RealTalk MS
RealTalk MS
Navigating multiple sclerosis is easier when you understand the science behind it. Join host Jon Strum each week as he translates complex MS research, treatment breakthroughs, and healthcare news into clear, accessible language. Whether you’re living with MS, caring for a loved one, or looking for answers, RealTalk MS connects you with top neuroscientists, advocates, and the information and insights that matter most to your MS journey.
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Sept. 7, 2026

Episode 471: Navigating an MS Relapse with Dr. F. Gabriela Karolidis

Episode 471: Navigating an MS Relapse with Dr. F. Gabriela Karolidis
RealTalk MS
Episode 471: Navigating an MS Relapse with Dr. F. Gabriela Karolidis
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Season 9 Research Insights MS Treatments

Key Takeaways

  • Dr. F. Gabriela Karolidis joined the podcast to provide a deep dive into understanding, managing, and navigating MS relapses.
  • The latest update to the Multiple Sclerosis International Federation's Atlas of MS reveals that global MS prevalence has officially surpassed 3 million people.
  • Wearable activity trackers offer valuable real-world mobility data that complements brief, in-clinic patient evaluations by capturing daily activity fluctuations.
  • A systematic review of vitamin D supplementation in adults with MS indicates mixed results and does not currently support high-dose vitamin D as a standalone treatment or replacement for disease-modifying therapies.
  • A Danish nationwide study found that while high-efficacy disease-modifying therapies effectively reduce relapse rates, their impact on progression independent of relapse activity (PIRA) requires further exploration.
  • A new study reveals that adverse social and socioeconomic factors are consistently tied to poorer cognitive outcomes in people living with MS, with a disproportionate burden on non-white individuals.
Relapses make life with MS unpredictable. Understanding what they are, why they happen, and how best to manage them can make a relapse less scary and easier to navigate.
This week, Dr. Gabriela Karolidis, a board-certified neurologist and neuroimmunologist at Thomas Jefferson University, joins us for a deep dive into MS relapses.

Dr. Gabriela Karolidis

The MS International Federation has just updated the Atlas of MS, showing more than 3 million people living with MS worldwide. We're sharing the details behind the new numbers.

We'll also share a study showing how wearable activity trackers add a dimension of real-world data that provides a more complete picture of an individual's mobility throughout the day.

We'll tell you about research on Vitamin D supplements that fails to determine whether they are beneficial for people living with MS.

We're sharing study results showing that social and socioeconomic factors clearly affect cognitive function among people living with MS.

We're also sharing results from a nationwide study in Denmark that focused on whether high-efficacy DMTs affect progression independent of relapse activity (PIRA).

And we'll tell you about a fall prevention study that you may be eligible to participate in (compensation provided!).

We have a lot to talk about! Are you ready for RealTalk MS??!

This Week: Navigating a relapse :22

Global MS prevalence surpasses 3 million :57

A study shows that wearable activity trackers help create a more complete picture of an individual's mobility 6:38

Researchers attempt to determine whether Vitamin D supplements help people living with MS 10:14

A study provides evidence that social and socioeconomic factors impact cognitive function in people living with MS 13:58

A nationwide study in Denmark focuses on whether high-efficacy disease-modifying therapies have an impact on progression independent of relapse activity (PIRA) 17:20

You may be eligible to participate in a fall prevention study (compensation is provided) 21:11

Dr. F. Gabriela Karolidis takes us on a deep dive into MS relapses 22:58

Share this episode 37:52

Next week 38:12

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LINKS

If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com

STUDY: Global Prevalence of Multiple Sclerosis Surpasses 3 Million: 2024 Update of the Multiple Sclerosis International Federation Atlas of MS
https://journals.sagepub.com/doi/10.1177/13524585261479954

RESOURCE: Multiple Sclerosis International Federation Atlas of MS
https://msif.org/atlas

STUDY: Diurnal Step Count Patterns in Progressive Multiple Sclerosis
https://journals.sagepub.com/doi/10.1177/13524585261475910

STUDY: Vitamin D Supplementation and Its Effect on Relapse Frequency and MRI Activity in Adults With Multiple Sclerosis: A Systematic Review
https://onlinelibrary.wiley.com/doi/10.1002/brb3.71692

STUDY: Social and Socioeconomic Factors and Cognitive Outcomes in Multiple Sclerosis
https://sciencedirect.com/science/article/pii/S221103482600475X

STUDY: Effectiveness of Escalation Versus Early High-Efficacy Therapies on Progression Independent of Relapse Activity In Multiple Sclerosis: A Danish Nationwide Study
https://neurologyopen.bmj.com/content/8/2/e001690

PARTICIPATE: University of Illinois Disability, Participation, and Quality of Life Research Laboratory Fall Prevention Study
Email: DPQoL-FallPrev@illinois.edu

REGISTER: ECTRIMS Patient Community Day
https://ectrimspatientcommunity.eu

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RealTalk MS Episode 471
Guest: Dr. Gabriela Karolidis

Frequently Asked Questions

What is an MS relapse?

An MS relapse occurs when the immune system mistakenly attacks myelin, the protective layer around nerve fibers in the central nervous system, disrupting signal transmission and causing new or worsening neurological symptoms.

What is a pseudo-relapse?

A pseudo-relapse is a temporary worsening of existing MS symptoms caused by triggers like heat, stress, or infections, rather than new inflammatory activity or demyelination in the central nervous system.

How many people currently live with MS worldwide?

According to the 2024 update of the Multiple Sclerosis International Federation Atlas of MS, the global prevalence of multiple sclerosis has officially surpassed 3 million, with an estimated 3.1 million people living with the condition.

Do wearable activity trackers help manage MS mobility?

Yes, continuous step count data from wearable activity trackers helps fill out a more complete picture of an individual's mobility by capturing how symptoms fluctuate throughout the day outside of the clinic.

WEBVTT

00:00:18.220 --> 00:00:21.290
It's September 8th, and we have a lot to talk about.

00:00:21.990 --> 00:00:26.900
Relapses make life with MS unpredictable. Understanding what they are,

00:00:26.900 --> 00:00:32.980
why they happen, and how they're best managed can help make a relapse less scary and easier to navigate.

00:00:33.750 --> 00:00:38.570
Our guest today is Dr. Gabriela Karolidis, a board-certified neurologist and

00:00:38.570 --> 00:00:43.450
neuroimmunologist at Thomas Jefferson University, where she also serves as a

00:00:43.450 --> 00:00:44.910
clinical assistant professor.

00:00:45.660 --> 00:00:50.420
But before we get to my conversation with Dr. Karolidis, there are a few other

00:00:50.420 --> 00:00:52.400
things that you should know about.

00:00:57.490 --> 00:01:02.470
Since 2020, the number of people living with multiple sclerosis worldwide was

00:01:02.470 --> 00:01:04.700
estimated to be 2.8 million.

00:01:05.280 --> 00:01:10.400
That's the figure that's been shared across advocacy, research, and clinical trials.

00:01:11.230 --> 00:01:15.920
Last week, that benchmark officially shifted. According to a landmark update

00:01:15.920 --> 00:01:20.340
to the Atlas of MS published by the Multiple Sclerosis International Federation,

00:01:20.740 --> 00:01:24.820
the global prevalence of MS has officially surpassed 3 million.

