Pioneering Research Examines the Role of Your Gut in Multiple Sclerosis

Updated on Mar 4, 2025 | Featured, Neurology

Stephanie K Tankou, MD, PhD

Is a crucial cause of multiple sclerosis (MS) residing in your gut? Stephanie K Tankou, MD, PhD, Assistant Professor of Neurology at The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, is conducting research designed to prove that specific gut bacteria generate inflammation that underlies MS.

“At some point in our life, we can become exposed to various environmental stressors that can lead to profound changes in the gut microbe composition and put someone at risk for developing MS,” she says.

Trillions of microbes called the human microbiome are living in each human. The largest community of microbes, called the gut microbiome, exist in the gut. They are essential for the proper development of your immune system and your brain.

“Studies have shown that a disturbance in the normal composition of these gut microbes can lead to many diseases, including MS,” she says.

Within a healthy individual’s gut, there is a delicate balance of pro-inflammatory and anti-inflammatory bacteria. Conditions favoring an overgrowth of the pro-inflammatory bacteria can trigger inflammation in the gut leading to the breakdown of the gut barrier, also known as leaky gut. In individuals with a leaky gut, microbes in the gut can enter the bloodstream, where they will activate various immune cells, including inflammatory cells that will destroy myelin—a sheath that forms around nerves—in the brain and spinal cord of MS patients.

Several studies, including ones conducted at the Tankou Lab found that mice infused with gut microbes taken from MS patients develop more severe inflammation in the brain and spinal cord than mice that received gut microbes from healthy subjects.

“These results suggest that alterations found in the gut microbe composition of an MS patient significantly contributes to the disease,” she says. “So, the question is what changes do we need to introduce in the gut microbiome of MS patients to stop the disease?”

Dr. Tankou joined the Center staff in 2019. While she sees MS patients, she spends most of her time in her research lab.

“I became interested in the gut microbiome because one of the biggest hurdles we run into with MS, or any neurological disease, is we do not have access to the disease tissue, to the brain or the spinal cord,” she explains. “Consider the gut microbiome as a remote control for your brain. I can control the level of inflammation in the brain of my MS patients by changing the composition of their gut microbes.”

To further her theory, Dr. Tankou’s lab found that an antibiotic called vancomycin, when given orally to mice with an MS-like disease, suppresses inflammation in the brain and spinal cord. Her study showed that administering vancomycin orally causes significant changes in the mice gut microbe composition, leading to an increase in the abundance of anti-inflammatory bacteria in their gut, which decreased inflammation in the brain and spinal cord of these mice.

For her current, ongoing study, Dr. Tankou received funding from the Doris Duke Charitable Foundation to examine the impact of vancomycin on newly diagnosed MS patients between the ages of 18 and 50 who have not taken any MS treatment. Participants receive either vancomycin or a placebo as well as provide blood and stool samples.

“We are hopeful that vancomycin will cause a dramatic shift in the gut microbe composition of these MS patients that will suppress inflammation in the brain,” says Dr. Tankou. The findings from this vancomycin trial could lead to the development of the first “bugs as drugs” for the prevention and treatment of MS. “Bugs as drugs” refers to communities of gut derived bacteria with anti-inflammatory properties that can be used to suppress inflammation and disease progression in MS.

Dr. Tankou maintains that “bugs as drugs” will be safer than the current MS treatments approved by the Food and Drug Administration, which are all based on chemical structures and come with a range of side effects, whereas using microbes means nothing foreign will be introduced into patients. “We expect a new ‘bug as drugs’ therapy to be just as effective as drugs we are currently using,” she says.

The promise and hope that Dr. Tankou’s pioneering lab offers will position the Center as an institutional leader in understanding what causes MS, as well as developing novel microbiome-based therapies for preventing and treating all forms of the chronic disease.

