In this educational video, Dr. Paul Anderson reviews therapeutic options for people with multiple sclerosis (MS). He begins with a disclaimer that the information is general and not a substitute for professional medical advice. He then outlines the main categories of treatment. First, disease‑modifying therapies (DMTs) aim to reduce disease severity and relapse frequency; he explains the role of interferon‑beta (a naturally‑derived cytokine mimic) and its typical side‑effects such as flu‑like symptoms and thyroid monitoring, and introduces newer biologic options including monoclonal antibodies and other targeted biologics. Second, he discusses management of acute exacerbations, emphasizing high‑dose steroids as the cornerstone and noting that exacerbations can be triggered by non‑MS factors (hormonal shifts, infections, toxins) which may affect steroid response and cause rebound worsening. Third, he covers symptomatic management for persistent issues like pain, headaches, weakness, and bladder or gait problems, stressing that symptom‑focused drugs complement DMTs. Fourth, he highlights the importance of rehabilitation—physical and occupational therapy—to maintain neural‑muscular connections and retrain function. Fifth, he stresses mental and emotional support, recommending psychologists, psychiatrists, and counselors experienced with chronic illness to address anxiety, depression, and psychosocial stress. Finally, he underscores that MS diagnosis can coexist with other aggravating conditions, requiring a collaborative, multidisciplinary approach among patients, neurologists, and his clinic to tailor therapy. He concludes with a call to action to visit dranow.com and to like, share, and subscribe.
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Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul. Our topics today include multiple sclerosis. And so we've been through, what is it, how's it diagnosed? We've been through other disorders, other health problems that might look like MS, but maybe aren't MS, or maybe are aggravating it. And the last 2 sections that I want to talk about are therapeutic interventions. So first off, if you have MS or you think you have MS or you have any other health condition, please see your healthcare provider. This is just general information. Don't take medical advice from people on the radio or TV or YouTube or TikTok, for heaven's sake. Just, this is just to round out information and give you ideas. But if you get any good ideas from what I say, take 'em to your own healthcare provider. So, Common standard, I want to do standard therapies in this section, then the last section I'll do integrative therapies. But common standard therapies, if you do have multiple sclerosis, and we, we went through in the prior section how sometimes you might have something that isn't MS but it's creating the same symptoms. Well, if that's the case, you really want to know about that because there are other things to treat. Then there's also the case where you might have MS and other things, and so then you might have treatments, uh, kind of going in a couple of different directions. But the idea is that we're trying to treat the underlying issues. So the first area of intervention is called disease modification, and that would be disease-modifying drug therapies. Now, the idea behind a disease-modifying drug therapy is that it will Either decrease the severity of your disease, decrease the frequency of your outbreaks or the disease, or a little of both. So the idea with disease-modifying therapy would be, let's see how long we can live with this with the fewest effects from the disease possible. Now, what category do the disease-modifying therapies usually fall into pharmacologically? Well, one of the major ones, and I remember when this came out as far as using it clinically for multiple sclerosis, are the interferons and interferon beta family specifically. Now, you might have heard of interferon being used in, say, chronic hepatitis, and that's usually interferon alpha and maybe other types as well. With multiple sclerosis, interferon beta is the preferred treatment of choice. And so what is interferon? Interferon is actually something our own body makes, and so the drug is just a mimic of what your body makes on the inside. So then you might think, well, why didn't my body make enough interferon to deal with this problem? Well, interferons are a family. There's a number of different subtypes, so beta is one subtype. But the main time that interferons are released naturally from the body is when we get an infectious inflammatory trigger, and then the interferons go and they do particular things like trying to decrease the amount of virus that comes into your body, telling your immune system to ramp up and do more, and then they do a whole bunch of other things. So interferon alpha, for example, if you have that released in your body or you get it as a drug, you can have a lot of transient, you know, fatigue and pain and sort of a flu-like feeling. And that's because when you're getting the flu, one of the big things released is interferon. Now, in the case of interferon beta, it's not quite— doesn't hit you quite like a Mack truck, but many people have fatigue and possibly headaches and pain, other stuff that occur for a short time after their interferon beta dose. The other thing that's really common with interferons is a decrease in your thyroid function. And so, you nowadays it's pretty common. Anybody prescribing interferons usually has you check on your thyroid function periodically as you go along. But certainly one of the problems with thyroid function going down is it doesn't help any of your other symptoms if you become hypothyroid from that drug. Another big category that is a bit newer are the monoclonal antibodies. And so when you see monoclonal antibodies, and we've heard about them in the pandemic and all that stuff, that's just a, a technology of making an antibody. So while there are monoclonal antibodies that are made to help you with attacking a particular infection, for example, there are also monoclonal antibodies that have nothing to do with that process and they're aimed at other parts of your immune system. So if you hear monoclonal antibody, most of the time the chemical name or the generic name ends in M-A-B, monoclonal antibody. But also you want to remember that they're not all the same thing. They're