00:01:25.380 --> 00:01:29.860
The new number is 3.1 million people living with MS globally.

00:01:30.560 --> 00:01:34.910
So let's break down what this update tells us, why prevalence is climbing,

00:01:35.220 --> 00:01:41.790
and why these numbers represent a critical baseline as the way MS is diagnosed is changing.

00:01:42.460 --> 00:01:51.040
This 2024 update drew on data from 133 countries Representing roughly 93% of the world's population,

00:01:51.800 --> 00:02:00.200
And when you look at the raw rate per capita Global prevalence has climbed to 38.1 per 100,000 people,

00:02:00.820 --> 00:02:05.580
Now to put that trend in MS prevalence in perspective In 2013,

00:02:05.580 --> 00:02:09.370
the global rate was 24.8 per 100,000.

00:02:10.220 --> 00:02:14.940
By 2020, it had reached 35.5 per 100,000.

00:02:15.610 --> 00:02:21.860
That means over the past decade, MS prevalence per capita has jumped 54%.

00:02:22.460 --> 00:02:26.550
Now, when people hear that more people have MS today than a decade ago,

00:02:26.890 --> 00:02:31.290
the first question that pops up is, does this mean the risk of developing MS

00:02:31.290 --> 00:02:32.590
is actually increasing?

00:02:33.350 --> 00:02:37.870
The research team behind this work was quick to point out that while environmental

00:02:37.870 --> 00:02:43.600
shifts can't be ruled out, the primary drivers are actually far more encouraging.

00:02:44.230 --> 00:02:46.390
First, diagnostic tools and

00:02:46.390 --> 00:02:50.840
clinical recognition of MS have improved significantly around the world.

00:02:51.190 --> 00:02:55.400
So MS is being detected now, when in years past, it wouldn't have been.

00:02:55.930 --> 00:03:00.770
And as we've discussed before on this podcast, people with MS are living longer.

00:03:01.450 --> 00:03:06.980
Reductions in mortality and access to disease-modifying therapies mean people

00:03:06.980 --> 00:03:10.350
with MS are surviving and aging with the disease.

00:03:11.040 --> 00:03:16.400
When survival increases, prevalence naturally goes up, even if the annual number

00:03:16.400 --> 00:03:19.840
of new MS diagnoses remains relatively steady.

00:03:20.910 --> 00:03:25.500
There are two specific findings in this update that do require some discussion.

00:03:26.190 --> 00:03:33.310
First, pediatric MS. Now, historically, data on children and adolescents has been extremely scarce.

00:03:33.870 --> 00:03:40.210
In 2013, the Atlas of MS recorded just 7,000 pediatric cases worldwide.

00:03:41.270 --> 00:03:47.560
In the updated 2024 report, that number surged to over 40,000 children and adolescents

00:03:47.560 --> 00:03:49.760
across 59 reporting countries.

00:03:50.510 --> 00:03:55.020
Experts emphasize this isn't necessarily an epidemic of childhood onset.

00:03:55.620 --> 00:04:00.250
Rather, it reflects clinicians finally having the training and diagnostic awareness

00:04:00.500 --> 00:04:06.270
to identify MS in young people who were previously overlooked or misdiagnosed.

00:04:07.050 --> 00:04:10.630
Second, the data highlights a stark global divide.

00:04:11.390 --> 00:04:16.540
Prevalence remains highest in Europe at 157 per 100,000,

00:04:16.940 --> 00:04:23.460
and the Americas, around 109 per 100,000, while low-income countries reported

00:04:23.460 --> 00:04:27.620
an average of just 3.3 per 100,000.

00:04:28.500 --> 00:04:34.100
As the paper's authors point out, 83% of all countries still report substantial

00:04:34.100 --> 00:04:36.770
barriers to getting an MS diagnosis,

00:04:37.290 --> 00:04:43.510
including shortages of neurologists, high personal health care costs, and a lack of MRI access.

00:04:44.180 --> 00:04:48.820
In many parts of the world, people aren't missing from the data because they don't have MS.

00:04:49.110 --> 00:04:52.180
They're absent because they never received a diagnosis.

00:04:53.390 --> 00:04:58.190
When we move from prevalence to incidence, data from 91 countries indicates

00:04:58.190 --> 00:05:03.480
that roughly 120,000 people are newly diagnosed with MS each year,

00:05:04.060 --> 00:05:08.050
or about 2.1 per 100,000 people annually,

00:05:08.670 --> 00:05:14.300
with women continuing to represent about 70% of all the MS cases globally.

00:05:15.150 --> 00:05:19.880
And capturing these numbers is particularly important as the global neurology

00:05:19.880 --> 00:05:27.450
community is in the process of adopting the updated 2024 McDonald criteria for diagnosing MS.

00:05:28.270 --> 00:05:32.840
As we've often discussed, the revised diagnostic criteria allow for earlier

00:05:32.840 --> 00:05:34.880
confirmation of disease activity,

00:05:35.410 --> 00:05:44.040
and reclassify certain presentations like radiological isolated syndrome or RIS as early MS.

00:05:44.900 --> 00:05:49.800
As those updated criteria enter clinical practice, prevalence numbers are going

00:05:49.800 --> 00:05:55.530
to increase, and the updated 2024 atlas provides the empirical baseline needed

00:05:55.530 --> 00:05:57.920
to measure that transition accurately.

00:05:59.010 --> 00:06:04.750
It's important to realize that counting every person with MS isn't just an academic exercise.

00:06:05.500 --> 00:06:10.470
These numbers impact health care policy, drug pricing negotiations,

00:06:10.680 --> 00:06:16.250
and how international health bodies like the World Health Organization allocate neurological care.

00:06:16.820 --> 00:06:22.670
And 3.1 million people represent a clear mandate for equitable access to diagnosis

00:06:22.940 --> 00:06:24.830
and treatment worldwide.

00:06:25.760 --> 00:06:29.840
If you'd like to review the research paper or the raw data, you'll find links

00:06:29.840 --> 00:06:33.690
to the paper and to the Atlas of MS in today's show notes.

00:06:38.290 --> 00:06:42.200
If you or someone close to you lives with MS, you're probably familiar with

00:06:42.200 --> 00:06:43.930
the typical visit to the clinic.

00:06:44.540 --> 00:06:49.370
Doctors commonly rely on measures like the Expanded Disability Status Scale,

00:06:49.370 --> 00:06:56.000
or EDSS, to evaluate balance and functional abilities and the timed 25-foot

00:06:56.000 --> 00:06:57.750
walk to measure walking speed.

00:06:58.360 --> 00:07:04.030
But those assessments are snapshots in time. They can only capture how an individual

00:07:04.030 --> 00:07:08.900
is functioning in that exam room for a few minutes every few months.

00:07:09.450 --> 00:07:14.530
And they miss how symptoms like fatigue, heat sensitivity, and natural daily

00:07:14.530 --> 00:07:17.710
rhythms can cause mobility to fluctuate throughout the day.