By Kenneth Bandler, a multiple sclerosis patient, advocate, and member of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Advisory Board

Learn more about the Corinne Goldsmith Dickinson Center for Multiple Sclerosis

“Like Turning Off a Light Switch”: Signs and Symptoms of Stroke

Updated on May 22, 2024 | Cardiology, Neurology, Vascular Health, Your Health

Slurred speech, an impaired gait, paralysis on one side of the face, arm, and/or leg—these are all signs of a stroke, especially if they appear suddenly. If you believe you or someone else is experiencing a stroke, call 911 immediately. Strokes are an emergency, and waiting can result in serious brain injury and even death.

Carolyn Brockington, MD

In this Q&A, Carolyn Brockington, MD, Director of the Stroke Center at Mount Sinai West and Mount Sinai Morningside, and Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, discusses the signs and symptoms of a stroke, the difference between a stroke and a mini stroke, and why you must act fast.

What is a stroke?                                                                                                         

Simply put, stroke is an injury to the brain caused by a reduction of blood flow—for example, a blood vessel is blocked by a blood clot. Strokes are an emergency because there is a restricted time period—just a few hours—for people to come in for treatment, where doctors can try to administer certain therapies to improve blood flow in order for the affected part of the brain not to be injured.

What are the signs and symptoms?

The signs and symptoms from stroke have to do with how the brain is organized. Primarily, the left side of the brain controls the right side of the body, and the right side controls the left. Let’s say somebody is not getting enough blood flow on the left side of the brain, depending on the part of the brain affected, they might develop right-sided weakness or right-sided numbness, or difficulty speaking, or difficulty understanding speech, etc. If someone has a stroke on the left side of the brain in the back, they may have vision problems but they’ll be able to walk around and speak. If they have a stroke towards the front of the brain, they might have more of a language problem but no vision disturbance. While it’s very hard to tell people exactly what type of symptoms they would have, the appropriate thing is to understand that the symptoms are sudden, like turning off a light switch. Pay attention to balance, eyesight, face asymmetry, arm or leg movement, speech or language.

Who is most at risk?

Everyone is at risk for stroke. Most people think you only have to worry about stroke when you are old. The truth is that the incidence of stroke increases as we get older, because some of the risk factors or the medical conditions that we know that increase stroke increase over time—high blood pressure (hypertension), diabetes, heart disease, elevated cholesterol, etc. However, the most important thing to understand is that anybody can have a stroke at any age. The fact that stroke risks increase with age doesn’t mean it can only happen when you get older. There are different reasons people might have a stroke at different ages.

If I think I or someone else is having a stroke, what should I do?

If you or someone else is having a stroke, time is ticking, so call 911. As doctors, we say “time is brain,” meaning every minute that goes by it has been estimated that approximately 1.9 million brain cells are potentially dying. Emergency Medical Services will dispatch the ambulance, which will take you to the closest designated stroke center that has the ability to assess you in a timely fashion and provide the appropriate treatments. At the Mount Sinai Health System, all of our eight hospitals have been designated as certified stroke centers, meaning that we all have multidisciplinary teams to provide the appropriate therapy within the clinical guidelines for the acute treatment of stroke.

How will I be treated for an acute stroke?

Once you are in the emergency room, there is a lot that needs to be done in a very short period of time to make sure you are eligible for acute stoke treatment, including brain imaging and blood tests, etc. Afterwards, we may be able to administer certain therapies, for selected patients, within what we call the “therapeutic window.”

For example, for acute stroke, there’s treatment we give intravenously through the IV in the emergency department. If there is a big blockage of a blood vessel, we might be able go in and pull that clot out. The time period for the intravenous therapy is within three hours of symptom onset, and for some people we can extend it to four and a half hours. People who receive treatment earlier typically do better.

Am I having a stroke?

It’s important for everyone of all ages to know the signs and symptoms of a stroke.  F.A.S.T and B.E.F.A.S.T, acronyms used by many medical and health organizations, including the American Heart Association and the American Stroke Association, can help you quickly spot the common signs and symptoms of stroke.

B is for sudden loss of balance. Your gait is suddenly off balance, as if drunk or suddenly dizzy.
E is for sudden loss of vision in one or both eyes. You may also see double.
F is for an uneven face. You are experiencing sudden facial weakness or numbness on one side.
A is for arms or leg weakness. You can’t outstretch your arm or leg or keep it up, and there is a sudden weakness and/or numbness on one side of your body.
S is for slurred speech. Aside from slurred speech, you may not be able find the right words, or may have trouble understanding others.
T is for time. “Time is brain.” Don’t wait and hope symptoms go away—call 911.

