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Multiple Sclerosis

Dr. Jagannadha Avasarala shares information about the causes, symptoms and treatments for multiple sclerosis.
Multiple Sclerosis
Featured Speaker:
Jagannadha Avasarala, MD, PhD
Dr. Jay Avasarala is a neurologist with extensive experience in the diagnosis and treatment of multiple sclerosis. Avasarala completed his neurology residency training at New York Medical College/St. Vincent’s Catholic Medical Centers and his fellowship training in multiple sclerosis at Washington University School of Medicine in St. Louis as a recipient of the National MS Fellowship Award. Following his fellowship training, he went on to become a faculty member at Wake Forest School of Medicine in Winston-Salem, N.C.

Learn more about Jagannadha Avasarala, MD, PhD

Melanie Cole (Host): For a person living with MS, physical wellness can involve so much more than just disease and symptom management. My guest today is Dr. Jagannadha Avasarala. He’s a neurologist with a specialty in MS at UK Health. Dr. Avasarala, I’m so glad to have you with us. We’re talking about a really great topic. Tell us what is MS, for the people that really don’t understand what this is.

Dr. Jagannadha Avasarala (Guest): Right, thanks for having me. Multiple sclerosis is a chronic neurological disease of the brain and the spinal cord and it typical effects young individuals and more so women than men, and that’s how one would look at it as a disease.

Host: Do we know what causes MS? Is it an autoimmune disease, doctor? Is it something that if you have family history of autoimmune? Tell us a little bit about that.

Dr. Avasarala: So MS is an autoimmune disease like you pointed out. It’s a disease driven by B cells and P cells which are a part of the immune system, and a person who has another immune disease can have MS and an additional disease affecting the brain or the spinal cord, although it is not necessary to have other diseases on top of MS, but it does also go along, like I said, other autoimmune diseases. To your question about whether family members who have other autoimmune diseases and therefore the person of interest with MS would be influenced by other autoimmune diseases in the family is debatable, but somebody who has a family member with MS obviously has an increased risk of multiple sclerosis. Keep in mind, this is not an inherited disease. It’s not an inheritable disease. The risk goes up if some of the family members, as in a sibling or parent having the disease or sometimes a twin having multiple sclerosis and the risks of the other twin who is unaffected, the risk of disease goes up.

Host: Then let’s talk a little bit about diagnosis and symptoms because some of the symptoms might mimic other diseases and it can be hard to diagnose it completely, can’t it? Tell us what might someone experience and at what age that they experience some of those symptoms?

Dr. Avasarala: Right, right, so the symptoms can very so like I said it could be optic neuritis, or it could weakness in a limb, or it could be a person has weakness in his leg or her leg, it could be a bladder symptom, sometimes it’s sensory with tingling and numbness that is persistent that lasts let’s say more than a couple of days for example and doesn’t go away, and it’s spontaneous in it’s onset. I mean it just pops out one day – it just pops up. It’s not as if something triggers it. I mean heat can worsen – heat can also bring on the symptoms, but typically when the symptoms present – to your question about confusion and why there is a misdiagnosis or why there is an overlap with other diseases, this is because there are so many neurological disease that MS can overlap with. So for example, somebody has acutely sudden onset for example some facial tingling and numbness and there is arm weakness or leg weakness, that can be part of a stroke for example, or for example something in the setting of somebody who has let’s say history of Lyme disease and that person has symptoms that may mimic multiple sclerosis and the question becomes is this Lyme disease or is this MS? How do we know which is which? So something that also mimics multiple sclerosis, other diseases like sarcoidosis, vasculitis for example, and other many, many diseases that produce similar symptoms and it’s hard to separate because there is a lot of overlap and one has to be cautious in giving out a diagnosis because there is a strong element of misdiagnosis and patients also get treated for a diagnosis, or a presumed diagnosis of MS and that can be an issue as well.

Host: So if you do diagnose it, and this is such a big topic, we could really talk about it all day, what is the first line of defense and treatment? Is it about managing the symptoms, managing the medications? Tell us a little bit about treatment.