00:07:18.600 --> 00:07:23.710
Newly published study results suggest wearable activity trackers can help to

00:07:23.710 --> 00:07:27.670
fill out a more complete picture of an individual's mobility.

00:07:28.310 --> 00:07:33.380
Researchers at the University of California, San Francisco, analyzed step count

00:07:33.380 --> 00:07:41.820
data from 529 adults between the ages of 18 and 65 with primary or secondary progressive MS,

00:07:42.250 --> 00:07:46.340
who wore Fitbit devices that tracked their movements around the clock,

00:07:46.680 --> 00:07:50.440
along with clinic checkups scheduled every three months.

00:07:51.100 --> 00:07:56.460
The UCSF research team examined this continuous minute-by-minute step data to

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map out how physical activity changes across an individual's typical day.

00:08:02.130 --> 00:08:06.110
In healthy adults, physical activity usually picks up in the morning,

00:08:06.550 --> 00:08:10.090
peaks around midday, and tapers off into the evening.

00:08:10.700 --> 00:08:14.980
In people with progressive MS, that pattern is different, especially during

00:08:14.980 --> 00:08:20.960
the late morning and afternoon hours, and the study data showed these differences were substantial.

00:08:21.900 --> 00:08:26.580
Compared to individuals with mild disability who did not require walking aids,

00:08:26.880 --> 00:08:30.030
scoring 3 to 3.5 on the EDSS,

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midday steps were roughly 50% lower for individuals with an EDSS score of 6

00:08:37.610 --> 00:08:44.140
and 70% lower for those with a score of 6.5, which indicates the need for a cane,

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crutches, or another walking aid.

00:08:47.830 --> 00:08:53.120
On the timed 25-foot walk, participants who took 8 seconds or longer to complete

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the distance took about 50% fewer midday steps compared to those who finished in under 6 seconds.

00:09:02.740 --> 00:09:07.030
The researchers found that while EDSS scores showed a stronger connection to

00:09:07.030 --> 00:09:13.660
daily step patterns than walking speed alone, combining both tests provided the clearest picture.

00:09:14.450 --> 00:09:18.860
Among the specific neurological functions assessed, walking ability had the

00:09:18.860 --> 00:09:24.990
strongest association with daily step counts, followed closely by motor function and coordination.

00:09:25.960 --> 00:09:30.470
So what does this mean? Because MS symptoms shift throughout the day,

00:09:30.740 --> 00:09:35.840
the study authors note that real-time continuous step profiles could serve as

00:09:35.840 --> 00:09:38.270
practical markers of physical performance.

00:09:38.760 --> 00:09:44.320
Instead of replacing clinical tests, wearable data could complement clinic visits

00:09:44.320 --> 00:09:45.990
and patient-reported outcomes,

00:09:46.440 --> 00:09:51.360
potentially helping neurologists identify exactly when mobility drops during

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the day, and ensuring that interventions like physical therapy were optimally

00:09:56.410 --> 00:09:57.930
timed for an individual.

00:09:58.390 --> 00:10:04.130
And optimally timing that PT session should lead to the patient getting a lot more benefit from it.

00:10:04.950 --> 00:10:10.070
If you'd like to review the details of this study, you'll find a link in today's show notes.

00:10:14.710 --> 00:10:18.790
For years, vitamin D has drawn significant interest in MS care.

00:10:19.280 --> 00:10:23.300
It's been noted that people with MS often have low levels of vitamin D.

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And because vitamin D plays a role in immune regulation, many patients,

00:10:28.500 --> 00:10:33.230
clinicians, and researchers have wondered whether taking vitamin D supplements

00:10:33.670 --> 00:10:36.720
could have a direct impact on managing MS.

00:10:37.460 --> 00:10:43.070
And the jury still seems to be out on this. A newly published systematic review

00:10:43.070 --> 00:10:49.940
of vitamin D clinical trials shows that the clinical evidence remains, well, inconsistent.

00:10:51.080 --> 00:10:55.940
Researchers analyzed published clinical trials evaluating vitamin D supplements

00:10:55.940 --> 00:11:03.100
in adults with MS across varied treatment durations, ranging anywhere from six months up to four years.

00:11:03.670 --> 00:11:08.350
The trials evaluated different forms and dosages of both naturally occurring

00:11:08.350 --> 00:11:11.250
vitamin D and lab-made vitamin D.

00:11:11.900 --> 00:11:15.650
And when it came to the effect of vitamin D supplements on MS relapses,

00:11:16.260 --> 00:11:17.770
the results were somewhat mixed.

00:11:18.420 --> 00:11:23.260
Five out of the six randomized controlled trials that assessed relapse outcomes

00:11:23.530 --> 00:11:27.520
found no statistically significant reduction in relapse rates,

00:11:27.950 --> 00:11:33.240
whether vitamin D was taken alone or alongside standard disease-modifying therapies.

00:11:34.230 --> 00:11:37.640
Only one clinical trial reported a significant benefit.

00:11:38.340 --> 00:11:43.660
Participants receiving one microgram a day of a lab-made version of vitamin

00:11:43.660 --> 00:11:51.990
D had a 10% relapse rate compared to a 32% relapse rate among those study participants receiving a placebo,

00:11:52.570 --> 00:11:56.710
and that represents an 80% reduction in relapse risk.

00:11:57.540 --> 00:12:02.130
Interestingly, the researchers noted that while relapses were largely unchanged,

00:12:02.490 --> 00:12:07.120
vitamin D did appear to have a more measurable impact on MRI scans,

00:12:07.510 --> 00:12:09.440
but even those findings were mixed.

00:12:09.910 --> 00:12:15.510
For example, in one clinical trial, adding naturally occurring vitamin D to

00:12:15.510 --> 00:12:20.700
ReBIF significantly reduced active lesions and overall lesion burden.

00:12:21.320 --> 00:12:25.880
And a secondary analysis of one of the trials included in this study found that

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trial participants receiving daily vitamin D alongside their treatment were

00:12:30.700 --> 00:12:34.580
more likely to remain free of new or enlarging brain lesions.

00:12:35.410 --> 00:12:40.130
Yet other studies showed conflicting results with no significant change in lesion

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counts. Some showed mixed results.

00:12:43.880 --> 00:12:49.500
Well, the research team pointed out several factors that by definition complicated their analysis.

00:12:50.300 --> 00:12:55.230
They found that baseline vitamin D levels varied widely among trial participants,

00:12:55.740 --> 00:13:01.340
and differences in formulations, dosages, and study lengths made cross-study

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comparisons very difficult.

00:13:04.390 --> 00:13:09.270
It also remains unclear whether people with an existing vitamin D deficiency

00:13:09.610 --> 00:13:15.960
respond differently to vitamin D supplements than those people with sufficient vitamin D levels.

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The researchers concluded that current data does not support high-dose vitamin

00:13:20.960 --> 00:13:26.100
D supplementation as a standalone treatment or as a replacement for standard

00:13:26.100 --> 00:13:27.700
disease-modifying therapies.

