better the patient will do overall,” Dr. Giesser says.
These drugs are an important tool in MS treatment. “Since the advent of disease-modifying therapies, I tend to rarely see the profound levels of disability that I used to see 40 years ago,” says Dr. Giesser. “There are about two dozen Food and Drug Administration-approved disease-modifying therapies that can decrease the occurrence of new areas of nerve damage.
The most common form of MS is called relapsing remitting. “Over three-quarters of people with MS start out this way,” says Dr. Giesser. They get an episode, which is the onset of neurologic impairment. Then they’re OK for a while until they get another episode. Disease-modifying therapy has shown to reduce the number and severity of attacks.”
Brown is currently taking one of the newer, highly effective disease-modifying therapies—which is an immunotherapy. “In her case, it’s resulted in clinical and radiological stability,” says Dr. Giesser.
“It’s a great medication that’s slowed my MS, and I haven’t had any new lesions in two years,” says Brown. “But we don’t know how much of this success is due to the medication and how much is due to how well I take care of myself.”
Dr. Giesser agrees. “Lifestyle strategies are equally as important in managing this disease as medications,” she says. “Brown’s healthy lifestyle, combined with highly effective therapy, has proven very successful.”
EVIDENCE-BASED DATA ABOUT EXERCISE AND DIET
Exercise plays a big role in Brown’s overall health. Each day she engages in some form of physical activity: walking on a treadmill, training with resistance bands and hand weights, or even playing tennis.
She’s also participated in Walk MS and Bike MS—the latter after not having ridden a bike since she was 10 years old. “But I got on that bike! I was riding along with other people, and it was amazing to see the support,” she says. “People with MS should exercise, just like we all should,” says Dr. Giesser. When she first began her practice, the conventional wisdom was that MS patients should not exercise or exert themselves, she says, adding: “That’s the worst thing doctors could have told them.”
Conventional wisdom is that exercise promotes cardiovascular health, bone health and endurance. However, for MS patients in particular, Dr. Giesser explains that exercise has also been shown in some cases to improve MS symptoms such as fatigue, muscle tightness and depression.
“In addition, we’re starting to get evidence-based data from animal studies showing that exercise and physical activity are anti-inflammatory and help establish new nerve connections. We also have some data that in people, they have the potential do the same thing,” she says.
Diet is also important for people with MS. “We’re also starting to get evidence-based data from small trials that certain diets might improve certain symptoms in patients with MS. A general guideline is to eat a diet that includes lots of colorful fruits and vegetables and avoid highly processed foods and saturated fats.”
According to Dr. Giesser, medications can lessen the symptoms of MS, and there are also certain strategies, such as physical therapy, occupational therapy and psychological counseling, that can benefit patients. She referred Brown to an occupational therapist, who gave her the tools to succeed in her career despite the occasional “brain fog” brought on by MS.
“The occupational therapist showed me apps that helped me organize my life so I wouldn’t need to hold so many things in my head simultaneously,” says Brown. “She also showed me exercises to help strengthen my fingers.”
These exercises not only helped Brown at a computer keyboard but also in two of her favorite hobbies—abstract painting and gardening—which help de-stress her. She’s also supplemented her care with Eastern medicine, such as acupuncture, and has learned to find quiet time and how to listen to her body. “If I push myself too hard, I could have an MS attack or my body will feel it the next day,” she says. “In the past, I told myself that I can push through—I can do it—but now I ask myself, “Should I?”
Although disease-modifying drugs may stop damage, they cannot repair the nerve cell’s myelin. However, researchers are hopeful about the potential to develop new therapies. “There’s a lot of work going on in MS research with compounds that can stimulate repair,” says Dr. Giesser. “The cells that make the myelin are called oligodendrocytes. In MS, the normal repair mechanisms where the oligodendrocytes would normally help repair the myelin are blocked or prevented from repairing or don’t mature. So researchers are testing compounds that will help these cells make more myelin when an area is injured.”
According to Dr. Giesser, MS diagnosing techniques also continue to improve as MRI software and hardware is tested and refined. “Researchers are also conducting trials now to look at new imaging metrics that will help us be even more sensitive and more specific,” she says.
THE DREAM OF “ONE-STOP SHOPPING”
MS patients are particularly frightened after their initial diagnosis. Thus, Dr. Giesser feels they would benefit from visiting multiple professionals back-to-back. Her ideal scenario would be for patients to receive all their information about medication, treatment, diet, exercise, counseling and other support specifically geared toward MS patients under one roof at PNI, in the form of “one-stop shopping.” Philanthropic support of the program would help develop this approach as well as provide for an expansion of MS programs.
“I would also like to have different programs for people at different stages of the disease, because someone who’s newly diagnosed has different needs than someone who’s been living with MS for a long time,” she says. She believes that this is a very hopeful time in the treatment of MS.
“This is a treatable and controllable condition, and it is absolutely possible to live well with MS.” Brown agrees and is grateful to the philanthropists and supporters of MS fundraisers for their heartfelt support of patients who are battling a lifelong condition. “Dr. Giesser has helped me see that MS is one part of me; it’s not all of me,” says Brown. “It can be an awakening that helps you look at what you want to do in life and find ways to do it—to not be frightened by the journey ahead but instead be excited about what’s to come.”