Want to learn more about the warning signs of a stroke? Check out this interactive F.A.S.T. guide from the American Stroke Association.

Hispanohablantes: ¿Crees que alguien está sufriendo un derrame cerebral? Sea R.Á.P.I.D.O.

What’s the difference between a stroke and a mini stroke?

When people say “mini stroke,” they mean a transient ischemic attack, or TIA. “Transient” means brief; “ischemia” means reduction in blood flow; and “attack” means an event that is a shorter period of time where not enough blood gets to the brain and causes symptoms. An example might be that somebody is walking down the street, and suddenly, they feel their left arm and leg is heavy. They are having difficulty moving, they may have some difficulty walking, and then a few minutes later it goes away. Both stroke and TIAs are caused by an interruption of blood flow to the brain. The big distinction is that the TIA is a shorter period of time where not enough blood gets to the brain, so it doesn’t cause a permanent injury.

What should I do if I think I had a TIA?

Even if the symptoms resolve, a TIA is an emergency. Even though a TIA doesn’t result in an injury to your brain, we need to identify the cause. TIAs are warning signs that a stroke may be looming. If we can find that you have an artery narrowing or problems with your heart or your blood or blood pressure etc, that gives us the opportunity to try to address the issue before you have a stroke. TIAs and stroke are both considered emergencies and require fast treatment.

How can I decrease my risk for having a stroke?

There are a lot of risk factors for stroke, both modifiable and nonmodifiable. Nonmodifiable risk factors include age and family history of stroke. Modifiable risk factors include high blood pressure, heart disease, and diabetes. Hypertension (high blood pressure) is the number one reason why people have stroke and heart disease. The identification of high blood pressure, and modifying it, usually through adopting a healthier diet, regular activity, and sometimes medication, is important. Speaking to your doctor about your risks provides an opportunity to modify or control risks better long-term to reduce your chances of having a stroke.

How to tell if someone could be having a stroke

Remember the B.E.F.A.S.T. acronym:

  • You notice they are suddenly acting or walking as if drunk or dizzy, but they have not had anything to drink
  • You ask them to smile, and their face is asymmetrical
  • Their speech is slurred or they are unable to find the right words, or they seem confused and have trouble understanding you
  • They have difficulty maintaining or are unable to lift their arms or legs
  • They have double or blurred vision

If you notice any of the above, call 911 immediately.

How will having a stroke affect me?

Many individuals recover well after a stroke, and enjoy a good quality of life. The challenge is that certain types of stroke have the potential of causing significant neurological impairment, which highlights the need for prompt identification of stroke symptoms and treatment. If you think having a stroke is inevitable, you are wrong—there are many things you can do to reduce the chance of it happening. However, it starts with partnering with your primary care physician to discuss your particular risk factors and determine what you can do to modify your risks—not just today, but long-term—to reduce your risk of stroke and maintain good brain health.

Have you or someone you love experienced a stroke? Learn about Mount Sinai’s services and therapies that can help

How to Manage Migraines During Stressful Situations

Nov 2, 2020 | Neurology, Your Health

Migraine headaches can be debilitating, and undue stress can exacerbate the condition, creating new problems. Lauren R. Natbony, MD, a headache specialist at the Mount Sinai Center for Headache and Facial Pain and an Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, provides some suggestions for how to manage your headaches when life gets stressful.

What’s the difference between a migraine and a regular headache?

Headache is a catchall term for any type of pain in the head. Almost everyone has experienced a headache in his or her life. Migraine, however, is more than just a headache. It is a chronic and disabling neurologic disease that affects the way the brain processes pain. Headache is only one symptom of migraine and typically presents with moderate to severe pain on one side of the head. The pain tends to have a pounding or throbbing quality and it often gets worse with movement. Other symptoms include sensitivity to light, sound or smells, nausea and vomiting. Some people may also see spots or flashing lights in their vision. We think that migraine is likely genetic, meaning that it runs in families and is inherited.

