Podcasts about Multiple sclerosis

As a country, we're living longer than ever before. The average life expectancy in the United States is now 79 years old, according to the Centers for Disease Control. But how are we doing when we get to our golden years? In Ohio, the answer is not necessarily the best, according to the latest America's Health Rankings Senior Report. This study from The United Health Foundation ranked Ohio 36th in the country in overall health for seniors. Some major concerns include suicide rates, drug related deaths, poverty and food insecurity concerns and levels of physical activity. When you add in concerns about mental function and emotional wellbeing, there's a lot to think about as we age. On Tuesday's edition of the "Sound of Ideas," we're looking at what we can do in our younger years to try to maintain our mental, emotional and physical health for as long as our bodies will let us. Guests: - Gary Grosel, M.D., Chief Medical Officer, UnitedHealthcare of Ohio - Lester Carney, age 92, Olympic athlete who won a silver medal in the 200-meter dash at the 1960 Summer Olympics in Rome, Italy - Robert Bermel, M.D., Staff Neurologist, Neurological Institute's Mellen Center for Multiple Sclerosis at Cleveland Clinic - Roopa Anmolsingh, M.D., Lead Geriatrician for Community Programs, Cleveland Clinic

Next week, Matt Knaggs and Colin Goodman will attempt to set a Guinness World Record for running the 350-mile length of Ireland with MS. This week, you'll meet Matt and Colin and learn why this undertaking is so important to each of them.  We're also sharing survey results that point to gaps in how we approach MS care from the day of diagnosis. We'll tell you what it really means when you read that the prevalence of MS is increasing. It isn't bad news at all! We'll provide you with all the details you need to register for ECTRIMS Patient Community Day. And, if you can spare 20 minutes, we'll tell you how you can participate in an MS research study from the comfort of your own home. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: We're hitting the open road in Ireland with Matt Knaggs and Colin Goodman  :22 Survey points to gaps in how we approach MS care from day one  2:48 What does the increase in MS prevalence really mean?  8:48 Register for ECTRIMS 2026 Patient Community Day  12:33 An opportunity for you to participate in MS research without leaving home   14:10 Matt Knaggs and Colin Goodman talk about their attempt to set a Guinness World Record for running the length of Ireland with MS  15:56 Share this episode  32:13 Next week  32:33 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/460 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com STUDY: Understanding the Unmet Needs of People with MS at Diagnosis and Throughout Their Care Journey: Insights from a Survey-Based Study https://link.springer.com/article/10.1007/s40120-026-00942-y STUDY: Drivers of Prevalence in Major Motor Neurodegenerative Diseases: Temporal Trends in Sweden and France (2003-2022) https://www.neurology.org/doi/10.1212/WNL.0000000000218072 REGISTER: ECTRIMS 2026 Patient Community Day https://www.ectrimspatientcommunity.eu PARTICPATE IN RESEARCH: Survey: Automatic and Reflective Determinants, Fatigue, and Physical Activity for People with Multiple Sclerosis https://purdue.ca1.qualtrics.com/jfe/form/SV_douenJftXAcGxVk JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 460 Guest: Matt Knaggs, Colin Goodman Privacy Policy

Selena Freisens, Head of Global Medical Affairs at Merz Therapeutics, is focused on increasing access to tools to support neurological health. They have developed a digital app iFlexo, which is designed to provide at-home physiotherapy for stroke survivors.  The app has been tested in Nigeria and Sierra Leone in partnership with the World Stroke Organization and is designed to operate offline as well, to serve users in rural areas with limited internet connectivity. Selena explains, "Our company is family-owned and in its fifth generation, so we have a rather long-term legacy, and the newer part is Merz Therapeutics, and our focus in Merz Therapeutics is on neuroscience. So we practically cover the number of movement disorders such as Spasms, Dystonias. We also have a focus on Parkinson's and Multiple Sclerosis."   "We continuously work on building this awareness and knowledge. One example is Parkinson's disease. And when I started working with Parkinson's disease, most of the patients would have off episodes, which are exacerbations of their symptoms, but many of these off episodes are underdiagnosed, and they're not really treated optimally. So it's really a lot of attention is needed to educate not only HCPs and, of course, some other stakeholders, but particularly patients."   "So the time also matters for stroke survivors. So it's very important that they start as soon as possible all the therapies, but also the physiotherapy at the same time. What this digital tool does is give two options. One is education on the one side, and on the other hand, a guided exercise that will enable people and stroke survivors to exercise at home. And with that, obviously, the personalized goals have been worked out together with the experts and HCPs so that they can achieve those goals faster, while working from home." #MerzTherapeutics #StrokeRehab #DigitalHealth #NeuroRehab #AccessToHealth #WorldStrokeOrganization #Physiotherapy #HealthEquity #TeleRehab #HCPs #Africafirst #AccesstoHealth #EquitableAccess #PostStrokeRehabilitation #PatientDrivenInnovation Merztherapeutics.com Download the transcript here

Selena Freisens, Head of Global Medical Affairs at Merz Therapeutics, is focused on increasing access to tools to support neurological health. They have developed a digital app iFlexo, which is designed to provide at-home physiotherapy for stroke survivors.  The app has been tested in Nigeria and Sierra Leone in partnership with the World Stroke Organization and is designed to operate offline as well, to serve users in rural areas with limited internet connectivity. Selena explains, "Our company is family-owned and in its fifth generation, so we have a rather long-term legacy, and the newer part is Merz Therapeutics, and our focus in Merz Therapeutics is on neuroscience. So we practically cover the number of movement disorders such as Spasms, Dystonias. We also have a focus on Parkinson's and Multiple Sclerosis."   "We continuously work on building this awareness and knowledge. One example is Parkinson's disease. And when I started working with Parkinson's disease, most of the patients would have off episodes, which are exacerbations of their symptoms, but many of these off episodes are underdiagnosed, and they're not really treated optimally. So it's really a lot of attention is needed to educate not only HCPs and, of course, some other stakeholders, but particularly patients."   "So the time also matters for stroke survivors. So it's very important that they start as soon as possible all the therapies, but also the physiotherapy at the same time. What this digital tool does is give two options. One is education on the one side, and on the other hand, a guided exercise that will enable people and stroke survivors to exercise at home. And with that, obviously, the personalized goals have been worked out together with the experts and HCPs so that they can achieve those goals faster, while working from home." #MerzTherapeutics #StrokeRehab #DigitalHealth #NeuroRehab #AccessToHealth #WorldStrokeOrganization #Physiotherapy #HealthEquity #TeleRehab #HCPs #Africafirst #AccesstoHealth #EquitableAccess #PostStrokeRehabilitation #PatientDrivenInnovation Merztherapeutics.com Listen to the podcast here

Click to Subscribe: https://bit.ly/Youtube-Subscribe-SoapDirt Young and the Restless spoilers show that Diane Jenkins (Susan Walters) plots a daring escape to free herself from the clutches of Patty's (Andrea Evans) sinister doctor. Meanwhile, Nikki Newman (Melody Thomas Scott) faces a daunting diagnosis that leaves her terrified. Victor Newman (Eric Braeden) is blindsided by a secret revelation, while Jack Abbott (Peter Bergman), in his growing desperation to find his wife, takes some risky decisions.  Y&R spoilers reveal that Victor proposes that Claire Grace Newman (Hayley Erin) spearhead a new publishing division. Concurrently, Victoria Newman (Amelia Heinle) accompanies her mother, Nikki, to the doctor where they receive a distressing diagnosis - a mass on her optic nerve could lead to blindness if left untreated. Despite the risks associated with surgery and her Multiple Sclerosis, Nikki is advised to act promptly.  The Young and the Restless spoilers indicate that while Nikki grapples with her health crisis, Diane attempts to crack Patty's doctor's phone passcode. Frustrated by her confinement, she requests to join the doctor outdoors, only to be redirected to the gym downstairs. Diane's clever manipulation of the doctor hints at her impending escape. Y&R spoilers hint that Jack dealing with Patty's erratic behavior and threats to Diane's safety. In his desperation to locate Diane, Jack instructs his son, Kyle Abbott (Michael Mealor), to tail the doctor when he leaves.  More Young and the Restless weekly spoilers confirm that Nikki, fearful of losing her sight and not wanting Victor's pity, insists that Victoria keep her diagnosis a secret. However, her secret doesn't remain hidden for long as Victor uncovers something surprising about Nikki's diagnosis.  And, Y&R weekly spoilers show that the Abbott family makes a risky move to rescue Diane, while Stephanie Simmons (Vivica A. Fox) recruits Nate Hastings (Sean Dominic) for a special project.  This episode was hosted by Belynda Gates-Turner for the #1 Soap Opera Channel, Soap Dirt. Visit our Young and the Restless section of Soap Dirt: https://soapdirt.com/category/young-and-the-restless/ Listen to our Podcasts: https://soapdirt.podbean.com/ And Check out our always up-to-date Young and the Restless Spoilers page at: https://soapdirt.com/young-and-the-restless-spoilers/ Check Out our Social Media... Twitter: https://twitter.com/SoapDirtTV Facebook: https://www.facebook.com/SoapDirt Pinterest: https://www.pinterest.com/soapdirt/ TikTok: https://www.tiktok.com/@soapdirt Instagram: https://www.instagram.com/soapdirt/

Vitamin D and multiple sclerosis have been linked for decades, but how strong is the evidence – and what does it mean for clinical practice? In this episode of the ECTRIMS Podcast, host Brett Drummond speaks with Prof. Eric Thouvenot from University Hospital of Nimes and Dr. Deborah Mason from Christchurch Hospital about the evolving science behind vitamin D and MS. Together, they explore: Why vitamin D deficiency is associated with increased MS risk The influence of latitude, sunlight exposure and genetics How vitamin D affects immune regulation and inflammation Findings from recent vitamin D supplementation trials As researchers continue to investigate vitamin D's role in MS, this episode provides a balanced look at what we know, what remains uncertain, and what it means for patient care.

"We aren't looking for answers yet. We're learning how to sit with the questions." As we prepare for an upcoming appointment with our neurologist, a simple question from Jennifer sparked a conversation neither of us expected to have. What if Dan's MS has progressed? To be clear, nothing has changed. We haven't received any new diagnosis, and Dan has not been reclassified from relapsing-remitting MS to secondary progressive MS. But after nearly three decades of living with Multiple Sclerosis and noticeable changes in his gait and energy levels, it felt like an important conversation to have. In this episode, we talk openly about our fears, questions, and uncertainties that can come with long-term MS. We discuss: What prompted us to start talking about disease progression before our upcoming neurology appointment How physical therapy has revealed both strengths and challenges in Dan's mobility and endurance Jennifer's experience transitioning from relapsing-remitting MS to secondary progressive MS years ago The realities of caregiving, aging, and adapting to changes in ability over time Why community, conversation, and preparation matter when facing difficult questions about the future More than anything, this episode is about facing possibilities without letting them define us. Regardless of what happens at our next neurology appointment, we are still the same people we were before we walked into the office. We hope you'll join us for this conversation, especially if you've ever wondered what the future might hold for your MS or how to navigate the uncertainty that comes with living with a chronic illness. *** Remember to rate, review, and subscribe to A Couple Takes on MS Podcast for two insightful perspectives on this one multifaceted disease.

