Barry Hendin, MD: Multiple sclerosis [MS] can be difficult in many ways. It can be difficult on a physical, neurological, and functional basis, but it can also be difficult in a psychological and social basis. We think that a support system is really important. Support systems may vary based on one’s community, one’s family, one’s friends, and one’s faith, but it is important. We think that patients stay connected. I think it’s important for their long-term health. I think it’s important for their long-term mental health. Additionally, in a proper MS treatment center, there should be available psychological support, whether that means psychiatry or psychology. There should be an attention given to cognitive changes—anxiety, depression—as all of those things bear heavily on the quality of life of patients with MS.
Amit Bar-Or, MD, FRCP, FAAN, FANA: Multiple Sclerosis impacts people in many different ways. While in clinical trials, historically, the most tested domain has related to physical disability—particularly the ability to ambulate, which is of course an important aspect of a person’s life—MS affects people in many additional, important ways. It can affect people cognitively, it can affect people’s vocation, and it can affect people’s ability to engage socially and in the work environment. It can cause substantial fatigue, which is very debilitating. It can impact relationships between people, including sexual function. The importance of having a lifestyle that is conducive and having a holistic approach toward the patient’s experience has only become more and more important.
There’s a lot of interest in diet, and in that context biologically, there’s a lot of interest in how diet can shape the microbiota or the microbiome, which is the reflection of microbiome microbes that are present within the gut that are now understood to shape the immune system in important ways that can even affect inflammation within the central nervous system. So the old expression of ‘you are what you eat’ seems to be increasingly true and true for multiple sclerosis. And while we don’t yet have a good sense of how to prescribe a diet for multiple sclerosis, having a balanced diet that is also complementary to a lifestyle that involves physical activity and positive thinking are all features that are increasingly recognized as important parts of the overall and holistic care of patients living with MS.
Barry Hendin, MD: We know that a number of comorbidities—hypertension, diabetes, obesity, and cigarette smoking—all increase progressive disability in MS, singularly or in combination, and reduce quality of life. And so, I think each of us pays attention to each of those, or we should be.