00:13:28.500 --> 00:13:32.880
And while taking vitamin D may still be useful in correcting an individual's

00:13:32.880 --> 00:13:34.360
nutritional deficiency,

00:13:34.910 --> 00:13:39.660
the authors called for larger randomized controlled trials to clarify whether

00:13:39.660 --> 00:13:44.920
vitamin D supplements offer any disease-modifying benefits beyond maintaining

00:13:44.920 --> 00:13:47.300
healthy vitamin D baseline levels.

00:13:47.900 --> 00:13:51.780
Now, if you'd like to review the details of this analysis, you'll find that

00:13:51.780 --> 00:13:53.550
link in today's show notes.

00:13:58.240 --> 00:14:03.730
When we discuss MS-related cognitive dysfunction, the conversation usually focuses

00:14:03.730 --> 00:14:07.350
on brain lesions, atrophy, and disease progression.

00:14:07.940 --> 00:14:12.760
But how much do our living environments, social ties, and even our economic

00:14:12.760 --> 00:14:15.580
backgrounds influence cognitive outcomes?

00:14:16.540 --> 00:14:20.230
Researchers from the University of Washington and the University of Michigan

00:14:20.520 --> 00:14:26.320
set out to investigate how social and socioeconomic factors connect to cognitive

00:14:26.320 --> 00:14:28.930
performance among people living with MS,

00:14:29.290 --> 00:14:32.570
and whether those associations differ by race.

00:14:33.390 --> 00:14:40.070
The researchers conducted a secondary analysis evaluating 274 adults living with MS.

00:14:40.750 --> 00:14:47.260
The average age of the study participants was about 51, 77.4% of the group was

00:14:47.260 --> 00:14:50.840
female, and 72.3% were white.

00:14:51.860 --> 00:14:55.750
To capture a comprehensive look at socioeconomic circumstances,

00:14:56.220 --> 00:15:00.920
the team evaluated four key factors—educational attainment,

00:15:01.470 --> 00:15:05.790
employment status, marital or cohabitation status,

00:15:06.290 --> 00:15:11.870
and neighborhood disadvantage, quantified using the Area Deprivation Index,

00:15:12.090 --> 00:15:17.570
which is a tool that measures and ranks neighborhoods by their socioeconomic disadvantage.

00:15:18.540 --> 00:15:22.290
Study participants completed a number of cognitive evaluations.

00:15:22.590 --> 00:15:27.220
These included self-reported cognitive abilities, as well as several objective,

00:15:27.220 --> 00:15:28.910
performance-based assessments.

00:15:29.460 --> 00:15:33.570
And for those of you who are detail-oriented, these assessments included the

00:15:33.570 --> 00:15:38.730
NIH Toolbox Cognition Battery, the Symbol Digit Modalities Test,

00:15:39.150 --> 00:15:44.350
the PACE Auditory Serial Addition Test, and the RAY Auditory Verbal Learning Test.

00:15:45.290 --> 00:15:50.180
The data showed that adverse social and socioeconomic conditions were consistently

00:15:50.180 --> 00:15:52.610
tied to poorer cognitive performance.

00:15:53.300 --> 00:15:58.960
Lower levels of education, unemployment, being unmarried, and living in neighborhoods

00:15:58.960 --> 00:16:04.000
with greater disadvantage each showed significant negative associations across

00:16:04.000 --> 00:16:05.410
all the cognitive measures.

00:16:06.350 --> 00:16:10.600
Additionally, the research team found that non-white participants performed

00:16:10.600 --> 00:16:15.210
worse across the objective cognitive tests compared to white participants.

00:16:15.970 --> 00:16:20.290
And race moderated some of these relationships. Specifically,

00:16:20.290 --> 00:16:24.840
the negative impacts of being unmarried and living with greater neighborhood disadvantage

00:16:25.230 --> 00:16:31.240
were more pronounced among non-white individuals with MS than among white individuals with MS.

00:16:32.090 --> 00:16:35.680
The researchers concluded that social disadvantage has a direct,

00:16:35.840 --> 00:16:41.770
measurable association with cognitive outcomes in MS, carrying a disproportionate

00:16:41.770 --> 00:16:43.830
burden for non-white individuals.

00:16:44.870 --> 00:16:49.310
These findings remind us that conversations about inequities in MS care and

00:16:49.310 --> 00:16:53.270
research have to go beyond issues related to access.

00:16:53.970 --> 00:16:57.910
They should serve as a reminder to clinicians that evaluating cognitive risk

00:16:57.910 --> 00:17:01.560
in an individual living with MS can't happen in a vacuum.

00:17:02.240 --> 00:17:06.950
Capturing the full picture of a person's cognitive health means factoring in

00:17:06.950 --> 00:17:09.970
their social context and even their zip code.

00:17:10.940 --> 00:17:16.070
If you'd like to review the details of this study, you'll find that link in today's show notes.

00:17:19.910 --> 00:17:24.640
Over the past few years, one of the most widely debated strategies in MS care

00:17:24.640 --> 00:17:29.700
has centered on how aggressively to treat MS right from the time of diagnosis.

00:17:30.630 --> 00:17:35.360
Do you start with a moderate-efficacy therapy that carries relatively minor

00:17:35.360 --> 00:17:40.490
risk and then escalate to a more powerful therapy if disease activity continues?

00:17:41.140 --> 00:17:45.520
Or do you start immediately with a high-efficacy disease-modifying therapy?

00:17:46.380 --> 00:17:50.920
While early treatment with high-efficacy DMTs has been shown to be effective

00:17:50.920 --> 00:17:52.680
at stopping MS relapses,

00:17:53.100 --> 00:17:57.740
their effectiveness at stopping disability worsening that accumulates quietly

00:17:57.740 --> 00:18:03.990
in the background, a process known as progression independent of relapse activity, or PIRA,

00:18:04.810 --> 00:18:06.770
well, that remains uncertain.

00:18:07.680 --> 00:18:12.890
Now, a nationwide study from Denmark may begin to provide answers to that question.

00:18:13.650 --> 00:18:18.210
Researchers from the Danish Multiple Sclerosis Registry at Copenhagen University

00:18:18.210 --> 00:18:27.900
Hospital examined data from 3,316 adults living with MS who began treatment between 2012 and 2022.

00:18:29.000 --> 00:18:34.960
2,722 of these patients began their treatment on moderate-efficacy therapies

00:18:35.210 --> 00:18:42.530
with the option to escalate, and 594 patients initiated treatment using high-efficacy therapies.

00:18:43.400 --> 00:18:48.810
These patients were followed for between one and a half and just over 13 years,

00:18:49.350 --> 00:18:54.520
and during this follow-up period, the research team tracked the time to an individual's

00:18:54.680 --> 00:19:00.760
first Pira event and their annualized relapse rate. Here's what they discovered.

00:19:01.820 --> 00:19:06.600
When it came to acute relapses, starting early with a high-efficacy therapy

00:19:06.810 --> 00:19:08.490
delivered a clear advantage.

00:19:09.230 --> 00:19:15.280
Early initiation of a high-efficacy DMT was associated with a 40% reduction

00:19:15.280 --> 00:19:17.150
in the annualized relapse rate.

00:19:17.930 --> 00:19:22.970
And by the way, this provides me with an opportunity to remind you that the evidence is clear.