Greg and Phil talk with Leann Stickle about the 12th Annual Tri2BeatMS Kids Triathlon, taking place tomorrow, June 13th, at Shore Acres Park. She shares her personal journey with Multiple Sclerosis, discusses the symptoms and challenges she has faced, and talks about what life looks like today. Leanne also highlights event details and explains how the triathlon helps raise awareness for MS while giving back to the community and inspiring young athletes.See omnystudio.com/listener for privacy information.

In this deeply healing episode of Mirror Talk: Soulful Conversations, Christine Ruch joins us to explore nervous system healing, body wisdom, chronic illness, emotional capacity, and the sacred journey of healing from within.Christine is a Holistic Transformation Guide who helps people reconnect with their body's innate intelligence and healing potential. After walking through her own 20-year healing journey with Multiple Sclerosis and chronic health challenges, she now supports others in restoring their nervous system, rebuilding self-trust, releasing stored trauma, and returning to deeper alignment in body, mind, soul, and spirit.This conversation is an invitation to stop fighting the body and begin listening to it. Christine reminds us that symptoms are not always enemies to silence. Sometimes, they are messengers guiding us toward truth, surrender, compassion, and inner restoration.In This Episode, We ExploreNervous system healing as a gateway to transformationHow chronic illness can become an invitation to listen more deeplyBuilding emotional capacity and resilienceWhy many people feel disconnected from their bodiesThe role of trauma, unresolved emotions, and stored pain in healingHow to release control and trust the body's intelligenceWhat aligned embodiment looks like in everyday lifeThe meaning of holding space without fixing or forcingHow personal healing contributes to collective healingA loving first step for anyone feeling tired, stuck, or discouragedKey TakeawaysYour body is not your enemy. It may be carrying messages that need compassion, attention, and deeper listening.Nervous system restoration can help create the inner safety needed for emotional release, trauma healing, and spiritual alignment.Healing is not only about symptom management. It is also about rebuilding trust with yourself and learning how to live from a calmer, more connected place.Emotions are not who you are. They can be witnessed, felt, and released without becoming your identity.The illusion of control can keep us disconnected from the deeper intelligence of the body. Surrender can open the door to liberation.Memorable Quotes“I love life.”“Your emotions are not who you are.”“She'd be really proud of me.”Chapters00:00 The Journey of Healing and Transformation07:44 Listening to the Body's Wisdom17:29 Trust, Surrender, and Self-Love22:01 The Illusion of Control25:10 Building Emotional Capacity27:53 Witnessing Emotions Without Judgment32:42 The Journey to a Calmer Nervous System36:29 Healing from Within38:03 Holding Space for Others42:51 Embarking on the Healing JourneyConnect with Christine RuchWebsite: https://www.christineruch.com/Substack: The Fresh LifeListen to This Episode If You Are AskingHow do I begin healing from within?Why does my body feel overwhelmed or unsafe?How can I rebuild trust with my body after illness?What does nervous system healing really mean?How can emotional capacity support trauma release and inner peace?Gentle NoteThis episode is shared for educational and inspirational purposes only. It is not medical advice. Please consult a qualified healthcare professional for medical diagnosis, treatment, or personal health decisions.If this conversation encouraged you, please share it with someone who is walking through a healing journey. Subscribe to Mirror Talk: Soulful Conversations, leave a review, and continue the journey with us as we explore healing, purpose, self-awareness, and transformation.Watch on YouTube: https://youtu.be/917B8Ex-SOc Try Aletheia today: https://aletheia.mirrortalkpodcast.com Ask what is on your heart. Mirror Talk will reflect back what may help you see more clearly. Try it here: https://mirrortalkpodcast.com/ask-mirror-talk/Could you support us by becoming a Patreon? Please consider subscribing to one or more of our offerings at http://patreon.com/MirrorTalk 

This week, our coverage of the Consortium of MS Centers annual meeting continues with my guest, Dr. Stephen Krieger. In a wide-ranging conversation, Dr. Krieger offers a very encouraging clinical trial update, shares his thoughts on what treating someone living with advanced MS ought to look like, and points out potential obstacles to implementing the updated criteria for diagnosing MS.  Dr. Krieger is a Professor of Neurology at the Icahn School of Medicine at Mount Sinai in New York, and a Multiple Sclerosis Specialist at the Corinne Coldsmith Dickinson Center for MS. We're also sharing results of a study that revealed some surprising connections between caffeine, alcohol, opioids, and MS symptoms. And if you're living with MS and you're the parent of a young child, we'll tell you about a book that belongs on your bookshelf. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: We're at the CMSC annual meeting with Dr. Stephen Krieger  :22 Study reveals the connection between caffeine, alcohol, and opioids and your MS symptoms    1:12 My Superhero with Wheels is the book you need if you're living with MS and have young children  5:15 Dr. Stephen Krieger discusses exciting clinical trial results, treating people with advanced MS, and potential challenges in implementing the updated criteria for diagnosing MS   8:39 Share this episode  30:22 Next week  30:41 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/458 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com STUDY: Daily Temporal Associations Between Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People with Multiple Sclerosis https://archives-pmr.org/article/S0003-9993(26)00035-3/fulltext BOOK: My Superhero with Wheels https://amazon.com/My-Superhero-wheels-True-Story/dp/B0GWVGSWX5/ref=sr_1_1 JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 458 Guest: Dr. Stephen Krieger Privacy Policy

In this episode of Brain Chat, I'm joined by MS advocate Nana Opong-Owusu and exercise physiologist Sheree Love for an honest and empowering conversation about movement and brain health.We talk about what it really looks like to stay active while living with Multiple Sclerosis—, rom navigating fatigue and fear of symptom flares to letting go of unrealistic expectations around exercise. This conversation is all about reframing movement as something that is accessible, adaptable, and supportive, not overwhelming.Together, we explore how intentional movement can positively impact cognition, mood, and overall nervous system health, and share practical ways to get started at your own pace.Whether you're newly diagnosed or further along in your journey, this episode offers real-life insight, encouragement, and tools to help you move in a way that works for you.

Sara Al Mheiri, Senior Programs and Community Outreach Specialist at the National MS Society joins us on the show to discuss the awareness webinar on June 5 as well as other educational programs organised by the group. In this podcast we learn more about the condition and the support on offer for families and loved ones. Listen to #Pulse95Radio in the UAE by tuning in on your radio (95.00 FM) or online on our website: www.pulse95radio.com ************************ Follow us on Social. www.facebook.com/pulse95radio www.twitter.com/pulse95radio www.instagram.com/pulse95radio

Montel Williams grew up in one of Baltimore's toughest neighborhoods. At 7 years old, a teacher tried to define him by the color of his skin. That day, he made a decision that shaped everything  no one else would ever own the definition of who he was.That mindset took him from the streets of Baltimore to the Naval Academy, from military intelligence to 17 years of daytime television with 100% creative control and through a diagnosis of Multiple Sclerosis he's been fighting for over 20 years.In this conversation, Moshe Popack sits down with Montel Williams to talk about discipline, faith, and what it really means to build a life on your own terms.Timestamp: 0:00 Growing Up in One of Baltimore's Toughest Neighborhoods3:30 The Belief He's Carried Since Childhood5:00 First African American to Graduate the Naval Academy Prep School7:00 How a Speaking Tour of 1.5M Kids Built a TV Empire9:00 100% Creative Control  Why the Show Lasted 17 Years10:00 The Real Reason Most People Never Know Who They Are11:30 What Fatherhood Actually Teaches You About Letting Go13:30 The MS Diagnosis and the Fight That Followed15:00 How to Reduce Inflammation and Take Control of Chronic Illness16:00 The Only Way Out Is Through  His New Project25:30 The Teacher Who Tried to Define Him in Second Grade27:00 What Montel Williams Wishes for the World

In this episode of the ECTRIMS Podcast, recorded in collaboration with the Multiple Sclerosis Journal "Controversies in MS" series, host Prof. Anneke van der Walt moderates a discussion between Prof. Andy Solomon and Prof. Enrique Gómez on one of the most debated developments in modern multiple sclerosis diagnosis. Together, they explore: • Why misdiagnosis remains a major challenge in MS care • The role of the central vein sign (CVS) and paramagnetic rim lesions (PRLs) in improving specificity • Whether expanding diagnostic sensitivity may increase false positives • The practical realities of implementing advanced MRI biomarkers globally • The importance of radiology training, implementation science, and AI-assisted imaging • How clinicians should approach MRI interpretation in real-world practice This conversation examines the balance between earlier diagnosis, diagnostic accuracy, and equitable implementation of emerging diagnostic tools across different healthcare settings. This episode is part of the MS Journal Controversies in MS series on The revised 2024 McDonald criteria can solve the misdiagnosis problem in MS. The accompanying Yes, No, and Commentary articles are available to read open access for the next month, compliments of MS Journal.  

“For a long time, I assumed caregiving was simply what spouses do. Then hernia surgery showed me just how much family caregivers carry every day.” We have participated in Older Michiganians Day at the Michigan State Capitol for more than two decades, advocating for programs and policies that help people age and live independently in their own homes. What began as advocacy for Jennifer and the MI Choice Medicaid Waiver Program has evolved into something much broader: advocating for caregivers, aging in place, and the support systems that help people live with dignity in their own homes. In this episode, we reflect on a surprising realization that the young couple who first attended Older Michiganians Day more than 20 years ago (that's us!) now officially qualify as "older Michiganians" themselves. We discuss Dan's opportunity to speak on the Capitol lawn about family caregiving, the lessons learned during his recent hernia surgery recovery, and why support for unpaid family caregivers is becoming increasingly important as Michigan's population ages. In this episode, we get real about: Realizing we have become the "older Michiganians" we once joked about not being How the MI Choice Medicaid Waiver Program helps Jennifer remain at home The often-invisible work performed by unpaid family caregivers Proposed Michigan legislation supporting family caregivers Aging with Multiple Sclerosis while continuing to advocate for change We hope this conversation encourages you to learn more about caregiving, advocacy, and the importance of supporting those who support others. Here are the links that offer further insights into our conversation: This conversation serves as a companion to our recent Older Michiganians Day essay, where we share photos from the event, Dan's speech, and additional information about the caregiving advocacy efforts discussed in this episode. Learn more about the Michigan MI Choice Medicaid Waiver Program Explore Older Michiganians Day 2026 resources supporting family caregivers and aging in place Thank you for listening to A Couple Takes on MS. We are honored to be included among FeedSpot's 40 Best Multiple Sclerosis Podcasts. While rankings aren't why we do this work, we're grateful for the opportunity to share our experiences and connect with others navigating life with MS. *** Remember to rate, review, and subscribe to A Couple Takes on MS Podcast for two insightful perspectives on this one multifaceted disease.

