The role of brain health in treating MS

Anna Thomasson|7th June 2019

Everyone’s neurological reserve, or brain volume, reduces as they get older. Multiple Sclerosis (MS) speeds up this process causing disability and dementia. Relapses cause brain volume shrinkage, which is thought to lead to the symptoms of MS. Rather than treating and reducing relapses, top neurologists like Professor Gavin Giovannoni, key opinion leader and Chair of Neurology at Barts and The London School of Medicine and Dentistry, are looking at the role of general brain health and prescribing earlier, more efficacious treatment to prevent brain damage.

Gavin is pioneering a holistic approach to treating MS. This approach is not just based on prescribing a therapy, but instead looking at the patient’s health holistically. It is about keeping the patient healthy through diet, exercise and other lifestyle changes, as well as through effective medication. He is looking at ways to implement these approaches in the face of opposition from traditionalists, along with how to effectively integrate them with the current healthcare system.

He is also overseeing the development of an app, which will become a platform to bring about substantial changes in the way MS is monitored and treated, giving patients autonomy and doctors easier access to symptoms and results. Here, Blue Latitude Health speaks to him about his work and his hopes for the future of MS treatment.

How does MS affect neurological reserve?

GG: MS greatly reduces neurological reserve capacity causing the brain to age. Everybody will get age-related cognitive impairment but it’s important that your reserves age normally. The idea is to try and shift the attention of the MS community to treat the disease holistically. It’s important not just to focus on reducing relapses, for example, but to think about how to maximise the brain health of their patients so that they can age normally. We need to focus on trying to optimise management early in the course of the disease to improve long-term outcomes. That’s the reason we called our initiative ‘Brain Health’. People need to treat it like an emergency.

Does this mean treating patients with more efficacious drugs at an early stage?

We call this strategy ‘flipping the pyramid’. We offer patients the most effective treatments upfront and that maximises and improves outcomes. With the higher efficacy drugs, we can make patients relapse free. Unfortunately, many neurologists are reluctant to do this, favouring more traditional treatment. One of the problems we have had in the past is this slow adoption of innovation.

What are you doing to solve this problem?

In Australia the MS neurologists know each other very well, they support each other in decision making. In the UK we don’t have a proper MS community. We’re trying to create that with a group called The MS Academy, which is an educational organisation. We’re bringing more people under this umbrella to create an association of British MS healthcare professionals.

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