00:19:23.540 --> 00:19:30.640
Starting a DMT early and staying on a DMT delivers real benefits when it comes to your quality of life.

00:19:31.330 --> 00:19:35.460
Getting back to the study, when the researchers looked at progression independent

00:19:35.460 --> 00:19:38.980
of relapse activity, the results told a different story.

00:19:39.730 --> 00:19:45.430
When it came to the time to a patient's first Pira event, there was no statistically

00:19:45.430 --> 00:19:49.930
significant difference between the two treatment strategies being compared.

00:19:50.880 --> 00:19:54.940
I think these results highlight a critical reality in modern MS care.

00:19:55.560 --> 00:20:00.770
While today's high-efficacy therapies excel at suppressing the peripheral inflammatory

00:20:00.770 --> 00:20:02.630
attacks that cause relapses,

00:20:03.320 --> 00:20:08.540
they don't appear to significantly alter the underlying biology-driving progression

00:20:08.540 --> 00:20:11.290
that occurs independently of those relapses,

00:20:12.030 --> 00:20:17.280
and that underscores a significant unmet need and a massive therapeutic gap.

00:20:18.250 --> 00:20:23.230
Developing treatments capable of targeting the compartmentalized disease processes

00:20:23.230 --> 00:20:28.450
that drive long-term disability accumulation should be at the top of every MS

00:20:28.450 --> 00:20:29.950
researcher's to-do list.

00:20:30.580 --> 00:20:34.910
And to my friends in the pharmaceutical industry, instead of focusing on one

00:20:34.910 --> 00:20:39.790
more therapy to treat relapsing MS, perhaps this is where your research and

00:20:39.790 --> 00:20:41.980
development dollars would be better spent.

00:20:42.830 --> 00:20:46.970
When it comes to understanding what will and won't effectively stop progression

00:20:46.970 --> 00:20:52.600
independent of relapse activity, this research from Denmark represents a very tip of the iceberg.

00:20:53.090 --> 00:20:56.960
We can expect to see a lot more research in this area in the near-term,

00:20:57.420 --> 00:21:00.050
in the mid-term, and long-term future.

00:21:00.720 --> 00:21:03.660
Meanwhile, if you'd like to review the details of this study,

00:21:04.130 --> 00:21:06.720
you'll find that link in today's show notes.

00:21:11.020 --> 00:21:14.990
If you're an adult living with MS and you use a wheelchair or scooter,

00:21:15.200 --> 00:21:19.300
you may be eligible to participate in a study focused on fall prevention.

00:21:19.580 --> 00:21:24.450
It's being conducted by the Disability, Participation, and Quality of Life Research

00:21:24.450 --> 00:21:27.040
Laboratory at the University of Illinois.

00:21:28.060 --> 00:21:32.030
In the study, you'll learn ways to prevent and manage falls with the goal of

00:21:32.030 --> 00:21:37.430
participating in enjoyable activities at home and in your community without risk.

00:21:38.070 --> 00:21:43.160
Study participants will be randomly assigned to one of two six-week fall prevention

00:21:43.160 --> 00:21:45.350
and management education programs.

00:21:45.970 --> 00:21:51.150
Participants will be asked to complete three online surveys and track the frequency

00:21:51.150 --> 00:21:53.790
of their falls over a 14-week period.

00:21:54.540 --> 00:22:02.260
Compensation for your participation will be in the form of at least $180 in Amazon gift cards.

00:22:03.140 --> 00:22:16.020
To learn more or check your eligibility for this study, you can email dpqol-fallprev at illinois.edu,

00:22:16.530 --> 00:22:19.830
and you'll find that link in today's show notes.

00:22:21.320 --> 00:22:24.810
I've always believed that one of the most challenging aspects of living with

00:22:24.810 --> 00:22:30.810
MS is its unpredictability, not knowing what may lie right around the corner

00:22:30.810 --> 00:22:34.740
when it comes to symptom worsening, when it comes to relapses.

00:22:35.350 --> 00:22:39.490
That's why I'm happy to be joined today by Dr. Gabriela Karolidis,

00:22:39.780 --> 00:22:43.440
who's going to demystify MS relapses,

00:22:44.070 --> 00:22:48.260
help us understand why they happen, what's happening when they occur,

00:22:48.540 --> 00:22:50.500
and how they can best be managed.

00:22:50.880 --> 00:22:54.660
In a moment, we'll meet my guest, Dr. Gabriela Karolidis.

00:22:57.790 --> 00:23:02.590
Relapses make life with MS unpredictable. Understanding what they are,

00:23:02.590 --> 00:23:09.190
why they happen, and how they're best managed can help make relapses less scary and easier to navigate.

00:23:09.990 --> 00:23:14.890
Joining me today is Dr. Gabriela Karolidis, a board-certified neurologist and

00:23:14.890 --> 00:23:19.810
neuroimmunologist at Thomas Jefferson University, where she also serves as a

00:23:19.810 --> 00:23:21.330
clinical assistant professor.

00:23:21.920 --> 00:23:24.030
Welcome to the podcast, Dr. Karolidis.

00:23:24.700 --> 00:23:26.740
Thank you for having me. It's my pleasure to be here.

00:23:27.470 --> 00:23:31.930
I always like to begin conversations like this one by getting our definitions out of the way.

00:23:32.190 --> 00:23:37.030
So I'm hoping you'll start us off by explaining what's actually happening inside

00:23:37.030 --> 00:23:40.180
the central nervous system during an MS relapse.

00:23:40.980 --> 00:23:45.070
That's a fantastic point, and I love patients to understand what's going on.

00:23:45.730 --> 00:23:50.240
So during a relapse, the immune system mistakenly attacks myelin,

00:23:50.680 --> 00:23:55.430
that protective layer around nerve fibers that helps transmit signal quickly and smoothly.

00:23:55.920 --> 00:23:58.600
And sometimes it can even disrupt the fibers themselves.

00:23:59.190 --> 00:24:01.920
This disrupts how the signals work throughout the nervous system,

00:24:01.920 --> 00:24:05.690
leading to symptoms like vision change, non-minus weakness, among a few others.

00:24:06.150 --> 00:24:10.620
And how you present is depending on where exactly in the central nervous system that occurs.

00:24:11.350 --> 00:24:15.770
And this is driven by an autoimmune issue. So these inflammatory or immune cells

00:24:15.990 --> 00:24:19.840
get mistakenly triggered to go into the blood-brain barrier and attack the myelin

00:24:19.840 --> 00:24:21.740
to an autoimmune pathology.

00:24:22.550 --> 00:24:27.600
We often hear terms like flare, attack, exacerbation, and relapse.

00:24:28.060 --> 00:24:30.600
Are these terms all describing the same thing?

00:24:31.410 --> 00:24:34.240
They are, and they're often used by patients interchangeably,

00:24:34.240 --> 00:24:38.080
although in medicine, we usually like to use the term relapse because that's

00:24:38.080 --> 00:24:39.970
what's used in our current MS guidelines.