Kim Curry was a radio broadcaster for 33 years in some of America's finest cities: Pueblo,Knoxville, San Antonio, Washington, D.C., Baltimore, and Miami. Curry was a DJ in differenttime slots and obtained the position of Program Director at two of America's legendary stations:KTSA-AM San Antonio and Power 96, Miami.The diagnosis of Multiple Sclerosis forced Curry to retire from broadcasting in 2005 resulting inrelocation, the search for doctors, therapists, and emotional family strain.. Eight years of rapidphysical decline was halted by the magic of modern medicine, chronicled in his memoir, “ComeGet Me Mother, I'm Through.”Curry has continued his writing journey, with two other published books. “The Death of Fairness”and “Bonnie's Law, The Return to Fairness" which was an “Amazon Number One Best Seller.”Tell Me What Happened features the music of Susan Salidor.More information about Susan Salidor can be found at her website Get Susan Salidor's One Little Act of Kindness Children's BookGet Susan Salidor's I've Got Peace in My Fingers Children's BookMore Information about our sponsor's 10 x 10 Blackhole Chess game can be found at www.blackholechess.com

Welcome to Episode 303 of the Spun Today Podcast—your home for honest conversations about writing, creativity, and the journeys that shape us. I'm your host, Tony Ortiz, and today we're releasing a truly special episode to honor World MS Day. In this heartfelt conversation, I sit down with my wife, Zoila Ortiz, to share her powerful story of living with multiple sclerosis. We dive deep into her first symptoms, the uncertainty of diagnosis, and the emotional and physical challenges that come with MS. Zoila walks us through her search for information, the importance—and dangers—of online self-diagnosis, and the strength found in community. Through candid discussion, Zoila offers an inside look at adapting to adversity, the rollercoaster of medications (Glatiramer by injection (Copaxone) and Fingolimod (Gilenya) to the current day infusion Rituximab which is a monoclonal antibody). We touched on clinical trials, and the vital role of support systems. She talks openly about how MS can impact confidence, independence, and daily routines—but also about how determination and a strong mindset can turn even the most daunting obstacles into new paths forward. We dig into the importance of raising awareness, supporting one another, and using our platforms to connect and inspire. Tune in for a conversation about resilience, empathy, and the healing power of storytelling—and learn how you, too, can advocate for others and yourself.   The Spun Today Podcast is a Podcast that is anchored in Writing, but unlimited in scope.  Give it a whirl.      Twitter: https://twitter.com/spuntoday  Instagram: https://www.instagram.com/spuntoday/  YouTube: https://www.youtube.com/@spuntoday   Website: http://www.spuntoday.com/home  Newsletter: http://www.spuntoday.com/subscribe    Links referenced in this episode:      Follow Zoila: @melodyrosa2083   What is Multiple Sclerosis video from ASAP Science: https://www.youtube.com/watch?v=Naecv3h868c   To donate for MS research or partake in activities like Bike MS, Walk MS, or just to learn more, check out the National MS Society: http://www.nationalmssociety.org/     Jpmetz YouTube Page: https://www.youtube.com/@jpmetz     Get your Podcast Started Today! https://signup.libsyn.com/?promo_code=SPUN (Use Promo code SPUN and get up to 2-months of free service!)   Check out all the Spun Today Merch, and other ways to help support this show! https://www.spuntoday.com/support     Check out my Books Make Way for You – Tips for getting out of your own way ÁBRЕТЕ CAMINO: CONSEJOS PARA DEJAR DE SER TU PROPIO OBSTÁCULO (Spanish Edition) FRACTAL – A Time Travel Tale Melted Cold – A Collection of Short Stories   http://www.spuntoday.com/books/ (e-Book, Paperback and Hardcover are now available)   Fill out my Spun Today Questionnaire if you're passionate about your craft.  I'll share your insight and motivation on the Podcast: http://www.spuntoday.com/questionnaire/     Shop on Amazon using this link, to support the Podcast: https://amzn.to/4km592l      Shop on iTunes using this link, to support the Podcast: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewTop?genreId=38&id=27820&popId=42&uo=10   Shop at the Spun Today store for Mugs, Notebooks, T-Shirts and more: https://spuntoday-shop.fourthwall.com/   Music: https://www.purple-planet.com   Outro Background Music: https://www.bensound.com   Spun Today Logo by: https://www.naveendhanalak.com/   Sound effects are credited to: http://www.freesfx.co.uk   Listen on: ApplePodcasts | Spotify | Pocket Casts | YouTube | Website

What if the future of multiple sclerosis treatment could go beyond suppressing inflammation - and actually help protect the brain? In this episode of Rx for Biotech, host Chris Leidli sits down with Jason Tardio, President & COO of Immunic Therapeutics, to discuss the evolving future of treatment for Multiple Sclerosis (MS), one of the most complex autoimmune and neurodegenerative diseases affecting millions worldwide. Jason shares his deep experience leading major MS franchises at Biogen and Novartis, explains how MS attacks the brain and spinal cord, and breaks down why many current therapies focus primarily on inflammation but may not fully address the neurodegeneration driving long-term disability. The conversation also explores Immunic's lead investigational therapy, vidofludimus calcium, an oral once-daily treatment being studied in Phase 3 clinical trials for relapsing multiple sclerosis. The company believes the therapy may offer a unique dual approach by targeting both neuroinflammation and neurodegeneration. Topics discussed include: • What causes multiple sclerosis • Early symptoms and diagnosis of MS • How MRI imaging transformed MS care • Why MS remains difficult to treat • The difference between inflammation and neurodegeneration • Oral therapies vs infusions and injectables • Progressive multiple sclerosis and unmet patient needs • The future of neuroscience, immunotherapy, and personalized medicine For patients, caregivers, healthcare providers, and anyone interested in the future of neurology and autoimmune disease treatment, this episode offers an accessible and hopeful look at where MS care may be headed next.

A cure for neurodegenerative diseases might be frolicking through the mountains. New research from…

What happens when a high-achieving, in-charge leader faces a challenge that can't be solved by sheer determination? In this episode, we sit down with Melissa Borowicz — CEO and owner of The Utech Group, organizational development expert, and co-author of Cracking the Rich Code — to explore what it looks like to face uncertainty through the lens of an ENFJ personality type. Melissa shares how her Big Five profile (94th percentile in adventurousness, 6th percentile in stress quotient) shaped her instinct to "always find a way" — and how an unexpected Multiple Sclerosis diagnosis in 2023 forced her to reckon with the shadow side of that same strength. We explore her development as a leader inside a second-generation family business, the tension between her natural independence and the need to receive support, and what she's learned about setting boundaries when your identity is built around achievement. In this episode you'll hear about: - What ENFJs look like under pressure — and what "laser beam eyes" and task-mode mean in practice - The difference between Interaction Styles (In Charge) and Essential Motivators (Catalyst) and how they showed up in Melissa's leadership journey - How her MS diagnosis accelerated both personal growth and organizational change - The framework she used to navigate life's most uncertain chapter — and why she wrote a chapter about it - Why "just do something" might be the most powerful advice for anyone stuck in uncertainty Whether you're a personality nerd, a leader navigating change, or someone facing something you didn't ask for, this episode will leave you thinking differently about how you're wired — and what your wiring reveals when life gets hard. Connecting the Dots is hosted by Steve Utech (Founder, illumyx) and Ryan Gracyalny (Director of Training & Development, The Utech Group). About Melissa Borowicz Melissa Borowicz is the CEO and Owner of The Utech Group, a second-generation family business specializing in organizational development, change management, and leadership training based in Green Bay, Wisconsin. With a master's degree in marriage and family therapy, Melissa brings a uniquely human lens to the complex dynamics of business — especially in family-owned companies navigating transition. Melissa is a co-author of Cracking the Rich Code, where she shares her personal chapter on mastering uncertainty and finding strength during her own Multiple Sclerosis diagnosis.

Balancing disease control with pregnancy and neonatal considerations in people with neuroinflammatory disease throughout the family planning, pregnancy, and postpartum periods is crucial. Modern treatment paradigms enable women to safely become pregnant and breastfeed alongside effective disease management. Shared decision making is an important part of this process. In this episode, Kait Nevel, MD, speaks with Ruth Dobson, MD and Kerstin Hellwig, MD, authors of the article "Family Planning in Neuroinflammatory Disease" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Dobson is a professor in the Centre for Preventive Neurology at the Wolfson Institute of Population Health, Queen Mary University of London, and a consultant neurologist in the Department of Neurology at the Royal London Hospital, Barts Health NHS Trust, in London, United Kingdom. Dr. Hellwig is a professor in the Department of Neurology at Katholisches Klinikum, Ruhr‑Universität Bochum, in Bochum, Germany. Additional Resources Read the article: Family Planning in Neuroinflammatory Disease Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @drruthdobson Full episode transcript available here

Clement Manyathela speaks to Clinton Rambanapasi, the Roche Medical Partner for Neuroscience, about what causes multiple sclerosis ahead of World MS Day. You’re listening to The Clement Manyathela Show on 702. Clement Manyathela makes sense of the news of the day while sharing information to guide you through daily life. As your morning friend, he tackles both the serious and the light-hearted on your behalf. Thank you for listening. Listen live on Primedia+ weekdays from 9 am to 12 pm (South African time) on 702 https://buff.ly/gk3y0Kj For more from the show and catch-up podcasts, visit Primedia+ https://buff.ly/XijPLtJ Subscribe to the 702 Daily and Weekly Newsletters https://buff.ly/v5mfetc Keep the conversation going online: 702 on Facebook https://www.facebook.com/TalkRadio702 702 on TikTok https://www.tiktok.com/@talkradio702 702 on Instagram: https://www.instagram.com/talkradio702/ 702 on X: https://x.com/Radio702 702 on YouTube: https://www.youtube.com/@radio702 See omnystudio.com/listener for privacy information.

Got feedback about this episode? Send Carolyn a textI'm joined by Winnipeg runner Darolyn Walker for a powerful and perspective-shifting conversation about running, resilience, and redefining what success looks like.Darolyn's story spans more than two decades — from competing at a high level in her university and national track days, to navigating a multiple sclerosis diagnosis in her mid-20s, to raising three children while continuing to train, race, and adapt through unpredictable health challenges.We focus in particular on her remarkable performance at the Boston Marathon, where she ran 3:05:37 while living with MS — a result that sits at the intersection of high level performance and deep gratitude for simply being able to run.But this conversation isn't really about times or records. It's about identity, acceptance, letting go of old definitions of success, and finding meaning in movement through changing seasons of life.SPONSOR: Cure Hydration. Staying hydrated isn't just about water — you also need electrolytes. Real ingredients. Real hydration.Visit curehydration.com/INSPIREDSOLES for 20% off. Connect with Darolyn:Instagram: @darolynwalkerFacebook: @darolyn.walker.7Connect with Carolyn:Instagram: @inspiredsolescast or @carolyn.c.coffinYou can help spread the running love! The best way to SUPPORT Inspired Soles is to share your favourite episode(s) with friends, subscribe, or leave a rating and review on Apple Podcasts. Connect on Instagram @inspiredsolescast or email guest ideas to inspiredsolescast@gmail.com. 

