Expert Support
Maintain your ability: keep what you’ve got for as long as you can
Dr. Virender Bhan, Neurologist
Part of all MS disease courses is the inevitable deterioration of ability in both physical and cognitive aspects over time. However, the majority of people with MS do not have severe disability. But because manifestations and the course of MS are different for everyone, it is hard to predict the level of disability someone could experience—which can include both physical and cognitive effects.
Physical disability is a result of the loss of motor skills; this is due to damaged myelin on nerve cells that cannot properly conduct the electrical impulses traveling from the brain to muscles to communicate movement and action. Cognitive problems can also result from MS; these include the ability to learn, remember, plan and problem solve. Both these changes can have a large impact on your ability to live your life.
Tip of the iceberg
It’s important to remember that your current experience with MS (mild or even no symptoms, or few relapses), may only be the “tip of the iceberg”. In explaining to his/her patients who are relatively symptom-free, Dr. Bhan comments, “many patients have difficulty understanding what’s going on inside their CNS [central nervous system] because they feel fine and can function the same way before they were diagnosed. I try to tell them there are both invisible and visible components to their MS and that we have to do something to slow the changes down, even if we can’t see them.”
The invisible disease activity occurs below the surface and may not translate to visible symptoms initially; it can include:
- swelling in the brain and the spinal cord (inflammation)
- damage to nerves (axonal transection)
- brain tissue loss (atrophy)
But once a diagnosis is confirmed, early intervention to maintain your ability is critical, even if you feel fine and are symptom-free. Over time, there is a steady development of usually irreversible invisible effects, and as they accumulate within the CNS they may lead to progression of disability. This disability manifests as visible symptoms, such as:
- physical disability (loss of sensory and/or motor skills)
- relapses (flare-ups that can affect a person's vision, walking, or speech)
- cognitive dysfunction (difficulty with problem solving, recent memory retention, and processing information)
Early treatment will help in the fight to maintain ability
Fortunately, even though MS may still be progressing under the surface, research has also shown that early treatment can help slow the progression of MS and preserve ability. I tell my patients that “we don’t have a cure yet but what is available can help you maintain your current level of functioning and delay progression of disability”, says Dr Bhan. “They want to continue doing what they were doing before their diagnosis, and disease-modifying therapies can help them do that.”
Researchers and scientists agree treating MS with disease-modifying drugs (DMDs) early in the disease course is extremely beneficial—and recommend that people should start treatment as soon as possible after they have been diagnosed with MS. Research shows there are several benefits of early treatment with disease-modifying therapy. Some include:
- Better chance of maintaining current level of functions and abilities
- The progression of the disease is delayed, sometimes even stopped
- The number and severity of relapses are reduced
- The number of brain lesions is reduced
“Our goal in using disease-modifying medications to treat MS is to ensure that our patients’ current physical and cognitive disability symptoms don’t progress”, says Dr. Bhan. “We want them to live productive lives—and preserving their ability is key to them doing that.”
Do everything you can
If you’re newly diagnosed, and have yet to decide on the right treatment course for yourself, and even if you’re currently on therapy, speak to your neurologist about what you can do to prevent further disease progression and disability, and ultimately maintain your ability. To prepare for this conversation, click here to discover helpful questions and discussions guides you can use at your next appointment and click here to learn more about disease-modifying therapy.
Click here to view a series of questions to ask your doctor. Click here to know more about various treatments and disease-modifying agents offered for the treatment of MS.
Or click on one of the links below to obtain a Doctor Discussion Guide for the patient:
Doctor Discussion Guide: newly diagnosed MS or possible MS
Doctor Discussion Guide: currently or previously treated MS
This feature is intended solely for informational purposes and is not a substitute for routine or urgent medical evaluation, treatment or consultation. Dr. Bhan’s guest editorial should not be construed as a medical opinion aimed at establishing a diagnosis or course of treatment. Individuals who are being treated should not construe information here as replacing or superseding recommendations of their own physician.