00:24:40.620 --> 00:24:43.570
But one distinction I'd like to tease out, that between these,

00:24:43.570 --> 00:24:47.730
oftentimes I'll hear my patients also use the word flare just to describe a

00:24:47.730 --> 00:24:51.160
day when their symptoms feel worse, even if it's from fatigue or heat,

00:24:51.460 --> 00:24:54.370
rather than new symptoms suggested on a relapse.

00:24:54.570 --> 00:24:58.400
So when I hear someone say that they're flaring, it's worth asking whether they're

00:24:58.400 --> 00:25:03.130
experiencing new symptoms or just simply temporary worsening of some of their prior existing ones.

00:25:04.140 --> 00:25:07.900
Well, that leads me to this two-part question. First,

00:25:08.440 --> 00:25:13.920
define what a pseudo-relapse is, and then how can things like a mild urinary

00:25:13.920 --> 00:25:19.130
tract infection, stress, or even a very hot day trick someone into thinking

00:25:19.130 --> 00:25:21.410
their MS is actively progressing?

00:25:22.330 --> 00:25:25.420
This is a common topic that we've covered. I think it's really important for

00:25:25.420 --> 00:25:29.190
patients to know today to be able to tease out their different symptoms.

00:25:29.790 --> 00:25:34.830
So while a true relapse represents new inflammatory activity or an attack,

00:25:35.510 --> 00:25:39.570
a pseudo-relapse is temporary worsening of prior symptoms because the nervous

00:25:39.570 --> 00:25:44.590
system is under some sort of rest, not because there's new damage or inflammation of prey.

00:25:45.360 --> 00:25:48.760
I typically describe a pseudo-relapse as a scar from prior inflammation,

00:25:49.180 --> 00:25:51.040
getting irritated and talking to you.

00:25:51.520 --> 00:25:54.970
Common triggers, like you mentioned, might be like a UTI, a cold,

00:25:54.970 --> 00:25:56.470
or some other viral illness.

00:25:56.870 --> 00:26:01.190
I oftentimes will also see stress, sleep deprivation, and really things that

00:26:01.190 --> 00:26:05.100
increase your body's internal temperature by just half a degree Celsius can

00:26:05.100 --> 00:26:09.180
affect that conduction down a scarred neuron and cause these symptoms.

00:26:09.180 --> 00:26:14.210
Even things like I had showered, I had summer's day, maybe you had a really intense gym workout.

00:26:14.750 --> 00:26:20.440
All of these make axon or firing down a damaged nerve where the myelin was attacked

00:26:20.440 --> 00:26:21.740
a little bit more difficult.

00:26:22.240 --> 00:26:25.560
And so while the signal may work adequately under normal conditions,

00:26:25.560 --> 00:26:28.900
when the system gets stressed, like when the body temperature rises,

00:26:29.250 --> 00:26:33.430
that's when the signal becomes a little less efficient. And that's what we call pseudo-relapse.

00:26:33.830 --> 00:26:38.230
But teasing that out from relapse or an insidventory attack is really important

00:26:38.230 --> 00:26:41.350
to kind of know the difference because it changes how we treat the two.

00:26:42.010 --> 00:26:47.140
Can you explain why a new or worsening symptom has to last at least 24 hours

00:26:47.140 --> 00:26:49.260
before it qualifies as a relapse?

00:26:49.900 --> 00:26:53.610
Definitely. So inflammation is not quick on or off.

00:26:54.000 --> 00:26:58.030
When the attack happens from those immune cells that go and attack the myelin,

00:26:58.030 --> 00:27:02.820
causing the disease process of MS, it doesn't come up quickly and go away quickly.

00:27:03.390 --> 00:27:07.160
When it comes on, we say lasting at least 24 hours, but classic,

00:27:07.160 --> 00:27:11.870
it usually lasts several days or even several weeks, peaks around one or two

00:27:11.870 --> 00:27:14.540
weeks and then can take weeks to months to recover.

00:27:15.120 --> 00:27:20.050
And so I focus on this because you don't want to get too hung up on really transient

00:27:20.050 --> 00:27:24.350
symptoms that might come on and off throughout the day because then you can get stressed out.

00:27:24.350 --> 00:27:27.760
Are the tingles I had in my arm for a few minutes or a few hours today or when

00:27:27.760 --> 00:27:32.860
I woke up after sleeping on an arm maybe, is this something new MS related or

00:27:33.380 --> 00:27:36.070
is that something else like you pinched a nerve or something with a certain

00:27:36.070 --> 00:27:37.530
position or a certain mechanic

00:27:38.020 --> 00:27:42.410
and so train the things that come on and off quickly i put less weight into

00:27:42.410 --> 00:27:46.530
it but if it's there and it's ongoing it's lasting more than a day and it's

00:27:46.530 --> 00:27:51.240
new and it's not to leave on for i pay more attention could this be an invest attack

00:27:52.350 --> 00:27:57.790
Are there specific red flag symptoms like sudden changes in vision or severe

00:27:57.790 --> 00:28:02.670
mobility issues where a patient shouldn't wait 24 hours and should call their

00:28:02.670 --> 00:28:04.480
neurologist's office immediately?

00:28:05.150 --> 00:28:10.660
Definitely. So acute symptoms like sudden facial droop, inability to speak,

00:28:11.070 --> 00:28:15.650
numbness or weakness of a limb could be something separate from MS like a stroke.

00:28:15.650 --> 00:28:19.550
And I would call 911 immediately for that for acute evaluation.

00:28:20.420 --> 00:28:25.520
Separately from vascular issues like stroke, MS symptoms can also be really severe.

00:28:25.520 --> 00:28:30.390
And so if you're unable to walk, unable to see, suddenly unable to control your

00:28:30.390 --> 00:28:34.720
bowel or bladder, that I would say message your care team a little bit sooner

00:28:34.720 --> 00:28:38.560
just to make them aware if there's more urgent evaluation that they would recommend.

00:28:39.540 --> 00:28:43.390
If someone believes they're experiencing a relapse, what information should

00:28:43.390 --> 00:28:45.910
they gather before they call their neurologist?

00:28:46.620 --> 00:28:51.350
I would take a note of what symptoms they're having and what is new symptoms

00:28:51.350 --> 00:28:56.250
that they never had before versus old symptoms or worsening of old symptoms.

00:28:56.250 --> 00:28:57.920
So knowing your baseline is important.

00:28:58.490 --> 00:29:02.050
How long symptoms have been going on for? And then just taking note,

00:29:02.050 --> 00:29:05.320
any changes or things throwing you off in the time leading into that,

00:29:05.320 --> 00:29:10.640
whether that was a current or recent infection, keeping in mind recent vaccines, illness travel,

00:29:11.020 --> 00:29:14.340
thinking any other things that could be associated with that presentation.

00:29:15.170 --> 00:29:20.370
If someone notices an old symptom flaring up versus an entirely new symptom

00:29:20.370 --> 00:29:24.730
appearing, does one point more toward a true relapse than the other?

00:29:25.730 --> 00:29:31.580
When you've had worsening of prior symptoms or when you've had redemonstration

00:29:31.700 --> 00:29:35.290
of prior symptoms, I should say, that points more toward the pseudo-relapse.