When a company proves it can see what others couldn't, the rules of drug development change overnight. Quantum BioPharma announced on May 18, 2026, that patient enrollment has reached the halfway mark in its collaborative imaging study with Massachusetts General Hospital, accompanied by encouraging preliminary results using a novel PET imaging technique capable of directly assessing demyelinated neurons with intact axons. The company's lead drug candidate, Lucid-MS, targets the underlying mechanism of multiple sclerosis—demyelination—rather than merely suppressing the immune system like most existing therapies. With an IND application submitted to the FDA on April 1, 2026, Quantum BioPharma is positioned at the intersection of breakthrough imaging science and first-in-class therapeutics.WHAT YOU NEED TO KNOWImaging Leap: PET scanning with [18F]3F4AP tracer provides up to 10x more accuracy than conventional MRI in measuring myelin damage and repair—potentially establishing a new FDA biomarker standard.Halfway Validated: First cohort successfully imaged at MGH showing robust signal in acute MS lesions; study completion expected within six months.First-in-Class: Lucid-MS targets PAD2 enzyme to prevent and reverse myelin breakdown—preclinical models demonstrated ability to help animals regain lost mobility.Commercial Scale: MS therapeutic market projected to exceed $38 billion by 2030, affecting 2.8 million patients worldwide with no current therapies addressing mobility restoration.STRATEGIC IMPLICATIONSThe MS treatment landscape is defined by what it cannot do. Virtually every approved therapy focuses on immune modulation—dampening the body's attack on its own myelin. But none address the underlying destruction happening to nerve fibers, and none restore lost mobility. Patients plateau on existing drugs, watching disease progression continue despite treatment. It's a multi-billion-dollar market built on managing symptoms, not reversing damage.Quantum BioPharma's approach disrupts that entire model. By targeting protein arginine deiminase 2 (PAD2)—the enzyme directly implicated in myelin degradation—Lucid-MS addresses neurodegeneration at its source. Phase 1 trials demonstrated a favorable safety profile. Preclinical models showed animals regaining the ability to walk. The oral formulation offers ease of administration versus injection-based competitors. And now, the MGH imaging partnership validates a tool that could measure myelin restoration in real time with unprecedented precision.CEO Zeeshan Saeed:“We've submitted the IND, we're at the halfway mark with MGH, and we're seeing preliminary imaging data that validates what we believed all along. This isn't about managing symptoms. It's about restoring what MS patients have lost. If this works—and we believe it will—we're talking about a fundamentally different standard of care.”INVESTOR TAKEAWAYQuantum BioPharma is executing on multiple fronts simultaneously: advancing a first-in-class therapeutic through FDA review, validating breakthrough imaging science with one of the world's premier hospitals, and preparing for Phase 2 initiation in a $38+ billion market with 2.8 million patients. The MGH study reaching its midpoint with encouraging preliminary results confirms the technical viability of precision myelin measurement. The IND submission positions Lucid-MS for near-term regulatory clarity. And the company's focus on demyelination—rather than immune suppression—addresses the core unmet need in MS: disease reversal, not just disease management. Quantum BioPharma offers investors exposure to a potentially transformative therapy at an inflection point in clinical and commercial validation.

May 30th is World MS Day! This year, the theme for World MS Day is "My MS Diagnosis," and I've been thinking about what happens right after that diagnosis. After an individual hears, "You have MS." This week, Dr. Nancy Sicotte joins me to discuss the things you should know, the things you should be thinking about, and the things you should be doing in the first 100 days following an MS diagnosis.  Dr. Sicotte is the Chair of Neurology and Director of Multiple Sclerosis and Neuroimmunology at Cedars-Sinai in Los Angeles, and she's the past Chair of the National MS Society's National Medical Advisory Committee.  We're also sharing results of a study that showed an exercise hormone protected neurons from inflammatory attack in a mouse model of MS. And we're sharing encouraging news about an experimental nasal spray that's been shown to delay disability progression and improve fatigue among people with non-active secondary progressive MS. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: World MS Day!  :22 Study reveals an exercise hormone has neuroprotective effects on a mouse model of MS    2:40 Tiziana shares evidence that Foralumab delays progression and improves fatigue in people with non-active secondary progressive MS  4:34 Dr. Nancy Sicotte looks at the first 100 days following an MS diagnosis  8:40 Share this episode  28:51 Next week  29:12 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/456 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com World MS Day Poster Maker https://worldmsday.org/poster-maker STUDY: The Exercise Hormone Irisin Has Neuroprotective Effects in a Mouse Model of Multiple Sclerosis https://www.nature.com/articles/s42255-026-01527-7 CLINICAL TRIAL: A Study of Nasal Foralumab in Non-Active Secondary Progressive Multiple Sclerosis Patients https://clinicaltrials.gov/study/NCT06292923 JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 456 Guest: Dr. Nancy Sicotte Privacy Policy

Click to Subscribe: https://bit.ly/Youtube-Subscribe-SoapDirt Young and the Restless predictions indicate that Diane Jenkins mysteriously goes missing, suspected to have been kidnapped. In the meantime, Phyllis Summers, played by Michelle Stafford, finds herself cornered, potentially leading to her surrender. This week we will see a lot of Nick Newman, Nikki Newman, Diane, Patty, Adam Newman, and Sally Spectra. Y&R predictions hint that Nick Newman, played by Joshua Morrow, is committed involuntarily to Fairview by his family, creating tension and suspense. Nick's health takes a dangerous turn, prompting a shocking decision from Victor Newman, played by Eric Braeden, and Nikki Newman, portrayed by Melody Thomas Scott, to prioritize Nick's health over their own disagreements. Nikki herself isn't spared from the drama; she's battling a recurrent headache that could be linked to her Multiple Sclerosis, adding another layer to the plot. The Young and the Restless spoilers show that Phyllis Summers is losing her leverage over Victor Newman, causing her to consider handing back Newman Enterprises to avoid jail time. On the other hand, Diane Jenkins, portrayed by Susan Walters, appears to have been kidnapped by Patty, causing panic and speculation among fans. Y&R spoilers reveal that Adam Newman, portrayed by Mark Grossman, is struggling with the news of Sally Spectra's, played by Courtney Hope, pregnancy. This news, delivered by Billy Abbott, played by Jason Thompson, threatens to reignite old tensions between the two men. Soap Dirt has grown to the most subscribed to Youtube soap opera channel. Visit our Young and the Restless section of Soap Dirt: https://soapdirt.com/category/young-and-the-restless/ Listen to our Podcasts: https://soapdirt.podbean.com/ And Check out our always up-to-date Young and the Restless Spoilers page at: https://soapdirt.com/young-and-the-restless-spoilers/ Check Out our Social Media... Twitter: https://twitter.com/SoapDirtTV Facebook: https://www.facebook.com/SoapDirt Pinterest: https://www.pinterest.com/soapdirt/ TikTok: https://www.tiktok.com/@soapdirt Instagram: https://www.instagram.com/soapdirt/

