Sammita Satyanarayan, MD,
Multiple sclerosis (MS) is an autoimmune disease where your immune system attacks your central nervous system, including the optic nerve, the brain, and the spinal cord. This can cause serious neurological symptoms, however the field has undergone advancements in recent years with more therapeutic options available to prevent disease worsening.
In this Q&A, Sammita Satyanarayan, MD, Assistant Professor of Neurology at The Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai, explains some of the symptoms of MS, how doctors diagnose this condition, and the unique services offered at Mount Sinai.
What are the symptoms of multiple sclerosis?
There can be a lot of different types of symptoms with multiple sclerosis. MS is a disease where a person’s immune system starts going after their own brain and spinal cord. There’s inflammation that can sometimes build and leave a scar in the brain or spinal cords. Those scars are called lesions, and we can see them on an MRI. Not all areas of inflammation necessarily cause symptoms that people feel. It’s sort of like traffic. If you have a small fender bender on a quiet neighborhood road, that might not cause you any type of traffic delay, since you can just go around it and there’s plenty of ways to get to the main road. But if you have that same type of accident on a crowded highway during rush hour, you’re definitely going to feel that traffic delay. In a sense, that’s sort of true for signals going through our brain and spinal cord. There are areas of the brain and the spinal cord that are more like neighborhoods and some that are more like highways. With MS, these delays affect our sensations, our actions, and our thoughts.
Can you give an example?
The symptoms of MS depend on where the inflammation actually is. Some people can have painful vision loss if the disease involves the optic nerve, which takes visual information from the eye to the brain. Some people can have inflammation in the spinal cord, and that can sometimes affect the sensation or strength in your arms or legs, or could affect urination, bowel movements, or sexual function. People can also have lesions in their brain, and that can cause symptoms like numbness or tingling in their face, trouble with dizziness or balance, double vision, and even sometimes trouble with cognition or memory.
What does it mean if you think you have symptoms like this?
There are a few important things to know about symptoms in MS. First, not everybody is guaranteed to have all of these possible symptoms. In fact, some people only ever have one. New MS attacks don’t usually have symptoms that come and go over the course of just a couple minutes or an hour. They usually worsen over days to weeks at a time before getting better. This is for the type of disease that most people get, which we call relapsing-remitting MS. It’s important to say that symptoms can improve over time. MS treatments these days have gotten really good, and while they do not fix any prior symptoms a person has, they are very good at preventing any new symptoms.
How do you diagnose multiple sclerosis?
MS is a life-changing diagnosis. And unlike other diseases, there isn’t one blood test that we can run and make the diagnosis. Therefore, doctors must be careful and comprehensive in our approach. We want to make sure that a person’s symptoms actually fit with MS, and want to make sure that we’re excluding other diseases that either don’t need treatment or need different non-MS treatments.
So what is involved?
We use different pieces of information to convince ourselves that this is a disease that’s happened in multiple places over multiple time periods, hence the name of multiple sclerosis. The types of information we use to assess this includes clinical symptoms, MRI, sometimes blood tests to rule out other diseases, and sometimes spinal fluid. With clinical symptoms, we look to see what’s affected. We look at what has happened over time with symptoms. We do a physical exam to see if we can find signs of injury to the nerves. We see if all those are consistent with what we expect in MS or if we get inflammation. We look at imaging and not just to see if there something on the MRI but we’re looking to see if there’s something specific for MS on the MRI. We look at the shape, the orientation, the location of what we’re seeing on the MRI to see if that characteristic of MS. We don’t have a blood test for MS, but there are times when we use blood tests to rule out other diseases. Lastly we sometimes use a bedside lumbar puncture, also called a spinal tap, where we look at the clear spinal fluid that surrounds the brain and the spinal cord. If there are signs of inflammation in the spinal fluid that are not in the blood, that can suggest there’s an inflammatory process in the brain or the spinal cord. But it’s just one piece of the puzzle. We are trying to fit all of these pieces together, and to do that we use an internationally approved set of diagnostic criteria to be able to actually make the diagnosis of MS.
What is unique about The Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai?
The Center, located at the Icahn School of Medicine at Mount Sinai, treats MS as well as other neuroimmunologic disorders. One of the things that makes this place special is the people. We have doctors who are deeply invested in all aspects of doctoring, whether it’s taking care of people, doing the cutting-edge research that helps advance the field, or even educating the next generation of doctors about MS. There are neuropsychologists who are learning more about cognition because we know that’s important to our patients. We have a group of nurse practitioners who are dedicated to the care and the well-being of our patients, as well as social workers and administrative staff who help people with getting the resources and medications they need.
How does the Center help patients live their lives?
One thing that is unique is the Center’s focus on the whole person. Despite all our advancements, our treatments are preventative. They help you for the future, but they don’t necessarily help with how you feel right now. That’s important, because while a big part of our job is to make sure that things don’t get worse, we also want to see people feel better. We know it takes a village to get there. We work with your diet, sleep, exercise, and mood because we know this affects your energy, strength, and cognition. And we know we have to find the best ways to help people not just survive, but really thrive. Our patients are not just defined by having MS. They’re defined by all the other things that they’re doing in their lives that are so important, and we want to keep them doing that.
What kind of research is being conducted in MS?
We are involved in a lot of different kinds of research at Mount Sinai, and we’re always looking for anyone who wants to get involved with that effort, such as participating in clinical trials. That’s how we push the field forward. Everything we know at this point in time about all the therapeutics available for MS is there because there have been people before us who have been willing to give their time to MS research. We’re involved in a lot of different types of clinical research. For example, we are participating in a clinical trial that’s testing a new kind of therapy for people who have progressive disease. We are involved in longitudinal research projects, which is where people don’t have to take a medication; they help us by monitoring their disease and their symptoms over the years, which helps us better understand MS as a disease. Unique areas of research at our Center include understanding the impact of MS on cognition, the role that diet might play in MS, and understanding the role of the gut microbiome. My research interests have been understanding how social disparities of health can actually impact access to care and even disability, both within MS and Neuromyelitis Optica Spectrum Disorder. It’s really important to think about, because in addition to learning how to treat people better, we want to make sure that we’re understanding how social and economic factors in a person’s life can also affect disability.
How can someone get involved with this research?
We’re also always looking for people MS or other types of conditions, or even people with no medical problems at all, to be involved in research studies. So if you’re a person with MS or a person without MS and want to get involved with our research, please reach out to one of the physicians at our Center or call or connect to talk to a research coordinator and see if you’d be eligible for any of our studies.