00:29:35.780 --> 00:29:40.870
And your care team will ask some questions, try to investigate with labs,

00:29:40.870 --> 00:29:44.350
maybe a urine study to see if there's any infections or different things that

00:29:44.350 --> 00:29:48.660
could be triggering that potential pseudo-relapse and seeing if we find a cause to that trigger.

00:29:49.320 --> 00:29:52.500
But if there are symptoms that are new and haven't heard before and they're

00:29:52.500 --> 00:29:55.510
ongoing, those are going to trigger your care team to worry about,

00:29:55.510 --> 00:29:57.080
hey, as soon as you'll shoot a tuck.

00:29:57.840 --> 00:30:02.260
Let's talk about shared decision-making for a moment. How do you and a patient

00:30:02.260 --> 00:30:06.800
decide whether a relapse is mild enough to let it resolve on its own rather

00:30:06.800 --> 00:30:08.390
than intervening and treating it?

00:30:09.040 --> 00:30:14.840
So when symptoms are mild or they're not impeding everyday functioning,

00:30:15.770 --> 00:30:20.250
We may say, hey, let's just manage with close observation. We can consider if

00:30:20.250 --> 00:30:21.960
imaging is necessary or not.

00:30:22.840 --> 00:30:27.390
If symptoms are moderate to severe, impacting life, impacting vision or ability

00:30:27.390 --> 00:30:32.520
to walk, though as we say, maybe we need to do a treatment with high-dose steroids,

00:30:32.520 --> 00:30:37.300
whether that's IV steroids or oral steroids, to help suppress that inflammation.

00:30:37.860 --> 00:30:42.450
But high-dose steroids are not changing MS trajectory and they're not changing

00:30:42.450 --> 00:30:46.590
long-term outcomes, but they help sometimes speed up the rate of recovery from

00:30:46.590 --> 00:30:51.090
the symptoms. And so with more moderate to severe symptoms, we consider steroids into the mix.

00:30:51.490 --> 00:30:56.290
And even more when you have severe optic baritis or maybe a lesion in the spinal

00:30:56.290 --> 00:30:59.690
cord, and if there's not much of a response to the dose of steroids,

00:31:00.080 --> 00:31:02.640
then we'll say, hey, do we need to escalate to the next step,

00:31:02.810 --> 00:31:04.330
which might be plasma exchange.

00:31:04.900 --> 00:31:08.850
What are those steroids actually doing to the inflammation, and how quickly

00:31:08.850 --> 00:31:10.930
can someone expect to start feeling better?

00:31:11.790 --> 00:31:16.200
Steroids like i mentioned don't use a long-term outcome so where you'll settle

00:31:16.200 --> 00:31:19.820
out in terms of symptom recovery is where you'll settle out but they can help

00:31:19.820 --> 00:31:21.960
us get there a little bit faster and they work

00:31:22.400 --> 00:31:26.460
as a cooling down of inflammation is how i usually try to explain it but they

00:31:26.460 --> 00:31:30.350
don't stop those immune cells from doing what they're doing in terms of attacking

00:31:30.350 --> 00:31:34.500
the myelin which is why separately disease modified therapies are so important

00:31:35.230 --> 00:31:38.660
so steroids will help pull things off and sometimes people will endorse some

00:31:38.660 --> 00:31:41.400
symptom improvement during their course of high-dose steroids,

00:31:41.400 --> 00:31:43.790
and usually we'll do three, sometimes five days.

00:31:44.490 --> 00:31:48.410
And usually by that three to five day period, if there's no improvement,

00:31:48.410 --> 00:31:52.890
with still significant symptoms, some will say, hey, do we escalate to the plasma exchange?

00:31:53.300 --> 00:31:57.190
But usually you see some turnaround happen during that initial high-dose steroid dose.

00:31:57.510 --> 00:32:01.030
The debridement, which is super variable, some people get complete resolution,

00:32:01.030 --> 00:32:03.370
other people get a headway of 50% better.

00:32:04.400 --> 00:32:05.930
Lots of variability within that.

00:32:06.890 --> 00:32:11.660
Steroids can sometimes have tough short-term side effects like mood swings,

00:32:11.660 --> 00:32:13.880
insomnia, or intense flushing.

00:32:14.600 --> 00:32:19.020
What's the best way for someone to ride out these side effects during those few days of treatment?

00:32:19.840 --> 00:32:23.310
So there are a lot of side effects that can happen. Some of the common ones

00:32:23.310 --> 00:32:27.280
we watch out for are increased blood pressure, increased blood sugar,

00:32:27.560 --> 00:32:30.590
stress or agitation, trouble sleeping.

00:32:31.050 --> 00:32:34.610
So we try to mitigate each of these as they occur. Obviously,

00:32:34.610 --> 00:32:40.070
we'll do some melatonin prophylaxis at night, sleeping is an issue.

00:32:40.460 --> 00:32:44.670
Different coping management strategies of getting really stressed or worked out.

00:32:45.120 --> 00:32:48.140
Certainly keeping an eye on blood sugar and blood pressure on this.

00:32:48.140 --> 00:32:52.490
And we tackle each of these as they happen because not everyone experiences this.

00:32:53.020 --> 00:32:56.240
Other things with acute steroids, there can be white cane, but that's usually

00:32:56.240 --> 00:32:58.470
with more extensive dosing that we'll see.

00:32:59.020 --> 00:33:02.320
We triage each of these independently and then just make everyone aware of the

00:33:02.320 --> 00:33:06.250
symptoms to watch out for so they know to monitor. And then we do our own monitoring.

00:33:07.080 --> 00:33:12.230
There's not one specific thing that people can do when they're on steroids to

00:33:12.230 --> 00:33:15.730
know to get ahead of these things, but just to know what to look for and to

00:33:15.730 --> 00:33:18.800
talk to their provider if you're experiencing any certain thing,

00:33:18.800 --> 00:33:20.270
and then we'll tackle each of these.

00:33:20.830 --> 00:33:26.950
We also will do prophylactic GI medications to help prevent reflux or ulcers

00:33:26.950 --> 00:33:29.100
from formate. And so we'll have you take those.

00:33:29.310 --> 00:33:33.050
We'll have you take the steroid with food to also help protect the GI stomach lining.

00:33:33.350 --> 00:33:36.880
I can usually also take vitamin D and calcium while you're on the course of

00:33:36.880 --> 00:33:38.660
steroid to help protect bone strength.

00:33:39.350 --> 00:33:43.900
When someone is on a high-efficacy disease-modifying therapy and they experience

00:33:43.900 --> 00:33:48.780
a relapse, their immediate fear is often, my DMT isn't working anymore.

00:33:49.490 --> 00:33:53.520
How do you evaluate whether a relapse means it's time to switch treatments?

00:33:54.230 --> 00:33:58.830
That's a good point. And so I take it from two parts. One, I bring the patient

00:33:58.830 --> 00:34:03.400
in for a clinical exam and I compare the prior neurologic exam to what I'm seeing

00:34:03.400 --> 00:34:06.640
on their exam to see are there any objective changes we're noticing.

00:34:07.020 --> 00:34:10.820
Things like their walking speed or walking distance, their strength,

00:34:11.270 --> 00:34:14.970
other sensory deficits or balance issues I might be teasing out that I'm finding

00:34:14.970 --> 00:34:16.780
new from the last time I examined them.