Palliative care in multiple sclerosis spans the disease course, from early screening and support after diagnosis to symptom management and quality‑of‑life optimization in midstage disease, and end‑of‑life care in advanced MS. This episode outlines a staged approach to palliative care, highlights the roles of neurology and primary care teams, and discusses tools such as patient‑reported outcomes and symptom scales to support ongoing assessment of patients and care partners. In this episode, Katie Grouse, MD, FAAN, speaks with Penelope Smyth, MD, FRCPC and Janis M. Miyasaki, MD, MEd, FRCPC, coauthors of the article "Palliative Care in Multiple Sclerosis" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Smyth is the director of the Division of Neurology in the Department of Medicine at the University of Alberta in Edmonton, Alberta, Canada. Dr. Miyasaki is a professor in the Division of Neurology in the Department of Medicine at the University of Alberta and the zone clinical department head for Clinical Neurosciences at Alberta Health Services in Edmonton, Alberta, Canada. Additional Resources Read the article: Palliative Care in Multiple Sclerosis Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Grouse: With the new treatments for MS, people might be saying palliative care is not relevant at all. It's about giving up hope and hopelessness. But this article covers why palliative care is important for your patients and families throughout their illness trajectory. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Drs Penelope Smyth and Janis Miyasaki about their article on palliative care in multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Welcome to the podcast, and please introduce yourselves to our audience.  Dr Smyth: Thank you, Katie. I'm Penny Smyth. I am a neurologist at the University of Alberta, a professor in neurology, and a clinical multiple sclerosis specialist.  Dr Miyasaki: Hi, Katie. Thanks for having us. I'm Janis Miyasaki. I am a movement disorder neurologist primarily who also provides neuropalliative care at the University of Alberta in Edmonton, Canada.  Dr Grouse: It's so great having you today to talk with us about your article. I thought this article was really a wonderful take on the topic. I learned a lot, and I'm really hoping all of our listeners will take advantage of this article and take advantage of all the learning they can get from reading about this topic. So, I wanted to start with a more general question, which is, what is the key message from this article that you're hoping your readers will take away?  Dr Smyth: In terms of key takeaways, I think it's our hope that neurologists will come away from reading this article with, really, an expanded understanding of what palliative care is and how that might be applicable to them in their care for their patients with MS along a continuum of treating people with MS, that there can be components of palliative care and strategies that can be integrated early after diagnosis in, really, anywhere along the continuum of caring for people with MS. We've called that kind of mid-stage. And then there are particular needs for people with MS and their care partners in late-stage or severe MS and end of life that might require different palliative care strategies. I think we kind of have maybe a bit of a bias sometimes in thinking of palliative care as more directed towards those that are near end-of-life. But in fact, it's a much expanded concept.  Dr Miyasaki: And I'll just add that we also discuss a palliative approach, that palliative care skills and philosophies can be used by generalists---in this case, neurologists who are providing care to people with MS---and that adopting certain skills and communication techniques can help us better address our patients' and their families' symptoms. And also to keep in mind that for most people with neurologic illness, the unit of care is not only the patient, but it's the patient and the family, however that family looks.  Dr Grouse: Now, Penny, I'm curious, how are early-stage and mid-stage multiple sclerosis palliative care strategies different from, say, a typical evaluation and counseling that a neurologist would give, say, an MS specialist or even a general neurologist?  Dr Smyth: Thank you, Katie. That's a great question, and something that actually I learned in writing this piece with Janice and from her as a neuropalliative care expert. I think in terms of early strategies around palliative care that can be helpful to the general neurologist in their office, palliative care is about holistic support for patients and their care providers spiritually, emotionally, physically. There are components of palliative care and symptom management and making sure that the patient is at the center of the care, as well as support for their care partners with their holistic approach of relief of suffering as well as offering hope. When I started this piece, I was thinking that many of us neurologists, I think, often informally utilize many of these components already when we're dealing with patients early on after diagnosis in terms of communication, counseling, and education; going through their fear of an uncertain future; spiritual well-being; and then connecting them with supports for adaptive coping strategies. And then as well in mid-stage, which is really around what we can do in symptom management and improving quality of life, with screening tools and patient-reported outcome measures. However, I have to say that there are many unmet needs for people with MS and their care partners that they identify that are clearly not being met by us neurologists in this day and age. So even though we may be incorporating some of these strategies, I don't think we're meeting the mark all the time and hitting the target, especially in our busy office practices, in various ways. Dr Grouse: Given that, at a high level, what are some important early-stage MS palliative care concepts that we should be keeping in mind when we are counseling patients in these stages of the disease? Dr Miyasaki: An important concept to keep in mind for neurologists dealing with early-stage MS patients is that for us, we feel successful that we have made a diagnosis. And yet for the patient, it is taking away that hope. Maybe it's not MS. Maybe I just have a numb hand and it's gonna go away. And for us to appreciate that while we make this diagnosis multiple times a week---or, for MS specialists multiple times a day---for this person, it is the first time, the first experience, and it shakes their entire foundation of who they are as a person, how they will perform all the tasks and roles that they have in society, in their professional lives, in their family structures, and in their close, intimate relationships. As physicians, we may be overwhelmed by acknowledging that. I feel that it's important for us to understand the needs that our patients have and to allow them to have their feelings. You know, feelings can feel messy and time-consuming, and yet when we fully see our patients, I feel that this is the best of medicine. And it certainly is, in terms of palliative care, the principle that we seek. We accept all of the patient, the joy and the sorrow, the anger and the frustration. We accept it all, and we try to determine what will serve this person who is suffering in front of us now.  Dr Smyth: There's another piece to this, which came up as Janice and I were writing together. We were talking about offering a prognosis to a patient as to how they would do, and this was something that I thought deeply about, because I said, we always communicate how uncertain the prognosis is and how we can't predict the future. And then she said to me, well, what about offering a roadmap to a person with MS soon after diagnosis as to how you're gonna determine how they do over the next couple of years? Which are really important years in terms of determining how patients are doing on their disease-modifying therapies, whether they're having progression or not, and things. It's a pivotal time. So, if you can offer a roadmap to a person with MS and say, look, this is when we will be following you up. This is how we will be following you with MRI and biomarkers if you have that available, and this is how we will determine how responsive you are and then how we move forward from there. Dr Grouse: Really important concepts. And the roadmap certainly makes a lot of sense to me and something that, apart from just being useful to the patient for so many reasons to help set expectations, you know, is useful for us to better partner with the patient so they understand this is sort of how we do things and everyone's sort of expectations are met. So, I think those sound like really great goals and things to keep in mind. Now, we talked about early-stage MS palliative care concepts. How does that change as you get into the mid-stage of the disease?  Dr Smyth: Yeah. So, this is reflecting the fact that the course of MS is so different and the experience of MS is so different person to person. And so, what do we do as neurologists when we follow these people long-term over years and decades of living with their MS as their needs evolve, as their symptoms evolve, and as their disability evolves? Well, really, this is about the time of getting into, what are the symptoms that they're struggling with, what are the causes of their suffering at various points? And then how do we identify that, maybe with use of patient-reported outcome measures, screening scales, things like that. And then how do we direct symptomatic management to the specific symptoms that are causing distress to the patient? As well as trying to improve their quality of life in various ways, treating their comorbidities, making sure to check on exercise, healthy living, and that kind of thing.  Dr Grouse: Now getting into, I think, topics that we're more used to thinking about when we think about palliative care: a lot of us, I think, are really unsure of the right time to discuss advanced care directives in the course of multiple sclerosis, and I think that's not helped by the fact that many of us are just, in general, not terribly comfortable talking about those types of things in general. What is your advice to questions like this?  Dr Smyth: And this is something that, again, Janice and I had to come together on, because there is no universal accepted time for when is the right time in multiple sclerosis to discuss advanced care directives and goals of care. And in fact, when they have looked at it in the literature, different things have come out. It has come out that neurologists can be uncomfortable discussing this. There's unique challenges to people with MS in that they have a diagnosis at a young age with an uncertain trajectory of how their course of disease is going to go. And many of these things lead care providers to be somewhat hesitant as to when is the right time, as well as, there were identified barriers within patients themselves as to when the right time might be to discuss. In that, you know, some of the coping strategies might be, as identified by some of the qualitative studies that have been done on this, around the fact that they would prefer to focus on the present rather than the future. In some studies expressed an ambivalence as to when they thought the right time might be, as well as some negative experiences that they might have had from providers trying to discuss these things in their previous experience. So, I went back to looking at the European guidelines for palliative care in MS, who suggested when a person might have severe MS---which they define as walking with bilateral aids for at least twenty meters or an EDSS of six or higher---or trigger-based, when there has been a change in the patient's status, when there's been a decline in some way or progression. Now, this is a little different, actually, than what we offer other people with neurologic diseases, and I don't know if that's the right answer. And this is where I'm going to turn it over to Janice, because I think we could learn something, as neurologists who treat people with MS, from our palliative care specialists.  Dr Miyasaki: I think of advanced care planning in a very different way. I think what a lot of the patients were expressing in the studies was that being asked about advanced care planning signaled to them in some way that they have reached this point in their illness where things aren't going so great and I anticipate that you may run into complications. Whereas in our movement disorder clinic, one of our fellows did a study looking at capacity for decision-making. And even in people who scored normally on the Montreal Cognitive Assessment, they had impairments in some of the domains of decision-making. And so, our philosophy in movement disorders at least---and some of our patients are quite young who have multiple system atrophy, they could be in their forties---we take the philosophy that everyone over the age of decision-making capacity, which is generally eighteen, should have some goals of care established. And how I introduce it in my clinic is, you know, for the young resident, you want the full-meal deal, because the likelihood of the resident surviving the ICU admission is very high. And then when we look at me, who… I am older, the likelihood of surviving an ICU admission is considerably lower. And so, the appropriate goals of care might be that I am willing to go to the ICU, and if things go well, then they can continue. But if things are not going well, they can have a discussion with my personal directive or power of attorney to talk about what the goals of care should be. And then the other aspect is sometimes having the conversation with family is really important because most of our families in hospital express an uncertainty. Am I doing the right thing? And they want to do the right thing for their loved ones. And most people actually say, if you ask them, I don't want to burden my family with making decisions that are going to tear at their hearts. So, then we can't actually make good informed decisions for our loved ones unless we have clear conversations. I think it does speak to our superstitious beliefs that if we talk about death, it's going to happen. But I hope the listeners will take my word for it, it really doesn't. And someone had a really good saying about the advanced directive. They're kind of like evening clothes. You should take them out every once in a while and make sure they still fit. And so, when you normalize it in this way, it helps people to just say, oh, yeah, it's once a year. Dr. Miyasaki is gonna ask me about how do I feel about those goals of care. And then it doesn't have this portent of, oh, I'm not doing well. Instead, it's just, this is what we should all be doing for our sake and for our family's sake.  Dr Smyth: Now, one thing that I have to add on to this is that it is important to try to establish advanced care directives before patients experience cognitive decline, because then that can make it a much more challenging conversation and brings nuances of challenge into the interactions, which, you know, are hard.  Dr Grouse: And Penny, I'm glad you brought that up, because I was really struck by that point too when reading this article, how easy it is to miss the subtle signs that cognitive changes are happening. I think it's just- it's a good kind of segue into that topic in general, but it is such an important link to, you know, making sure that you get those advanced directives at a time when the patient's really able to express and understand what they're talking to you about. Now, on the topic of the cognitive screenings, what's a good way to do this type of screening, and why is this type of screening so particularly important in the case of multiple sclerosis?  Dr Smyth: Yeah. Thank you, Katie. I think that it's important for our listeners to think about and recognize when we see our patients with MS because it is one of the invisible symptoms that people with MS can live with and may not be apparent on regular conversation in the office. So, it's important to deliberately ask about subjective challenges in cognition. Ask the partner about how they're doing in terms of their cognition in various ways. As well as asking them and exploring then, how are they doing in their professional roles if they're working or in their surroundings? How are they coping on a daily basis on a cognitive level in addition to a physical level? We know that cognitive issues are actually the biggest contributor for not working and are a huge driver of disability in MS in terms of functioning, even more than physical decline in many ways. So, it is important for us neurologists to keep top of mind and to think about and deliberately attend to. There are screening tests that we can do in the office. The easiest for us, which measures the verbal processing speed, is the SDMT test, which is a ninety-second test matching symbols and numbers. It's easy to do. You can train a MOA to do it before you see the patient and things like that, and it just gives you an idea as to where the patient is at. And usually they're having difficulties if they're greater than two standard deviations below the norm for their age, or if there's a significant drop of four or eight points, and that might signal to you that there might be more going on. You can explore it, and then if you do have this available, the ability to refer for neuropsychological testing if there's questions. But often we can't get it with the MoCA score, unfortunately.  Dr Grouse: Talking about all these concepts, I think they all sound great. I think a lot of us hearing this will naturally say, "Yes, these are absolutely things we should be incorporating in the care of these patients." What I wondered about was, certainly we're all very busy, it is really hard to find time for a lot of these things. We don't always have access to specialists who can help us with some of these conversations. How can we find time, and how can we work this into the care of our patients effectively and still make time for all the other things we have to talk about, and make sure that we're seeing all of our other patients and staying on time and all of those things?  Dr Miyasaki: Yes. I think that's the challenges of dealing with people who actually, over time, their care needs increase, is huge in neurology. I can't think of a single subspecialty where care actually gets easier. It's constantly getting harder. You know, having come from private practice, I completely understand my colleagues' challenges in the community. Some of the ways that other groups have managed this when they don't have government or university support in their center is actually to look at not-for-profits. There are a lot of not-for-profits that can help in terms of wayfinding for social services, explaining to the patients and the family what is available to them. And in fact, some of them can also provide some cognitive supports, as well as point them in the way of day programs. And many of them have very established caregiver support groups, as well as patient support groups for various stages of their illness. So, I think it requires for the individual or small or even a large group practice to be inventive, to look in your community and see what resources are available and free for your patients in order to establish that loose team without boundaries to help your patients. Of course, for those in academic centers, I know that times are tight for all of us, and if you haven't established a team, it is a challenge; and then learning how to write a business plan or a briefing note for your institution and to learn how to speak the love language of administrators, is really key to putting forward the needs of our patients. Which, compared to heart attack patients or hips and knees, they are very rare, and yet our patients can result in significant cost to the healthcare system. So, we do have an opportunity to make the case that putting a little bit of investment in the ambulatory setting can result in significant cost savings to the system when it comes to acute care hospitalization.  Dr Smyth: So, I was thinking, Janis, as you were talking about that, when you were talking about not-for-profit groups, it's really the MS societies in various countries that are very active in this and have a lot of resources available, especially for care partners.  Dr Grouse: Those are really great tips. Thank you for bringing those up as potential other resources we can take advantage of. I wanted to ask specifically about physician-assisted death and assisted suicide, which certainly does come up, especially in later-stage parts of the disease. How can palliative care specialists be helpful when patients do express interest in these types of interventions?  Dr Miyasaki: As you know, Katie, in Canada, we've had a legislative right to access to what we call medical assistance in dying. When the legislation passed, one of my other colleagues and I felt that these were the only conversations we were having with our patients. In all this experience, I have sort of developed in my mind a framework of people who are what we call MAID-curious. They want to know what their rights are and how it would look, when they feel the time is close, for them to exercise that right. And then there are those who are fearful of future suffering. And some of them may have a very unrealistic view of what the future will look like. And this may be in particular for multiple sclerosis because many of the public's view is based on what treatment was like thirty years ago. It may not be informed by more recent treatment where patients actually do quite well, and the majority never get to progressive MS. And so, to explore and be open to that request is the first thing that is important. And then if the person has unresolved symptoms that, traditionally, we can't care for, the palliative care specialist can be very helpful because they just have inventive ways of looking at things. They look at it outside the box, and they have a different toolkit available to them. I would not want all neurologists to just send all these patients requesting physician-assisted death to their palliative care colleagues. But I think for those who are having unaddressed symptoms, it can be very helpful. Certainly, if there is an acute event in the hospital, then this is a time of crisis. And often hospitals will have an in-hospital palliative care team who can come and speak to the patient about what is going on and address some of their needs. And I would also like to emphasize the importance of spiritual care, because for many of our patients, they are not just having the physical suffering, they are also having the spiritual suffering of hopelessness or of feeling that they are a burden or that they just are not seen because a lot of the symptoms in MS are invisible. To have that understanding by a spiritual care counselor is really helpful for the people to feel understood and to reduce some of that suffering.  Dr Grouse: That's a really great point, I think, to end on, and I think it really ties in a lot of the themes that we've been talking about today. Thank you so much for coming to talk with us today. It's been such a pleasure having you both here. Dr Smyth: Thank you. Dr Miyasaki: Thank you, Katie. Dr Grouse: Again, today I've been interviewing Drs Penelope Smyth and Janis Miyasaki about their article on palliative care in multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 17 of Winning Isn't Easy. In this episode, we'll dive into Why ChatGPT Can't Get Your ERISA Disability Claim Right (and What Actually Works).Let's say you're living with fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, multiple sclerosis, Parkinson's disease, or recovering from a stroke, and the high-stakes, cognitively demanding job you once handled now feels out of reach. What should you do next? Stop working and file for ERISA disability benefits? Talk to an attorney? Or rely on generalized advice from online tools or AI? In this episode, we examine why one-size-fits-all answers (typically provided by AI) often miss the mark. Disability carriers don't evaluate claims in the abstract, they scrutinize how your specific symptoms translate into functional limitations, especially when cognitive impairment is involved. Drawing on real cases, we break down how insurers assess these conditions, where claimants go wrong, and why incomplete or generic guidance can jeopardize otherwise valid claims. We also explore how an evidence-driven approach, backed by experienced legal guidance, can make the difference between approval and denial. If you're navigating a complex disability claim tied to cognitive or neurological conditions, this episode offers a clearer view of what actually matters, and how to protect your benefits.In this episode, we'll cover the following topics:One - When ChatGPT Gives You the Wrong AnswerTwo - How Disability Carriers Really Evaluate Cognitive Impairment ClaimsThree - The “Own Occupation” Trap and How to Win Your CaseWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

