Apple Podcasts 
Spotify July 6, 2026
Episode 462: Taking Your MS to College? Understand Your Right to Accommodation with Britt Neff
The Americans with Disabilities Act ensures that people living with disabilities receive reasonable accommodations at work. That law also applies to students attending most colleges and universities. And the ADA doesn't limit itself to physical disabilities. It's often applied to invisible disabilities, as well.
This week, Britt Neff, the Access Specialist at the University of Washington School of Law, joins me to explain all the ways the accommodation process can work for college students living with MS.
We'll also tell you about PTD802, an oral remyelination therapy that's just been given a green light from the FDA to begin human clinical trials
We're sharing evidence from an important study that should make you feel more confident about getting those MMR (measles, mumps, rubella) and chickenpox vaccines.
You'll learn what researchers at the Cleveland Clinic discovered when they asked the question, "Can someone living with MS over the age of 60 discontinue their disease-modifying therapy?"
And we're sharing the details about an AI application that can predict -- with 90% accuracy -- whether someone with MS is at risk of experiencing cognitive decline over the next few years.
We have a lot to talk about! Are you ready for RealTalk MS??!
This Week: Understanding "reasonable accommodation" at college :22
FDA approves oral remyelination therapy PTD802 for Phase 1 clinical trial 1:07
Study results: MMR (measles, mumps, rubella) and chickenpox vaccines are shown to be safe for people with MS 4:52
Study results: Is it safe for someone living with MS over 60 to discontinue their DMT? 7:34
Study results: AI predicts future cognitive changes among people with MS with 90% accuracy 10:45
Britt Neff explains the many types of accommodation available to college students with MS 15:01
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Next week 28:44
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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
Pheno Therapeutics
https://phenotherapeutics.com
STUDY: Live Attenuated MMR and Varicella Vaccinations and Multiple Sclerosis Activity
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2849165
STUDY: Long-Term Follow-Up of Patients with Multiple Sclerosis Over Age 60: Comparing Clinical and Radiological Outcomes in Disease-Modifying Therapy Continuers and Discontinuers
https://journals.sagepub.com/doi/full/10.1177/20552173261448005
STUDY: Explainable Artificial Intelligence to Predict Neurocognitive Disorder Progression in Multiple Sclerosis Using MRI and Clinical Data
https://onlinelibrary.wiley.com/doi/10.1111/ene.70568
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RealTalk MS Episode 462
Guest: Britt Neff
WEBVTT
00:00:18.380 --> 00:00:21.340
It's July 7th, and we have a lot to talk about.
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The Americans with Disabilities Act ensures that people living with disabilities
00:00:26.460 --> 00:00:29.370
receive reasonable accommodation at their job.
00:00:29.940 --> 00:00:34.490
That law also applies to students attending most colleges and universities.
00:00:35.030 --> 00:00:40.000
And the ADA doesn't limit itself to physical disabilities. It's often applied
00:00:40.000 --> 00:00:42.790
to those invisible disabilities as well.
00:00:43.370 --> 00:00:47.500
Britt Neff is the access specialist at the University of Washington School of
00:00:47.500 --> 00:00:53.070
Law, and she's joining me in today's episode to explain how the process of accommodation
00:00:53.070 --> 00:00:56.470
works for college students who are living with MS.
00:00:56.910 --> 00:01:01.610
But before we get to my conversation with Britt, there are a few other things
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that you should know about.
00:01:07.600 --> 00:01:12.330
Over the years, the available disease-modifying therapies have done an increasingly
00:01:12.330 --> 00:01:17.560
good job at pumping the brakes on the immune system to prevent or at least slow
00:01:17.560 --> 00:01:21.310
down new myelin damage in someone living with MS.
00:01:21.770 --> 00:01:25.000
But what about repairing the damage that's already been done?
00:01:25.740 --> 00:01:30.760
Because myelin repair, or remyelination, carries with it the promise of restoring
00:01:30.760 --> 00:01:37.090
lost function, that question has made remyelination a very hot topic among MS
00:01:37.090 --> 00:01:40.700
researchers and among people who are living with MS.
00:01:41.630 --> 00:01:46.800
Now the FDA has given the green light to biotech company Phenotherapeutics to
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start human clinical trials on their experimental oral remyelination therapy, PTD-802.