00:34:17.440 --> 00:34:22.230
We also use MRI imaging to investigate is there a new lesion that we're seeing

00:34:22.230 --> 00:34:26.370
correlating with these symptoms or new enhancement correlating with these symptoms.

00:34:26.700 --> 00:34:31.300
And if we see that, then we assess, depending on where we're at in that disease-modifying

00:34:31.300 --> 00:34:34.880
therapy regimen, if there's a need to switch or to maintain.

00:34:35.530 --> 00:34:40.240
Does having a relapse mean that individual will definitely have permanent long-term

00:34:40.240 --> 00:34:43.630
disability or is full recovery possible?

00:34:44.330 --> 00:34:48.230
I think the latter is an important thing to remember. So MS,

00:34:48.380 --> 00:34:54.150
last week, it comes on with this inflammatory episode and it'll recur with time treated.

00:34:54.660 --> 00:34:58.520
But after some time, the inflammation goes off and then there's that recovery

00:34:58.520 --> 00:35:02.620
period in which your body tries to heal the myelin damage that happened.

00:35:02.980 --> 00:35:06.910
So cladicycle, we see pretty good recovery from MS relapses,

00:35:07.270 --> 00:35:10.990
but the extent to which someone might recover is very difficult to predict.

00:35:11.590 --> 00:35:15.890
I have patients that recover completely without any residual symptoms.

00:35:16.220 --> 00:35:19.470
And then I have patients that have some degree of recovery, but not complete

00:35:19.470 --> 00:35:21.110
back to where they were at for.

00:35:21.730 --> 00:35:27.010
The stage of severe disability can happen, but it's not as common within a mess

00:35:27.010 --> 00:35:30.860
as it is in some of our other autoimmune or demyelinating conditions.

00:35:31.190 --> 00:35:34.960
And so there's usually an expected good degree of recovery, but don't forget

00:35:34.960 --> 00:35:37.690
there's always variability and everyone's on a spectrum.

00:35:38.460 --> 00:35:43.510
Can things like physical therapy, rest, and lifestyle adjustments play a role

00:35:43.510 --> 00:35:46.380
in helping someone bounce back after a relapse?

00:35:46.980 --> 00:35:51.970
Absolutely. I love to engage our different specialties to help play into it.

00:35:51.970 --> 00:35:53.250
And I do see a difference.

00:35:53.610 --> 00:35:57.290
Having a good neurophysical therapist, occupational therapist,

00:35:57.520 --> 00:36:00.950
speech therapist, sometimes a vision rehabilitation program

00:36:01.280 --> 00:36:06.300
are all different components that we work with and help regain that balance

00:36:06.300 --> 00:36:12.250
issue, that motor strength issue, sometimes that proprioceptive sensory issue to help you adjust

00:36:12.640 --> 00:36:16.650
and work through some of the deficits to get back to as baseline as you can.

00:36:17.560 --> 00:36:22.850
Anxiety from worrying about the next relapse can get to the point where it paralyzes someone.

00:36:23.360 --> 00:36:26.250
What advice do you have for managing that uncertainty?

00:36:26.810 --> 00:36:32.360
So to that, I would say it's true. We can't predict when the next MS relapse

00:36:32.360 --> 00:36:37.450
will hit, but we can focus on the things we can control to keep people feeling

00:36:37.770 --> 00:36:41.060
as active and in control of their lives as possible.

00:36:41.390 --> 00:36:45.780
So the most important thing in this is getting on a good disease-modifying therapy

00:36:45.940 --> 00:36:47.860
to help prevent future relapses.

00:36:48.390 --> 00:36:52.000
And then otherwise, also focusing on good lifestyle changes,

00:36:52.000 --> 00:36:55.780
healthy behaviors that promote a healthy central nervous system.

00:36:56.060 --> 00:37:01.740
From having a good diet, exercise, these promote oxygen and nutrient-rich blood

00:37:01.740 --> 00:37:03.290
to get to your brain tissue.

00:37:03.410 --> 00:37:07.460
You also want to limit things like smoking or vaping, manage cardiovascular

00:37:07.460 --> 00:37:11.940
risk factors like blood pressure, diabetes to help make sure perfusion to the brain is good,

00:37:12.340 --> 00:37:16.870
keeping up to date with other aspects of health, all to prevent a healthy brain

00:37:17.020 --> 00:37:19.510
and then help manage overall brain health and

00:37:20.290 --> 00:37:21.950
the overall MS wellness picture.

00:37:22.410 --> 00:37:26.070
So it's sort of two-part, making sure we're on therapy, making sure we're in

00:37:26.070 --> 00:37:29.650
close contact with your provider, getting our annual surveillance scan,

00:37:30.050 --> 00:37:34.040
and then also living a healthy life together. These really help manage the disease.

00:37:34.870 --> 00:37:39.120
Dr. Gabriela Karolidis, thank you for all you do to improve the lives of people

00:37:39.120 --> 00:37:42.170
living with MS. And thanks for talking with me today.

00:37:42.820 --> 00:37:44.830
Absolutely. It was my pleasure. Thank you for having me.

00:37:45.710 --> 00:37:50.390
That's going to wrap up this episode of Real Talk MS. Real Talk MS is powered

00:37:50.390 --> 00:37:52.110
by the National MS Society,

00:37:52.430 --> 00:37:56.610
and you can share this episode of the podcast by letting your friends or family

00:37:56.610 --> 00:38:01.580
members know that all they have to do is point their web browser at realtalkms.com slash,

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471.

00:38:04.890 --> 00:38:09.100
You'll find that link in today's show notes, so you can easily copy and paste

00:38:09.100 --> 00:38:11.590
it right into an email or a text.

00:38:12.450 --> 00:38:16.200
This year's joint meeting of the European Committee for Treatment and Research

00:38:16.200 --> 00:38:21.040
in MS and the America's Committee for Treatment and Research MS is going to

00:38:21.040 --> 00:38:24.060
be the largest MS research conference in the world.

00:38:24.650 --> 00:38:28.830
And over the past few weeks, I hope I've given you some good reasons to register

00:38:28.830 --> 00:38:34.350
and participate either in person or online in the ECTRIMS Patient Community

00:38:34.350 --> 00:38:39.550
Day on Friday, October 23rd from 3 to 6 p.m. Eastern Time.

00:38:40.210 --> 00:38:45.190
Next week, one of the global experts who's going to be part of Patient Community Day, Dr.

00:38:45.190 --> 00:38:49.910
Jennifer Graves, and the host of the ECTRIMS podcast, my friend Brett Drummond,

00:38:50.120 --> 00:38:54.360
will be joining me to give you a special preview of what you can expect to see

00:38:54.360 --> 00:38:57.240
and hear during ECTRIMS Patient Community Day.

00:38:57.810 --> 00:39:04.100
I hope you'll join me next week to get this sneak peek of ECTRIMS Patient Community Day 2026.

00:39:04.950 --> 00:39:11.910
I'm Jon Strum. Thanks for listening. Stay safe and make healthy choices.