When we talk about managing Multiple Sclerosis, our conversations naturally focus on things like disease-modifying therapies, mobility, MRI scans, and symptom management. But in this week's episode, we're shining a light on a critical aspect of MS wellness that doesn't get nearly enough attention: your oral health. Living with MS can introduce a whole host of unexpected challenges to maintaining a healthy mouth. And beyond preventing tooth decay and gum disease, emerging research suggests that chronic oral inflammation, like periodontal disease, can trigger systemic inflammation throughout the body. Dr. Ann Spolarich joins us to break down the science, explain the risks, and offer practical suggestions for maintaining oral health for people living with MS and their care partners. We're also sharing study results that revealed 1,000 differences between immune cells in men and women. (And we're explaining why that's important) If you're a parent or caregiver for a child or teen with MS, we'll tell you everything you need to know about the FDA approval of Ocrevus for treating pediatric MS. We're sharing the details of an AI partnership designed to shorten the time to an MS diagnosis and track progression in real time. We're sharing the details of another AI partnership designed to test a pill that will ease MS-related depression and fatigue. And we'll tell you about a way that you can participate in MS research from the comfort and convenience of your own home. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: The connection between your oral health and MS  :22 Study reveals 1,000 differences between men's and women's immune cells    1:30 FDA approves Ocrevus for children over the age of 10 with relapsing remitting MS  3:28 An AI partnership designed to shorten the time to an MS diagnosis and track progression in real time  5:43 An AI partnership to test a pill that will ease MS-related depression and fatigue  9:24 An opportunity to participate in MS research from the comfort and convenience of your own home  13:16 Dr. Ann Spolarich discusses the connection between your oral health and MS  13:16 Share this episode  29:45 Next week  30:05 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/455 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com STUDY: The Impact of Sex on the Immune System Explored at the Single-Cell Level https://www.cell.com/ajhg/fulltext/S0002-9297(26)00153-9 ONLINE SURVEY: Bladder-Related Fall Risk in People with MS https://www.nationalmssociety.org/how-you-can-help/get-involved/participate-in-research-studies/rs-bladder-fall-risk JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 455 Guest: Dr. Ann Spolarich Privacy Policy

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice.In this Mind Moments episode, Scott Grossman, MD, assistant professor of neurology and ophthalmology at NYU Grossman School of Medicine, discusses emerging research on inter-eye retinal nerve fiber layer (RNFL) asymmetry as a biomarker of prior optic neuritis in pediatric-onset multiple sclerosis (POMS). Drawing from data presented at the 2026 American Academy of Neurology Annual Meeting, Grossman explains how optical coherence tomography (OCT) may help improve diagnostic confidence in pediatric MS by identifying remote optic nerve injury, while also outlining how a 4-micron inter-eye RNFL difference emerged as the optimal threshold in this cohort. The conversation also explores the role of OCT within the updated 2024 McDonald Criteria, the feasibility of integrating OCT into routine neurology practice, challenges surrounding normative pediatric OCT data, and future research directions involving visible light OCT and broader population datasets. Looking for more Multiple Sclerosis discussion? Check out the NeurologyLive® Multiple Sclerosis clinical focus page.Episode Breakdown: 1:15 – Optic nerve involvement and updated MS diagnostic criteria  3:20 – Pediatric RNFL asymmetry thresholds and interpretation of study findings 5:15 – Clinical implications of OCT biomarkers in pediatric-onset MS  6:40 – Neurology News Network  8:40 – Feasibility of incorporating OCT into neurology and MS practice  10:15 – Future research directions, including normative data and visible light OCT The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: FDA Approves AXS-05 as New Treatment for Alzheimer Disease Agitation FDA Approves Ocrelizumab for Pediatric Patients With Relapsing-Remitting Multiple Sclerosis Efgartigimod Gains FDA Approval as First Treatment for Seronegative Forms of Myasthenia Gravis Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

What do patients want to know about biosimilars? Credit available for this activity expires: 5/13/2027 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1003363?ecd=bdc_podcast_libsyn_mscpedu