00:01:55.110 --> 00:02:01.010
PTD-802 targets a specific protein in the brain called GPR-17,
00:02:01.480 --> 00:02:06.750
which, if you aren't a neurobiologist, might sound more like a droid from Star Wars.
00:02:07.380 --> 00:02:11.710
So let's break down this protein in plain English and see what makes it a very
00:02:11.710 --> 00:02:15.970
attractive target to a scientist working on remyelination.
00:02:17.200 --> 00:02:21.510
Think of the brain of someone living with MS like a construction site,
00:02:22.070 --> 00:02:24.790
and the job is to repair damaged myelin.
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That protective coating around your nerves.
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Your central nervous system has a crew of baby cells called oligodendrocyte
00:02:33.360 --> 00:02:35.900
precursor cells, or OPCs,
00:02:36.730 --> 00:02:42.280
whose sole job is to grow up, mature, and wrap new insulation,
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new myelin, around those damaged nerves.
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Everyone starts out with this capability, but that process eventually stops
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working for people with MS.
00:02:53.360 --> 00:03:00.830
Now, GPR-17 is a protein that acts like a cellular brake pedal on these baby cells, those OPCs.
00:03:01.840 --> 00:03:09.850
Under normal conditions, GPR-17 tells these cells, don't grow up just yet, wait until we need you.
00:03:10.390 --> 00:03:17.750
But in an MS brain, because of ongoing inflammation, that GPR-17 brake pedal gets stuck to the floor.
00:03:18.470 --> 00:03:23.350
The baby cells can't mature into the cells that normally repair damage in the
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central nervous system.
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In other words, the construction crew stays on the bench, and that myelin never gets repaired.
00:03:31.890 --> 00:03:37.440
What makes this new drug, PTD-802, so unique is that it's an antagonist,
00:03:37.880 --> 00:03:41.360
which is a fancy science word for a blocker.
00:03:42.010 --> 00:03:47.270
It steps in and wedges itself under that stuck brake pedal, lifting it up.
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And by blocking that GPR17 protein, it lets those baby cells finally grow up
00:03:54.600 --> 00:03:59.580
into mature adult cells that can get to work rebuilding the myelin sheath.
00:04:00.180 --> 00:04:06.710
That's the theory of how PTD802 should work. But we shouldn't get ahead of ourselves.
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This FDA clearance is for a phase 1 clinical trial.
00:04:11.880 --> 00:04:16.360
That means scientists are first testing it in healthy volunteers to make sure
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that it's safe before they test how well it actually repairs myelin in people living with MS.
00:04:23.070 --> 00:04:28.000
It's the very first step on a long road, but it represents a massive leap forward
00:04:28.000 --> 00:04:34.050
from just managing MS inflammation toward actually healing the central nervous system.
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You can be sure we'll be tracking this trial closely as the work gets underway. way.
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If you'd like to learn more about Phenotherapeutics, the company behind PTD-802,
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you'll find a link in today's show notes.
00:04:52.480 --> 00:04:57.290
Results of a recently published study provide some reassuring news about a question
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that I know has caused some anxiety for many of you, and honestly,
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for a lot of clinicians, too.
00:05:03.910 --> 00:05:09.340
We're talking about vaccines, specifically the MMR, that's the measles,
00:05:09.340 --> 00:05:13.420
mumps, and rubella vaccine, and the chickenpox vaccine.
00:05:14.160 --> 00:05:18.230
Both of these are what we call live attenuated vaccines.
00:05:18.880 --> 00:05:24.040
That means they use a tiny weakened version of the actual virus to teach your
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immune system how to fight it.
00:05:26.130 --> 00:05:30.700
And because they provoke a strong immune response, there's been a long-standing
00:05:30.700 --> 00:05:36.490
worry in the MS world about whether a live vaccine could rev up the immune system
00:05:36.490 --> 00:05:40.100
so much that it actually triggers an MS relapse.
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And because of this fear, a lot of people face vaccine hesitancy,
00:05:45.210 --> 00:05:49.610
especially when they're told they need to get these shots before starting an
00:05:49.610 --> 00:05:52.300
immunosuppressive disease-modifying therapy.
00:05:52.960 --> 00:05:56.910
Well, a team of researchers in Spain decided to get some hard data.