Dr. Avasarala: So treatment has come a long way. The very first drug in terms of FDA approval for multiple sclerosis began in 1993. There were injectable therapies that were first introduced into the market and then came the oral medications and now we just ballooned into much more sophisticated medications that also includes intravenous preparations called monoclonal antibody and we also have bone marrow transplantation as part of the therapy that is beginning to rise up to – that has the potential I guess to become main stream but it’s a very years away, maybe it’s 10 years away, you know it’s tough to estimate that, but MS therapies have come a long way and to answer your question about is it symptom management or is it trying to halt the progression of the disease – most of the drugs currently that they have in the market and the two new medications that have also been introduced for debility related concerns with MS, most of the drugs treat the neural inflammation. So they treat the inflammatory component of the disease primarily and address the debility to a degree, but now there are two new drugs, Mavenclad and Mayzent, which are designed for secondary progressive multiple sclerosis management and these drugs are targeted to trying to prevent worsening of debility. So whether you treat the inflammatory component or the debility aspect of the disease, one has to be reminded that these medications do not represent a cure. So the goal is to stop the disease in its tracks and hold the patient in the functional status with which he or she presents to the doctor. So a person who was walking and presents to me, for example, with multiple sclerosis, I want her to keep walking 20-25 years from now, meaning the time of the diagnosis. So the goal is to keep the patient exactly in the physical status with which he or she presents to the doctor. Although ideally the patients want to get back to their basic health status, and it may or may not happen in the near future, but the primary goal as it stands now is to help the patient remain stable.

Host: Then tell us doctor, how’s the treatment of MS at UK different from other places in Kentucky?

Dr. Avasarala: Well I mean being a university center we have - typically we give every medication that is prescribed at any large medical center, we have infusions, we have the latest I guess drugs that are given at any large center. So for example if you take Stanford University or pick a place, you know Johns Hopkins, what they give is what they give people – what we give here. In the private world is this being replicated, I guess if there are MS experts in the area, which I believe there are in Louisville, they might be doing similar approaches, but we at UK have what the rest of the world does. Pretty much what the rest of the country or the world does, is what we do. We also have some clinical trials that we are enrolling in, so we are pushing boundaries as far as new medications are concerned and I guess trying to introduce tomorrow’s medications, tomorrow’s medicines that would probably be approved in a few years, we also have clinical trials for those type of drugs at UK.

Host: How exciting and what a time to be in this field. Doctor, as we wrap up, research has shown that healthy diet and exercise, ongoing preventive care, can really help overall health for patients with MS. Speak about really your best advice but about living a healthy lifestyle, managing expectations, whether they be public perception or mental health or exercise, tell us a little bit about the lifestyle for someone with MS and what you tell people every day.

Dr. Avasarala: Right, excellent questions all, but I think what I tell my patients is the following, like you said, we have medications now – we probably have almost close to 20 or between 20 and 22 medications now, FDA approved just for multiple sclerosis. You know from 1993 up until now there’s been a quantum leap in terms of medications that we are able to give, number one. Number two, lifestyle, swimming is the best way to go if you want to be active. In multiple sclerosis, with rising body temperature when a person exercises, even one degree rising core temperature can have an adverse effect on a patient’s symptomatology. So worsening of symptoms or a new symptom might pop up. So swimming is the best way to do it because the water is cooler on a person’s body and it can help take away the dissipated heat. As far as diet is concerned, the usual I guess advice that I give is to make sure that they eat low salt and low fat, typically almost like a cardiac diet if you will, what you would tell a cardiac patient is what in this process you do – eat a lot of fiber obviously, keep the bowels healthy, drink plenty of fluids, make sure that you have no – a person doesn’t have bladder issues because bladder issues can be part of MS so we want to keep them away, and then make sure that the patient – depression sometimes and fatigue can be issues as well. So we treat them and if need be and also getting a good night’s sleep, so general health related concerns and topics would be how we cater each person’s I guess requirements, but my team also tells them to check the National MS Society website because there’s lots of information about diet, exercise, and well being also other health groups and patients with MS who have similar issues and so forth. So these days everything on social media, one can be active on apps obviously galore to obviously help patients, and like I said if somebody wants to exercise I tell them again and again to try and enroll themselves in a swimming class or a swimming exercise program to keep themselves healthy and active.

Host: Wow that’s great information doctor, thank you so much for coming on and sharing your incredible expertise and explaining this all so very well to us. That wraps up another episode of UK Healthcast with the University of Kentucky Healthcare. Head on over to our website at for more information and to get connected with one of our providers. If you found this podcast informative, please share it with your friends and family on social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.