Advances in immunotherapies for multiple sclerosis and related disorders have increased the risk of infections and raised important questions about vaccination efficacy. This episode reviews infection risks across treatment classes, emphasizes the importance of monitoring and patient education, and discusses optimal vaccine timing to preserve protective immune responses. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Avindra Nath, MBBS, FAAN, coauthor of the article "Infection Risk and Vaccine Considerations in Multiple Sclerosis and Related Disorders" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Nath is the chief of the Section of Infections of the Nervous System at the National Institute of Neurological Disorders and Stroke, National Institutes of Health, in Bethesda, Maryland Additional Resources Read the article: Infection Risk and Vaccine Considerations in Multiple Sclerosis and Related Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Full episode transcript available here Dr Berkowitz: Over the last decades, there has been a revolution in the treatment of multiple sclerosis, neuromyelitis optica spectrum disorder, and other immune-mediated neurologic conditions with countless new, highly effective medications. However, with every new treatment comes new risks; and in the case of immunomodulatory therapy, many of those risks relate to infection. Today, I have the privilege of talking with an expert on this topic, Dr Avindra Nath, about the infectious risks of treatments for multiple sclerosis and other immune-mediated neurologic disorders.  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Avi Nath about his article on vaccine considerations and infection risk in multiple sclerosis and related disorders, which he coauthored with Dr Amit Bar-Or. This article appears in the April 2026 Continuum issue on multiple sclerosis. Welcome to the podcast, Dr Nath, and could you please introduce yourself to our audience?  Dr Nath: Thanks very much for inviting me to this podcast. I'm absolutely delighted to have the opportunity to discuss our areas of interest and expertise related to infections and vaccinations for MS patients. My area has been studying the infections of the nervous system since the beginning of the AIDS pandemic, and over the years and decades, we've developed expertise related to various types of CNS infections. That includes ones that are developing in individuals who have immune compromise due to a variety of different reasons. Dr Berkowitz: Fantastic. Well, glad to have the opportunity to speak with you today. When I was in medical school---and you were my attending, actually, we were just reminiscing, which we probably think was not that long ago, but is now over twenty years ago---there were just two medications for MS, right? Beta interferon and glatiramer acetate. And now we have over a dozen, and it's amazing to think of all the progress in these last two decades, as well as for related diseases like NMO. I don't think we even had the aquaporin-four biomarker, right, when I was working with you as a med student in the early 2000s. Dr Nath: And that certainly dates me a lot.  Dr Berkowitz: Both of us.  Dr Nath: Yeah.  Dr Berkowitz: Of course, with all these new treatments, these have been amazing advances for our patients, right? But these come with new treatment-related risks to monitor for with the immunomodulatory medications for MS and related disorders. And one of those most important risks is that of infection. So, your article reviews the potential infectious complications of medications used to treat MS, NMO, etc, and also covers considerations related to thinking about vaccines in this patient population. So, as the MS treatment landscape grows, I can say as a general neurologist, keeping up with all these medications and what to screen for and what to worry about and when to vaccinate just becomes more challenging every year. And your article has so many helpful tables, some organized by medicine, some organized by- sorry, medication, some organized by infection, some by vaccines. So, this is gonna be a great resource for our providers to print out and tape up in their clinic rooms. We won't be able to get into all the depth and detail that you have in this article today, but I do want to focus on some of the key points here related to the common medications we use for MS and which infections to think about and which vaccine considerations we might need to keep in mind for these medications. But before we delve into the drugs, I just wanna ask you more broadly, you talk in the article about the challenge of patients with immune-mediated diseases who are on immunomodulatory therapy being at risk for both flares of their disease and for infections; and these infections can present somewhat atypically, right, in immunomodulated hosts, to maybe coin a term you can correct me on, because they can't mount the full inflammatory response. So how do you approach new symptoms in patients on these immunomodulatory medicines as far as distinguishing disease flare from a treatment-related infection?  Dr Nath: So, I have to say that although a lot of new treatments have come along for MS, and they've really, you know, improved the outcome tremendously and there are so many different options, it has also kept people like me relevant because they cause a lot of various types of infections, and so keeps me in business all the same. But just as you mentioned, there's so many of them, even I have difficulty keeping track of what does what. So, you do need to be able to refer back to published literature, and the tables, I hope, will be quite useful in that regard. You're absolutely right, and you can get new infections, you can get reactivation of existing infections, and you can get atypical presentations of various types of infections that you may not normally think of. So that presents multiple challenges to the treating physician. The other interesting thing about MS is, just as you mentioned, that you already have CNS lesions to begin with. Now, on top of it, you have an infection, so now how to sort out what is the existing disease and what is the infection, it can again become challenging. But one thing is for sure: all these infections are caused by an organism. So, what you really need to do is, the underlying diagnostic is to demonstrate the presence of the organism. Whether you demonstrate it depending on the infection in the spinal fluid or in the brain or, you know, some peripheral organ system, that is going to be key to making the diagnosis. So, all your clinical acumen is good, but that alone may not be sufficient. Dr Berkowitz: Very good. So, when you see a, a patient now who has a new neurologic symptom in the context of an immune-mediated disease who's on immunomodulatory therapy, what goes through your mind? Are you thinking this disease and this drug, and sort of what are the infections, and does the syndrome match? Or are you thinking, you know, you can't always rely on the imaging to distinguish between, say, a flare of an MS and PML because white matter lesions could look similar? How do you sort of approach this scenario when it comes up?  Dr Nath: So, you're right. You have to keep an open mind so that even though you know some infections are more likely to occur with certain types of medications, that doesn't mean that others cannot occur. So, I think when you first see the patient, you should not jump to conclusions, but rather have an open mind. But yes, for example, your patient is on natalizumab, the chances of PML are going to be high. It's a very interesting drug. It does not cause immune compromise in the periphery, but what it's doing is preventing these cells from getting into the brain. So, because then it's acting at the blood-brain barrier. So that means that organisms that are already present in the brain have an opportunity to get reactivated. Turns out you don't have a lot of organisms in the brain, except JC virus seems to be one of them that does somehow, in some individuals, manage to reside out there. And so that can get reactivated. It can get reactivated in the periphery and then enter the brain, too. So, where the very specific mutations have to occur in that virus in order to take residence in the brain. That would be a suspicion that you might have, and MRI can be useful in, again, helping you think about that possibility. If you have typical lesions involving the U fibers, they're demyelinating, usually you do not have much edema around them because patient is immune compromised, but certainly within the brain in these individuals. And so, then you need to demonstrate the organism. The demonstration of the organism should be in the spinal fluid and not in the blood because in the virus, it can-- is reservoir in the kidneys and in the lymph nodes, and periodically it'll shed into the blood. Detection of the organism in the blood can be a false positive, but in the spinal fluid, it shouldn't be there unless you have an infection. Or if you cause a traumatic tap, I guess, if a patient is viremic, that's a possibility, but those are extremely rare. So at least for PML, that's the way that you would diagnose it. Now, you can develop, for example, if an individual is on fingolimod, you can get a wide variety of infections. Here it's a totally different type of mechanism of action. Here the cells are trapped within the lymph nodes, so that means now your entire periphery is immune compromised, right?  So here you can get viral infections, bacterial infections, fungal infections. So here, if a patient presents with new neurological symptoms, you have to have a really open mind for all these possibilities. Now, let's say a patient was on dimethyl fumarate, and dimethyl fumarate causes neutropenia early on. So here you have to worry about an individual developing bacterial infections, so latent tuberculosis or bacterial meningitis can occur in these individuals. That's something to keep in mind. It's not that other infections cannot occur with dimethyl fumarate, you can see PML and other things too, but the chances of bacterial infections are greater. So, you got to make sure that you draw all the cultures for that purpose. Similarly, if you're on a complement inhibitor, like a C5 inhibitor or the thing that I could use in NMO, there are the chances of meningococcal meningitis. So, these patients, you need to prevaccinate them before you start these kinds of treatments and look for that possibility. When you suspect bacterial infections, particularly acute bacterial meningitis, there time is of essence. Also, in some of the acute viral infections, for example---herpes encephalitis is another one---you have to be so careful, and if you suspect any of them, even if they're with possibly atypical manifestations, you treat first and then diagnose later, and draw all your cultures, whatever you need to, and just treat them. And these infections can also cause cerebral edema, so one has to be careful about doing spinal taps in these individuals. You want some kind of neuroimaging before you do them. In the days when we didn't have neuroimaging, we used to say, "Okay, if your patient has focal neurological signs or is comatose, you don't do it." But these days, you can get imaging very quickly and very easily. All the-- Because of our stroke management, we've learned how to do them so quickly. So, I think there's little excuse not to do imaging and prevent herniation from occurring.  Dr Berkowitz: That's very helpful. So, using the information we know about the drug, and we're going to rapid-fire review some of that in a bit to know what infections the patient is susceptible to, but acknowledging that any patient can get any infection, right? Whether they're on particular medications or not. And then if you're not sure, based on the neuroimaging, which as you said, is helpful, but not always helpful in distinguishing between infections and flares or, as you said, in the case of meningitis, encephalitis, early on at least, especially in immunocompromised or immunomodulated, quote unquote, patient might not see the typical imaging. So really, when safe, getting CSF or cultures, PCRs, and other infectious studies too is really gonna be the definitive diagnostic maneuver here. Is that fair summary across the board?  Dr Nath: I think you said that absolutely right. And you summarized that correctly. And, you know, thing about infection, a lot of neurological diseases are, you know, diagnosed by clinical acumen, like your Parkinson's and Alzheimer's and others. Think about infections is caused by an organism, demonstrate the organism, right? That should be your goal. It doesn't mean that clinical acumen is not important, but here you have an opportunity to demonstrate the organism, so you should depend upon that.  Dr Berkowitz: Okay. Well, you gave us a nice segue by talking about some of the infections to worry about with some of the medications. So what I'd like to do now for the sort of second half of our interview here is to go through some of the more common medications used for MS, and if we have time, for NMO, and just sort of go kind of rapid fire here, and for each medication, if you can tell us the kind of top infectious concerns and whether when to consider them or what screening needs to take place before or during administration of the medication, and then any vaccine considerations we should be aware of. Some of these will obviously be quite short depending on the medicine. So, going back to the two medications I alluded to earlier that were the only ones in play when you and I last saw each other on the wards when I was a medical student, beta interferon, glatiramer acetate, any infections or vaccine considerations with these medications?  Dr Nath: No, I think they're probably your safest medications now as far as immunomodulatory therapies are concerned. These two, and IVIG, if you ever use them, are probably the safest, do not require any vaccine considerations, per se. Dr Berkowitz: Perfect. Okay. So, moving on to fingolimod and others in the sphingosine-one phosphate receptor modulator family, what are the infectious considerations? Any prescreening or vaccination considerations?  Dr Nath: I think all your patients should be prescreened for antibodies to JC virus, because there is a risk for PML, and those who are positive should be closely monitored. So, it's not an absolute contraindication for using these medications, but they just require closer monitoring. With this class of drugs, PML is of consideration. Also, these varicella-zoster virus infection, yeah, with that you can develop zoster encephalitis or myelitis. It can present with motor symptoms as well, which can be atypical. You don't usually see them otherwise in immune-competent individuals. So, varicella-zoster, sometimes you can develop encephalitis, also vasculitis with varicella-zoster, so one has to be careful. So, getting the shingles vaccine can be actually very helpful to prevent these things. And then some patients can even develop herpes simplex encephalitis also, and that can be extremely atypical. So, they don't- they can involve the basal ganglia, can involve the brain stem and cerebellum. So again, your index of suspicion should be very high. Interestingly, although HSV encephalitis has been associated with NMDA receptor encephalitis, those reports of NMDA receptor encephalitis have not been published yet with NMS patients. Not sure why, maybe they just have been missed. But that doesn't seem to be a major concern. And then there are a whole host of other infections that can occur with this class of drugs, and that can include toxo; fungal infections, particularly crypto. There's a case report of histoplasmosis; hepatitis virus, particularly hepatitis C; and then the poxvirus is a good example. You can get molluscum contagiosum; warts with papillomavirus; you can get atypical mycobacteria; and even Kaposi sarcoma, which is HHV8. So, there's a huge variety of infections with the sphingosine one phosphate receptor modulators.  Dr Berkowitz: And any- aside from screening for JC virus before initiating these, any- and then continuing to monitor for JC antibody index, any other considerations as far as labs to send, monitoring before or on the drug or vaccine considerations for patients on fingolimod and the others in this category, siponimod, etcetera?  Dr Nath: Yeah, there are a lot of things to consider. All the details are really available in the chapter if you look at them. But briefly, all the things that one could potentially vaccinate patients for, all these infections I mentioned, one should do so. The timing is critical so that if you can do it before treatment, I think, before starting treatment, that is absolutely important. And you got to give them at least, you know, two to three weeks for these vaccines to take effect before starting your medication. If your patient already arrives on a medication, then you got to play this game of you know, before the next dose, give them again two to three weeks before the next dose and start vaccinating them and get all the vaccines in. Broadly, about the things to worry about the vaccines are you have live vaccines, and you've got the inactivated vaccines or the subunit vaccines. You have to be careful with live vaccines, because if your patient is immunocompromised, that virus can sometimes itself cause harm. For example, you know, yellow fever is one, and there you can develop encephalitis from it. Measles, mumps, rubella, these are all live vaccines. Now, the good thing is that a lot of us have been immunized very early in childhood, but that may not be the case any longer. And so, these things, one has to be very careful with when you're giving live vaccines, that we want to avoid them as much as possible, and individuals are gonna be immune-compromised. But all the others, meningococcus, for example, you should- the HPV vaccines, the varicella zoster vaccines, all these things, you've got to pre-vaccinate and make sure that they have an antibody response to them before starting immunocompromising therapy. Dr Berkowitz: Perfect. Okay, moving on to some of the other orals. What infectious and/or vaccine considerations do we have with teriflunomide?  Dr Nath: Okay, yeah. Teriflunomide is a very interesting drug. It's relatively safe. There is concern about the possibility of varicella zoster infection, people have reported that, and also tuberculosis. But PML is extremely rare, if not at all, and we haven't seen herpes encephalitis quite yet.  Dr Berkowitz: Got it. How about dimethyl fumarate? Dr Nath: Yeah. So dimethyl fumarate is... as I mentioned earlier, it's interesting because it causes this neutropenia. It's transient, but it occurs early on, and these patients can be at risk of PML, although small. They can develop varicella zoster virus infection, herpes encephalitis, and also fungal infections. For example, cryptococcal infection has been reported with dimethyl fumarate. Dr Berkowitz: Okay. We've spoken a bit about natalizumab and PML, and you have extensive information on this in your article, and I'll defer the reader to that. But for natalizumab, what are the key points every neurologist should know about natalizumab and PML as far as from the practical perspective, screening, frequency of screening, when to worry, when to not use natalizumab at all in the first place based on what you find in your screening for JC virus? What are the key points every neurologist should know?  Dr Nath: Uh, yes. You bring up an important point, and that is all patients should be monitored for JC virus. If they're JC virus-negative, so that's your most ideal patient to go on natalizumab, but that doesn't mean they cannot get infected with the virus. In fact, there's an interesting study claiming that, you know, patients, when they get these infusions, they're all sitting in the same room getting infused. Some have JC virus, some don't have JC virus, and so there's the potential that we may be aiding the transmission here in some way or another. The virus is an interesting one. It comes out in urine, and then it's spread through oral contamination, gets into the tonsils, and then spreads from there to your marrow and resides in the kidney and the marrow, as well as the lymph nodes, forever. So, you, you have to monitor these patients to see that during the course, even if they're negative, they could turn out positive. So, every six months or a year, an antibody test should be done on all patients irrespective. If a patient already has antibodies, that's not an absolute contraindication. It just means you've got to monitor them closely for development of new symptoms, and if, whenever there are new symptoms, don't just assume this is due to MS, but just make sure the MRI is done with and without contrast. The- and if there's still a suspicion, that you do a CSF evaluation for JC virus. Just detecting, looking for JC virus in the blood, a rising titer is another thing that can help you. And so, the titer is also important. And the reason you have rising titers is it means that there's an infection that's already occurred in the brain, and the immune system is reacting to that infection by increasing titers. But that alone is not sufficient to make the diagnosis. You still- that gives you an index of suspicion. You've got to then do the MRI and the spinal tap to, you know, be absolutely certain. So, each patient is a little bit different, so the way you monitor them is going to depend on where they are. You know, if they've had prior immunomodulatory therapy before starting natalizumab, or if they're on natalizumab for more than two years, then the chances of PML are much greater, so you may want to monitor them more closely. Uh, they never had any prior immunomodulatory therapy, you're just starting natalizumab, maybe once a year is sufficient. So, I think you've got to tailor it depending on what your risks are for each patient. Dr Berkowitz: Perfect. That's very helpful. And again, you write extensively about PML and natalizumab and PML considerations in your article. So, for a more detailed and in-depth discussion of what we just discussed, definitely hope readers will take a look at your article. Okay. Last but not least---certainly not least, 'cause we're using these probably, it seems, the most commonly in many places I've worked---rituximab, ocrelizumab are B-cell therapies for MS. What are some of the infectious and vaccine considerations related to these infusion medications?  Dr Nath: So, there's concern for PML with anti-B-cell therapies also, maybe not to the same degree as natalizumab, but the same principles should be applied. A lot of people think that these are relatively safe. I don't think so. I think we see enough number of patients on B-cell therapies with PML. So, I would use the same caution because these infections are... you know, can be fatal. So, one should be very careful, even with anti-B-cell therapies. And just with natalizumab, you also have the risk of VZV infection causing shingles. HSV1 has been reported, but there's another interesting complication that has been reported with anti-B-cell therapies, and that is severe West Nile encephalitis. And as mosquitoes-borne diseases are getting more and more prevalent, and we're seeing West Nile cases erupting every summer, I think one's got to be, you know, very cognizant of the fact that this can occur. These patients should take precautions to prevent mosquito bites from occurring and not expose themselves to areas where they could be at risk for it. Unfortunately, there is no vaccine for it and no specific treatment for West Nile. So, all one can do is use prevention strategies for mosquito bites.  Dr Berkowitz: Yeah, I'm glad you mentioned that. I think the only really truly severe neuroinvasive cases I've seen of West Nile virus have indeed been in patients who were being treated with B-cell therapy. Not, if I'm remembering correctly, for immune-mediated disease, but for a lymphoma, so probably other confounding factors there. But yeah, it's a disease we learn about and think about, but I've only seen the most severe cases in patients who had abnormal immune systems, so I'm glad you flagged that. This has been a very helpful discussion, and I've learned a lot from you. I learned a lot from your article, just as I did when you were my attending some 20-something years ago on the wards when I was a medical student. So, it's good to continue learning from you through your writing and research, and today from getting to talk to you again. I encourage our readers to read your article and to bookmark those tables for when these considerations come up for your patients on these immunomodulatory therapies and you're wondering which infections to worry about and how to manage vaccines in this patient population. So again, today I've been interviewing Dr. Avi Nath about his article on vaccine considerations and infection risk in multiple sclerosis and related disorders, which he wrote with Dr. Amit Bar-Or. This article appears in the April 2026 Continuum issue on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues, and thank you again to our listeners for joining today.  Dr Nath: Thank you so much, Aaron, for that wonderful interview, and I'm extremely proud of all your accomplishments over the last 20 years. You've done an amazing job, and it was such a pleasure to see you and to be able to do this interview with you. Thank you again.  Dr Berkowitz: Thanks. That means a lot. I never would have imagined- we won't say 20, how many, but 20-something years ago as the medical student looking up to you and all your expertise on these infections and all of your research that led to so much of our understanding on these, that I would find myself interviewing you two decades later. So, for all the students listening, you never know where you'll end up, but I appreciate your very kind words.  Dr Nath: That's what we hope for all our students. Thank you so much.  Dr Berkowitz: Thanks again.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