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They tracked 369 people with MS.
00:06:01.170 --> 00:06:06.520
About a third of them received the MMR or chickenpox vaccine because they weren't
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yet immune to chickenpox or mumps, while the rest of the study participants
00:06:11.260 --> 00:06:15.500
had already developed immunity, so they served as a control group.
00:06:16.180 --> 00:06:20.680
The researchers followed everyone for a full year. Are you ready for the results?
00:06:21.490 --> 00:06:28.070
There was absolutely no evidence that getting these vaccinations increased the risk of an MS relapse.
00:06:28.770 --> 00:06:33.820
The numbers were completely stable between the vaccinated and unvaccinated groups.
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In fact, the researchers took it a step further and looked at MRI scans for
00:06:38.830 --> 00:06:41.110
a subset of the study participants.
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They found zero increase in inflammatory activity after the vaccinations.
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On the MRIs, there were actually fewer signs of active inflammation after the
00:06:53.180 --> 00:06:55.000
vaccination than before.
00:06:56.020 --> 00:07:01.830
So what does this mean for you? Well, it means these vaccines do exactly what they're supposed to do.
00:07:02.330 --> 00:07:07.130
They protect you from dangerous infections without awakening your MS.
00:07:07.940 --> 00:07:11.800
The results of this study fully support the current guidelines that say you
00:07:11.800 --> 00:07:17.860
should get checked and fully immunized against measles and chickenpox before starting a new DMT.
00:07:18.880 --> 00:07:21.860
So if your neurologist brings this up at your next appointment,
00:07:22.390 --> 00:07:25.340
you can look at the data and feel confident moving forward.
00:07:25.880 --> 00:07:30.360
And if you'd like to review that data, you'll find a link in today's show notes.
00:07:34.350 --> 00:07:37.830
Thanks to the efficacy of newer medications and earlier treatment,
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people with MS are living longer than ever before.
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So, let's talk about a question that a lot of long-time listeners wonder about
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as they transition into a new stage of life with MS.
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Can I ever stop taking my disease-modifying therapy?
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As we get older, our immune systems naturally change and slow down.
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This process is called immunosenescence.
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Because of this, MS relapses generally become much less common after the age of 60.
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At the same time, the risks associated with disease-modifying therapies,
00:08:15.430 --> 00:08:20.100
like serious infection, those risks tend to go up as we age.
00:08:20.700 --> 00:08:25.150
It leaves a lot of people wondering if the risks of staying on a treatment start
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to outweigh the benefits.
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Researchers at the Cleveland Clinic tracked 600 MS patients who were all over the age of 60.
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About a third of them chose to stay on their DMTs, while the other two-thirds
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stopped taking them, usually in their mid-60s.
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The research team followed these folks for a median average of 10 and a half
00:08:46.790 --> 00:08:49.630
years. That's a tremendous amount of data.
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And here's the big takeaway. Over that entire decade of follow-up,
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only 3.3% of all the patients experienced a relapse after the age of 60,
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and there was absolutely no statistically significant difference in relapse
00:09:06.930 --> 00:09:11.240
risk between the people who stayed on their meds and the people who stopped.
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For the vast majority of older adults, the clinical flares completely quieted
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down, regardless of their treatment status.
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But, and yes, there's a but here, the study brought to light an important nuance
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that shouldn't be ignored.
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While clinical relapses were incredibly rare, the researchers found that new
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activity on MRI scans was actually quite common.
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Roughly a third of the patients in both groups showed new T2 lesions on their
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routine MRI scans over time. So what does that mean?
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Honestly, the researchers admit they don't fully know if these new lesions translate
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into progression or symptoms down the road, or if they're just a byproduct of aging with MS.
00:10:00.550 --> 00:10:05.200
Clearly, there is more research required to answer this very important question.
00:10:05.640 --> 00:10:11.560
But based on the outcome of this study, stopping a DMT after age 60 appears
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to be safe when it comes to preventing relapses.
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But it's not a set-it-and-forget-it situation.
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If you and your neurologist decide to transition off your treatment,
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you'll still need to keep up with regular MRI monitoring to see what's happening under the surface.
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It's an important conversation starter for your next neurology appointment,
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especially if you're approaching that 60-plus milestone.
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In the meantime, if you'd like to review the details of this study,
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you'll find that link in today's show notes.