a way to make a particular biologic product, but they're not all the same thing. And then another group which is growing and growing are other biologicals. So monoclonal antibodies are a biological. Actually, the interferon beta is technically a biological drug. But then other biologicals may be many other types of targeted therapies. So disease modification is kind of a cornerstone of multiple sclerosis care. So we're talking about standard therapies. Then there are prescriptions for exacerbations of your symptoms, flare-ups, if you will, etc. And normally these flare-ups are caused by an increase in inflammation in the nervous system. And so in many, many cases, The flare-up medications or the exacerbation medications are going to be— the cornerstone is going to be high-dose steroids just to beat down the inflammation. Now, the other thing which sort of ties into the previous and the next section is, let's say you're having an exacerbation, something's making your MS symptoms worse, but it's not some mysterious, you know, um, ghost-like inflammation. We're just going to put some steroids in to make it stop. But actually, it's one of these other things that we talked about. That's a real good reason for an exacerbation. You could have a hormonal shift. You could be having a shift in your blood counts and other stuff like that. You could be having a toxic influence or an infectious influence. And sometimes those are very hard to tease apart because your symptoms are going to look exactly like just a multiple sclerosis exacerbation. One of the things that can happen is if you have that exacerbation and then you get the high-dose steroids and you get some temporary relief, but then you get a rebound where your symptoms get a lot worse, that's pretty common when there's more than just the MS creating the exacerbation. Then there's sort of the chronic managing of your symptoms, and then that depends a lot on what are your symptoms. So, for example, if you're on the disease-modifying drugs and you're doing, you know, everything you're being told to, but you still have resistant headaches, or you still have, you know, sort of repeated you know, weakness or pain or something like that, usually those things would be treated symptomatically. So what could we do for your pain? What beyond steroids could we do for your inflammation? What could we do for other stuff? So symptomatic management does become very important. Now, the hope always is in the standard sort of treatment process is that the disease-modifying drugs are going to knock down the intensity of the disease. And then you're going to not need as much, you know, exacerbation treatment or symptomatic management. But you likely will need some symptomatic management. There's also the physical function issues. So, let's say you're having trouble with bladder control or you're having trouble walking or you're having difficulty with control over a particular limb or appendage or something. The rehab can be very useful with those sorts of conditions that are going on. Because if you are doing, say, you know, physical and occupational therapy, what it's trying to do is keep your brain and your body in connection and either retrain the part of the body that's not working correctly or retrain you to work around that problem or any number of other things that would occur and go on. So rehabilitation and therapeutic interventions, whether it's physical therapy or occupational therapy, et cetera, are critically important as well. And then there's a very, very critical part, which is mental and emotional support. In our practice, I've worked with some really wonderful psychiatrists and psychologists and other types of specialized counseling folks who specialize in chronic diseases, chronic diseases and cancer, the kind of things that we see. And that becomes very, very critical and important because whatever is wrong underneath, whether this is just MS or it's MS and other stuff, one of the biggest burdens on the person and on your psyche, your overall thought processes, is the fact that you have a chronic problem, you have chronic condition It's affecting you physically, mentally, and emotionally. It's affecting you socially. And it's not just— no one's going to wave a magic wand and make it go away. Well, that puts your brain into a really difficult position, which essentially is, gee, we're, you know, probably never getting out of this problem here. I didn't want this problem. I didn't ask for this problem. What am I going to do about it? I feel, you know, really, you know, just totally either, you know, a lot of people will be anxious about it, a lot of people get depressed, a lot of people will become withdrawn, a lot of people will have other, you know, issues, uh, psychosocially. So the emotional support through trained interventional work with, you know, psychologists, psychiatrists, counselors, etc. And as I said, there are people who do this and they specialize in the area of people with chronic illness. That can be just like the rehabilitation for your body and your mind, the mental and emotional support from the counseling world can be life-saving in many cases and also just make your quality of life improve, which is terribly important as well. So as we wrap up here, I want to just make a couple of kind of big picture points. One is As we've talked about, sometimes the diagnosis of MS is just the multiple sclerosis. Sometimes it's multiple sclerosis and other mitigating aggravating factors. Sometimes it's not multiple sclerosis at all, but it's other aggravating factors. These are not as easy as it might sound to sort of tease out and look at. And in my experience, a lot of times, those cases where we were able to find out the other things that were going wrong, it was a collaboration between the patient, their neurologist, and, you know, myself or my clinic, all trying to work on our individual areas of specialty to sort these things out. The next thing is that the standard type therapies, if you do have MS, are very, very useful, and often they can modify your disease. And you also want to remember you need to yourself of any type of therapy, whether it's physical or occupational therapy or mental-emotional therapy. But we're out of time for this section. Dr. Paul here with Medicine and Health. Check us out on dranow.com. Like, share, and subscribe, and I'll see you for the next section.
