A peek behind the paper – Jiwon Oh on the diagnosis and management of secondary progressive multiple sclerosis

Written by Jiwon Oh (University of Toronto, Canada)

Take a look behind the scenes of a recent Review article published in Neurodegenerative Disease Management entitled, ‘Diagnosis and management of secondary-progressive multiple sclerosis: time for change‘, as we ask first author Jiwon Oh (University of Toronto, Canada) about the diagnostic and management issues surrounding progressive multiple sclerosis (MS). Jiwon also discusses the importance of patient involvement and alternative therapies.

Could you introduce yourself and explain what stimulated your interest in progressive multiple sclerosis research and care?

I am a neurologist specializing in the care of people living with MS at St Michael’s Hospital at the University of Toronto (Canada). I am also a scientist and conduct research focused on developing advanced MRI techniques in the spinal cord and brain that can be used in clinical practice. I lead the MRI research program at St Michael’s Hospital, where I am the principal investigator on a number of local, national and international collaborative MRI studies.

My interest in progressive MS research and care naturally developed while caring for people living with MS and realizing that truly one of the greatest unmet needs we have in the field is better ways to manage and treat people living with progressive MS.

Could you provide a brief overview of the diagnostic and management issues you discuss in your review?

The diagnostic and management issues highlighted in this review article summarize challenges that I encounter on a daily basis, as a clinician. Specifically, the diagnosis of progressive MS is challenging to make, as there is no clear laboratory test or MRI measure that we can use to definitely come to the diagnosis. Although neurologists often suspect that MS patients may be transitioning to secondary-progressive MS, it is a difficult topic to approach, as the diagnostic uncertainty makes clinicians reluctant to talk to patients about the possibility and the emotional toll of this diagnosis can be substantial for patients.

Outside of diagnostic issues with progressive MS, even when a patient definitively develops progressive MS, another great challenge is adequately monitoring these patients to assess for whether they have responded appropriately to treatment. As a field, we do not yet have optimal clinical tools to measure subtle amounts of progression in patients. Furthermore, when patients are treated with a disease-modifying treatment, it is unclear whether the “response” we are looking for is a slowing down of the rate of progression or halting of progression all together.

These are amongst the many challenges that many MS specialists encounter frequently in clinical practice, that further research will hopefully clarify in the coming years.

In your review, you consider the role of the patient in management decisions. Why is patient involvement so important?

Patient involvement is key throughout all stages of MS disease management, and for any chronic disease, for that matter. In a chronic neurological disorder that spans decades such as MS, I believe that the patient needs to be fully aware and invested in every stage and aspect of their care plan, for any treatment to be successful.

It is only with patient empowerment and buy-in, as well as a strong patient–physician relationship that is built on open communication that treatment plans can be maximally optimized to ultimately improve the lives of people living with MS.

Do you think alternative therapies have a role to play in multiple sclerosis care, given the increased psychological pressure put on patients by the disease?

I believe that a wide variety of alternative therapies play an extremely important role in MS care. These therapies include physical and occupational therapy, neuropsychological therapy and complementary therapies such as mindfulness, massage therapy and meditation. For many of these alternative therapies, we don’t yet have strong scientific evidence to definitively state that they are beneficial in MS, but there are many ongoing studies that will hopefully provide evidence in the upcoming years. Nonetheless, from my own personal experience as a clinician, I find that many of these therapies are an essential component of chronic MS care, and can sometimes even make a greater difference in day-to-day life that patients can perceive in comparison to some of the “evidence-based” therapies that we prescribe (such as disease-modifying treatments).

Are you involved in any other work that investigates progressive multiple sclerosis and how are you hoping this will impact the field?

I am the lead investigator of the Canadian Prospective Cohort Study to Understand Progression in MS (CanProCo), which is a recently launched national prospective cohort study designed to better understand progression in MS. This is an effort that has brought together clinicians and scientists across Canada with expertise in many different scientific fields, including neuroimaging, neuroimmunology, epidemiology and health outcomes that are highly relevant to understanding progression in MS. By combining the strengths of various fields of study and with a wide range of devoted clinicians and scientists, we are hopeful that over time, this will be a true Canadian contribution to the field of progressive MS.

Do you have any hopes or expectations for the field of progressive multiple sclerosis over the next 10–15 years?

I have high hopes for the field of progressive MS and believe that there will be substantial advancements in our understanding, and subsequently, the ways we treat and monitor progressive MS in the future. There is international recognition that this is an area where the MS field needs to devote time, energy and resources, which has led to the establishment of international collaborative organizations such as the International Progressive MS Alliance, as well as national efforts such as CanProCo. I believe these focused efforts will result in important scientific discoveries and that the face of progressive MS will dramatically change in the next 10–15 years akin to the dramatic positive changes we have seen in the last 10–15 years with relapsing-remitting MS. I believe that the future is bright, and look forward to a day when I can discuss a wide range of treatment options with people living with progressive MS.

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The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Neuro Central or Future Science Group.