00:10:45.760 --> 00:10:50.690
We know that cognitive changes, things like brain fog, trouble multitasking,
00:10:50.690 --> 00:10:55.010
or memory slip-ups, are incredibly common among people living with MS.
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But one of the biggest frustrations for both patients and their neurologists
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has always been the unpredictability.
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There isn't a reliable way to examine someone early on and say,
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here is your specific risk for cognitive decline over the next few years.
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Well, results of a new study might be changing that narrative.
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A team of researchers in Italy developed a multimodal AI model designed to predict cognitive worsening.
00:11:23.940 --> 00:11:28.650
Now, multimodal just means the AI doesn't look at only one piece of the puzzle.
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It digests a whole mix of data collected right at the start.
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Standard brain MRIs, detailed structural brain measurements,
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demographic information like age, clinical scores like disability levels,
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and what we call cognitive reserve,
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which is essentially the brain's baseline resiliency to damage.
00:11:51.080 --> 00:11:55.770
They tested this AI model on a group of adults with MS over a span of about
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three and a half years, and the accuracy of this tool was impressive.
00:12:00.340 --> 00:12:05.470
The AI model was able to correctly predict which patients would experience cognitive
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decline and which would remain stable in about 90% of the cases.
00:12:11.410 --> 00:12:13.660
And here's what makes this study a little special.
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The researchers didn't us build a black box AI that spits out a prediction without explaining why.
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They used what are called explainability tools so they could see exactly what
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data points the AI valued most.
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And the top indicators the AI used to predict a higher risk of cognitive decline
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were the loss of volume in the cortical gray matter, a person's age,
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shrinking in specific memory-centric regions of the brain called the thalamus
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and the hippocampus, a higher burden of MS lesions and a lower level of cognitive reserve.
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Besides the demonstrated 90% accuracy, what makes this particularly encouraging
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for the MS community is the shift toward proactive personalized medicine.
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If a tool like this can be integrated into routine clinical care,
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it means neurologists could flag high-risk patients years before noticeable
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cognitive decline sets in.
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That opens the door for early aggressive interventions, whether that means adjusting
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a disease-modifying therapy, starting targeted cognitive rehabilitation,
00:13:23.780 --> 00:13:27.320
or focusing heavily on brain-healthy lifestyle modifications.
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It's truly a leap forward in taking the guesswork out of cognitive monitoring.
00:13:33.290 --> 00:13:37.910
And as AI continues to impact every facet of healthcare, it's a trend we're
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going to keep a close eye on.
00:13:39.930 --> 00:13:44.940
If you'd like to review the details of this study, well, you'll find that link in today's show notes.
00:13:46.220 --> 00:13:50.500
We've covered some really encouraging news in this episode, from the first human
00:13:50.500 --> 00:13:55.360
trial of an oral therapy that could repair myelin and restore lost function,
00:13:55.840 --> 00:13:58.630
to the evidence-based safety of important vaccines,
00:13:59.120 --> 00:14:05.170
to AI being able to proactively predict MS-related cognitive issues years before
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an individual experiences those issues.
00:14:08.460 --> 00:14:12.930
There's a lot to be excited about. At the same time, people living with MS need
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to know how to live their best lives and enjoy the best life experiences now.
00:14:18.310 --> 00:14:22.730
And there probably isn't a life experience that shines brighter than the time
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someone spends attending college.
00:14:25.510 --> 00:14:29.610
Of course, the classes are important, but so is everything else that's part
00:14:29.610 --> 00:14:30.980
of the college experience.
00:14:31.460 --> 00:14:35.590
And if you're a student living with MS, you don't have to miss that experience.
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In fact, your college experience can be tremendously enhanced by knowing how
00:14:40.540 --> 00:14:42.420
to ask for the right accommodation.
00:14:43.070 --> 00:14:47.690
In a moment, my guest, Britt Neff, is going to join me to explain exactly what
00:14:47.690 --> 00:14:52.410
a college student with MS can expect in the way of accommodation and how to
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make sure that accommodation is in place by the time classes begin.
00:15:00.890 --> 00:15:05.220
The Americans with Disabilities Act ensures that people living with disabilities
00:15:05.220 --> 00:15:08.350
receive reasonable accommodation at their job.
