Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer
Question: Why does each person with MS experience different symptoms?
Answer: It shouldn’t surprise us that everyone experiences their MS differently since we are all unique, but the individual factors producing that uniqueness are worth considering in some detail.
We begin our lives with innate differences that include gender, race, and genetics. All of these things influence the course of MS. The age of onset of MS may influence the course of MS. As we age, we change and MS changes. Other factors differentiate us as we age: the course of MS may be influenced by our general health and habits. Illnesses such as uncontrolled diabetes or uncontrolled cardiovascular disease or obesity are associated with a greater risk of progression of multiple sclerosis. Lifestyle contributes to the course of MS including exercise, a healthy diet, and tobacco avoidance.
And then there are the features of MS inflammation and progression that everyone experiences differently. These differences include the location of lesions in the brain or spinal cord and the number of those lesions. These specific locations of nerve damage determine which functions are affected. For example, nerve damage along the optic nerve can create visual issues… and nerve damage along the spinal cord can lead to mobility issues… but these symptoms can also be caused by lesions in other locations, helping to make MS such a complicated illness. We are also becoming increasingly aware of brain reserve and central nervous system resilience, and that some people appear to be able to tolerate their MS lesions better than others.
In addition to these physical differentiations, we have very different ways and styles of adapting psychologically. Each person copes with their MS differently from others, and it’s one of the reasons that we focus on mental health and maintain social connections. Depression and anxiety are treatable disorders and influence our ability to adapt.
These are just some of the physical and psychological differences that influence the unique ways each person experiences multiple sclerosis. Fortunately, we have more than 20 disease-modifying therapies and multiple symptomatic therapies that can take individual differences into account and treat each person uniquely. This is the concept of precision medicine and personalized care.
I am optimistic that advances in research, technology, and therapeutics will allow us to better identify these differences, with the goal of providing the best care for each individual with MS.
Barry A. Hendin, MD, is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.