This presentation was part of the Chicago Wellness for MS Forum held Saturday April 22, 2023
Watch the full presentation: Neuromyelitis optica spectrum disorder and What is New in MS? with Dr. James Voci
Food allergies and autoimmunity are rapidly increasing with the increase in processed food and other environmental factors
Man often becomes what he believes himself to be. If I keep on saying to myself that I cannot do a certain thing it is possible that I may end up by really becoming incapable of doing it. On the contrary if I have the belief that I can do it I shall surely acquire the capacity to do it even if I may not have it at the beginning. -Mahatma Gandhi
Neuromyelitis optica spectrum disorder (NMOSD)
NMOSD is a variant of MS that was originally recognized in 1894. It’s inflammation of the spinal-cord and optic nerve. Inflammatory demyelination in the brain and optic nerve. There are four subtypes of NMOSD and it’s important to check if you have MS or NMOSD as it’s similar but treated differently than MS. Symptoms are blindness in one or both eyes, altitudinal vision feedback, weakness in arms and legs, painful spasm, bladder and bowel problems, vomiting and hiccups, confusion, seizure and coma. NMOS is typically more aggressive than multiple sclerosis.
Diagnosed by MRI of brain and spine and check annually with MRIs. The cervical spine should be imaged every other year. Lesions in the cervical spine put you in a higher risk category. You can get a blood test for the AQP-4-IgG antibody or a lumbar puncture to check if you actually have MS or if you actually have NMOSD.
Treatments for NMOSD
Acute exacerbations are treated with steroids or plasma exchange.
Four medication work. They are all monoclonal antibody therapies, which are very safe drugs and good and closing down NMOSD
- Eculizumab (Soliris)
- Satralizumab (Enspryng)
- Ineblizumab (uplizna)
- Rituximab – not FDA approved but sometimes used off label
If the above drugs don’t work, there are options to use immune suppressive drugs like Azathioprine, Mycophenolate, Methotrexate, Cyclophosphamide, or Tocilizumab.
Physical therapy, physical and mental wellbeing can slow down the immune system and reduce symptoms. Phototherapy approaches like red light therapy is not harmful but there is no research yet to its effectiveness. Anything that works for you, like acupuncture or other holistic treatments may help.
New topics in MS research
New medications under study are BTK inhibitors to modulate B cells and microglia (immune cells in the central nervous system). New serum markers are blood tests will help neurologists identify MS and know how well your DMT is working for you.
Aging and continued immune modification. The immune system keeps you well against cancers and other illnesses. It’s unknown if there are risks associated with keeping someone of immunosuppressant drugs for decades. If you haven’t had a relapse in a decade you may want to talk to your neurologist about changing your medication or taking a less intense drug.
Artificial intelligence will help in diagnosis in reading imaging in brain atrophy and brain volume, monitoring treatment effectiveness.
James Voci, MD is the Chair for Yoga Moves MS. He received his undergraduate training at Haverford College in Philadelphia followed by Medical School at the University of Pennsylvania. There, his interest in Neurology was nurtured by a strong faculty which included Dr. Robert Lisak who later became Chairmen of Neurology at DMC in Detroit. His residency in Neurology was performed at University Hospitals of Cleveland/Case Western Reserve University where he served as Chief Resident in his final year. Upon completion of his training, he served on the faculty there as Assistant Professor Of Neurology, performing both research in molecular biology as well as the instruction of new residents. In 1996 he left for private practice and eventually arrived in the metro Detroit region in 1999 where he has remained since. Dr. Voci currently serves as the Director of Neurology at St. Francis Hosp in Evanston. He is actively involved in the care of Multiple Sclerosis patients both clinically and with clinical research studies. And, yes, he actively practices yoga. He has been the Chair of Yoga Moves MS since 2014.