00:15:08.950 --> 00:15:12.350
That law also applies to most colleges and universities.
00:15:12.820 --> 00:15:17.050
And today, Britt Neff, the Access Specialist at the University of Washington
00:15:17.050 --> 00:15:23.720
School of Law, is joining me to discuss how the process of accommodation works for college students.
00:15:24.390 --> 00:15:25.750
Welcome to the podcast, Britt.
00:15:26.480 --> 00:15:27.620
Thank you so much.
00:15:28.170 --> 00:15:33.300
Can you describe your role as an Access Specialist? and how you interface between
00:15:33.680 --> 00:15:38.450
the Disability Resources for Students Office and the UW School of Law?
00:15:38.890 --> 00:15:45.410
Sure. So my role is to work with students and faculty.
00:15:46.870 --> 00:15:51.240
So first I'll meet with the student. We'll have a discussion of the impact of
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their disability. We'll discuss their documentation.
00:15:54.410 --> 00:16:01.090
We'll go over accommodations. And then we will discuss what the process is for
00:16:01.090 --> 00:16:02.820
utilizing those accommodations.
00:16:03.830 --> 00:16:05.890
All of the accommodations are going to be based on,
00:16:07.950 --> 00:16:12.060
the impact of the disability and whether or not those accommodations actually
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provide access to the program.
00:16:14.180 --> 00:16:19.490
But at the same time, I'm also here to answer questions for faculty.
00:16:20.210 --> 00:16:24.610
If they have questions about how to make a particular accommodation work in
00:16:24.610 --> 00:16:29.570
their classroom, I'm here to help them think through that or think through effective alternatives.
00:16:30.230 --> 00:16:37.700
If we really come to a point where they feel an accommodation would fundamentally
00:16:37.700 --> 00:16:39.700
alter the learning outcomes of their class.
00:16:40.320 --> 00:16:45.530
So that's my role is to kind of be the mediator.
00:16:46.160 --> 00:16:50.800
Federal law requires colleges to provide reasonable accommodation to students
00:16:50.800 --> 00:16:52.690
with documented disabilities.
00:16:53.320 --> 00:16:56.950
What does that term reasonable accommodation mean?
00:16:58.220 --> 00:17:04.510
Yeah, a reasonable accommodation is an adjustment to a program or a class or
00:17:04.510 --> 00:17:07.000
sometimes a piece of equipment that would allow,
00:17:07.920 --> 00:17:14.070
or adaptive technology, that would allow the student to access the content of
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the class and effectively demonstrate their knowledge of the material.
00:17:19.390 --> 00:17:24.290
So that's what an effective accommodation is.
00:17:25.150 --> 00:17:28.780
It's also a legal term because once we actually put it in place,
00:17:29.090 --> 00:17:35.030
then the university is required to provide it and or consider effective alternatives
00:17:35.030 --> 00:17:38.380
to allow the student to participate in the program.
00:17:38.750 --> 00:17:43.630
So what are the first steps a student living with MS should take to begin the
00:17:43.630 --> 00:17:45.850
process of requesting accommodation?
00:17:46.320 --> 00:17:52.540
So the first process would be to contact the Disability Services Office and,
00:17:53.120 --> 00:17:59.850
complete an application, typically, and notify the university and the disability office,
00:18:00.940 --> 00:18:06.050
mainly specifically the disability office, the need for an accommodation.
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And then begin what we call an interactive process, which is to discuss with the student,
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what their needs are, their documentation, and what accommodations might be
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appropriate based on the program that they're in.
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So is there a point in this process where the student living with MS should
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be discussing their needs with their professors?
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I guess my advice would always be to...
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Talk with the Disability Services Office and begin that conversation.
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Students can discuss with their professors their disability as they see fit.
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Students never require to disclose the nature of their disability,
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except when discussing it with the Disability Services Office.
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They're not required to give that information to their professors,
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because it's the job of the Disability Services Office to have that conversation,
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evaluate the documentation, and discuss the accommodations.
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I think it is important for students, once the accommodations are set up,
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to have a conversation with their faculty member about the accommodations and how they,
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might be implemented in their class. And so that's really the important piece
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of communication, especially when we're talking potentially about something
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like a disability-related absence.
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Communication is key because the professor needs to know what to expect to the
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greatest extent possible because
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