How does stress affect migraine sufferers?

Stress can cause migraine and migraine can cause stress. Since they both feed each other, it can turn into an endless cycle. Stress causes various chemical and hormonal changes in the body. In some people, these changes can trigger a migraine. And, if your body is accustomed to daily stress, a day without stress—like a weekend or special event—can result in a letdown migraine. This can be a real bummer and can ruin any attempt to unwind.

How should migraine patients cope with unexpected stressors?

The COVID-19 pandemic is a great example of an abrupt, unexpected stressor and a change from normalcy. First, it is important to recognize that the migraine brain is very sensitive to change. Thus, keeping a consistent schedule every day to minimize change is crucial for migraine sufferers. Multiple lifestyle modifications can also help the brain cope better with stress.

What can patients do to help manage their migraines?

First, establish a sleep routine, as sleep is essential for brain health. Try to go to bed at the same time every night and wake up at the same time every morning. While it can be difficult to get good quality sleep during stressful times, it’s something that should be prioritized for everyone—especially migraine sufferers. It is also important to have a morning routine, whether it’s going outside for some fresh air after waking, talking on the phone to a loved one, or drinking a hot beverage while reading the newspaper.

You should also eat something rich in protein within 30 to 60 minutes of waking up. Throughout the day, eat healthy, nutritious meals with plenty of fruits, vegetables, and protein. Try to eat something with protein every three to four hours. Protein helps to stabilize blood sugar levels, and abrupt changes in these levels can trigger migraine. Also, be sure to stay hydrated by drinking at least 64 ounces of water a day.

Another thing that can be helpful is exercise, which is a great stress reliever. Engaging in regular physical activity—ideally at least 30 minutes, five days a week—will help reduce stress not only in the moment but also over time. Relaxation techniques like yoga and meditation are also helpful and have evidence for benefit in migraine

Do I need to schedule an office visit with a headache specialist or are video visits just as worthwhile?

Video visits are a great option for those with migraine and headaches. The fact is, patients with migraine do not love coming into the office. Travel to the office itself can be a stressor. Likewise, the office can seem bright and noisy and trigger a migraine for some.

Seeing patients in their own space is extremely helpful. For example, I have patients who do not know all the medications they are taking. During video visits, I have them walk over to their medicine cabinets and show me the bottles. We review the medications—and their doses—and I can give them much better advice. I also have patients who will tell me they do not have space to exercise. During video visits, I can see their home and together we can carve out a space for exercise. I can also suggest different lifestyle techniques based on their living environment to improve headaches.

Why see a specialist?

It’s important that migraine sufferers work with doctors who understand the condition. There are many treatments available, but treatments should be tailored to each patient’s lifestyle and health concerns. I aim to help my patients control their headaches, especially during stressful life events.

At the Mount Sinai Center for Headache and Facial Pain, we understand what you are going through and are committed to working with you to get you the relief you need.

Learn more about the Center for Headache and Facial Pain at Mount Sinai
Read more from Mount Sinai about Your Health

June is National Aphasia Awareness Month

Jun 9, 2015 | Geriatrics, Neurology, Speech Pathology

June is National Aphasia Awareness Month–an annual national campaign by the American Heart Association and the American Stroke Association to share information about aphasia , and about those  living with aphasia or caring for people with aphasia, to the general public. Aphasia is a language disorder that disrupts  verbal communication by interfering with speaking, understanding, reading and writing; it is typically caused by strokes that occur on the left side of the brain. (more…)

Caring for patients with Alzheimer’s makes way for new memories

Sep 3, 2013 | Neurology, Patient Story

This post originally appeared on www.LiveWellNewYork.com By Hulya M. Erhan, PhD, Clinical Neuropsychologist at the Yarmon Neurobehavior and Alzheimer’s Disease Center

Elizabeth Padilla and her mother, Petra, share many of the same qualities. Both are vibrant, chatty and independent. But Elizabeth began to notice that her mother was being robbed of the traits they once shared.

The culprit was Alzheimer’s disease. (more…)

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