What happens when you experience MS symptoms, but don't yet have a diagnosis? In this episode of Living Well with MS, we hear from Maureen Haith, who first experienced neurological symptoms in 2002 but wasn't diagnosed with multiple sclerosis until 2019. Along the way, she was told she had clinically isolated syndrome (CIS) – a term many people are unfamiliar with, but which can be an early stage of MS. Maureen shares her experience of recognising early symptoms, navigating uncertainty, and deciding when and how to tell others about her condition. She also reflects on how discovering the Overcoming MS programme influenced her lifestyle, from diet and exercise to building community through local support groups. This is a thoughtful and reassuring conversation for anyone facing MS diagnosis uncertainty, exploring practical ways to take control and make sustainable lifestyle changes over time. Watch this episode on YouTube. Keep reading for the topics, timestamps, and our guest's bio.   02:02 First MS symptoms: fatigue, tingling and early warning signs 03:49 New symptoms appear: changes in walking and sensation 04:55 What is clinically isolated syndrome (CIS) and why it matters 07:38 Deciding when and how to share an MS diagnosis 11:37 MS risk and family: understanding genetics and environment 14:23 Discovering Overcoming MS and making lifestyle changes 16:35 Finding support: building connection through local MS circles 20:19 Following the MS diet while travelling and eating out 26:03 Managing weight on a whole food plant-based diet 29:29 Coping with brain fog: practical tools that help 31:33 Advice for newly diagnosed: start small and build gradually Read all of the Overcoming MS books Find plant-based restaurants on the Happy Cow website Check out the Chef Cards for eating in a restaurant New to Overcoming MS? Learn why lifestyle matters in MS - begin your journey at our 'Get started' page Connect with others following Overcoming MS on the Live Well Hub Visit the Overcoming MS website Follow us on social media: Facebook Instagram YouTube Pinterest Don't miss out: Subscribe to this podcast and never miss an episode. Listen to our archive of Living Well with MS here. Make sure you sign up to our newsletter to hear our latest tips and news about living a full and happy life with MS. Support us: If you enjoy this podcast and want to help us continue creating future podcasts, please leave a donation here. Feel free to share your comments and suggestions for future guests and episode topics by emailing podcast@overcomingms.org. If you like Living Well with MS, please leave a 5-star review.

What if all the mistakes you've made, the shame you've carried and the terrible way you have treated yourself, are all part of the journey back to who you truly are. My ex-husband always used to say, "Sometimes we have to go to the wrong place to get to the right place” and he was right. And no, the irony is not lost on me ;)  The newest episode of Heal with Kelly is near and dear to my heart because I sit down with my beautiful friend Jamie Lynn Sigler — beloved for her role as Meadow Soprano in HBO's The Soprano's.  We dive into her powerful new book out this week called  And So It Is... A Memoir of Acceptance and Hope. Jamie is incredibly brave and raw in her writing.  She shares with radical honesty and humility and her story rocked me to my core while lighting me up with hope and compassion.  Jamie has lived with Multiple Sclerosis (and Lyme) for 25 years. For most of that time, she hid it — from directors, from co-stars, from the world. Before her diagnosis, she hid an eating disorder and a suffocating shame that wasn't even hers.  She shares what those years of silence cost her, and how finally telling the truth, the most courageous act one can do, actually set her free.  I cried so many times reading Jamie's new book. I saw myself in so much of her story and her journey is truly gripping, heartbreaking, and full of miracles. I could not recommend this book more.   In this episode we go deep on the inner voice that intends to protect us but turns out to be far more harmful than any external enemy. We discuss the way shame cripples our sense of worth and what it actually looks like to stop performing and start living. Jamie opens up about her son Beau's near-death experience — and the message he brought back that became her lighthouse. She shares the moment she fell to her knees in a hospital hallway and felt, for the first time, that she was not alone. And she talks about what it means to finally walk into a room and say: this is how I move. This is who I am.   This conversation is about surrender and breakthrough, plant medicine and prayer, generational healing and the stories we carry in our bodies. It's a reminder that healing is never about fixing what's broken — it's about remembering who you are beneath everything you've been told to hide. Key Moments You'll Love ✨ :

There are many treatment options for people with relapsing MS. Patients should be carefully monitored to assess treatment response, and a change in treatment approach should be considered if safety concerns emerge. In this episode, Teshamae Monteith, MD, FAAN, speaks with Ellen M. Mowry, MD, MCR, and Daniel Ontaneda, MD, PhD, coauthors of the article "Treatment of Multiple Sclerosis" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Mowry is the director of the Multiple Sclerosis Experimental Therapeutics Program and a professor of neurology at The Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Ontaneda is the director of research at the Mellen Center for Multiple Sclerosis and a professor of neurology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, Ohio. Additional Resources Read the article: Treatment of Multiple Sclerosis Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @EllenMowryMD Full episode transcript available here Dr. Monteith: There are so many new treatment strategies for multiple sclerosis, which is a blessing, but it does come with the complexity of really just trying to nail down the approach. I just got finished talking to Drs Ellen Mowry and Daniel Ontaneda about their article on treatment of multiple sclerosis. We discussed relapses, weighing escalation versus early high-effective treatment and progressive disease. This is a must-listen-to podcast. I hope you enjoy it as much as I enjoyed talking to them.  Dr. Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr. Monteith: This is Dr. Teshamae Monteith. Today, I'm interviewing Ds Ellen Mowry and Daniel Ontaneda about their article on treatment of multiple sclerosis, which they wrote with Dr. Darin Okuda. This article appears in the April 2026 Continuum issue on multiple sclerosis. Welcome, both of you. How are you?  Dr. Mowry: Great. And thank you so much for having us.  Dr. Monteith: Absolutely. So, why don't you both introduce yourself?  Dr. Ontaneda: All right. My name is Daniel Ontaneda. I'm a neurologist at the Cleveland Clinic. I spend the majority of my time doing research, but I still dedicate about a day a week to seeing people with MS in clinic.  Dr. Mowry: I'm Ellen Mowry. I'm also a neurologist, but practice at the Johns Hopkins University. And similar to Dan, I mostly work on research, but also have an active clinical care component, taking care of people with MS.  Dr. Monteith: Well, thank both of you for writing this article and being on our podcast. I assume you guys have probably known each other for quite a while now.  Dr. Mowry: Yes. Dr. Ontaneda: Yes. Dr. Monteith: What inspired you to get into multiple sclerosis research and then clinical care?  Dr. Ontaneda: I always loved neurology, and I think a lot of us who go into neurology are attracted to the complexity of the human brain and how the nervous system works. But what really hit home to me was a family member of mine who had multiple sclerosis, and he was being treated in a time where we really didn't have super effective disease-modifying medications. And so, as I went through my medical career, I always kind of kept an eye on what was happening with multiple sclerosis, and I started my training at a time where it was really flourishing in terms of the medications available, so that's what inspired me to go into MS. It's a disease that we can definitely treat, and you can change outcomes for people. So, that was it.  Dr. Monteith: Yeah, that personal experience can be very impactful.  Dr. Mowry: My journey started, actually, because I was thinking about whether I wanted to be a physician at all, and I happened to land, just after high school, a position with a neurologist who happened to mostly focus on multiple sclerosis and taking care of folks with multiple sclerosis. And by the end of the summer, I knew I wanted to go to med school and I wanted to be a neurologist and I wanted to work with people with MS. I thought I would be a clinician exclusively, but I think as time went on and I started to hear the consistent questions that people I served were asking in the clinic and realizing that those questions could be turned into research projects that could address their concerns, I moved more and more towards research. Dr. Monteith: Great. There are a lot of really detailed information in the article, so I think that research mind is very useful, and I see that in the writing. Why don't we talk about the goal of the article? Dr. Ontaneda: So, I think the goal of the article was to set out kind of what the large view of what treatment for multiple sclerosis looks like. And, you know, many times we divide the treatment of multiple sclerosis into these large pillars, and I think that's what we did in the article. The first was, you know, what do you do with a person who has an MS attack or relapse? The second is, what medications do we use to treat the relapsing forms of multiple sclerosis where there is a lot of acute inflammation, focal inflammatory lesions that are occurring? And then the final one is, what do you do with individuals who have a more progressive form of the disease where they're accruing disability slowly and gradually? Dr. Monteith: And what were some of the main points? Dr. Mowry: Dr. Okuda provided a really nice section on the treatment of acute relapses in multiple sclerosis, and it's important to understand what we talk about when we are saying "relapse". For people with MS, many symptoms can fluctuate and occur and then get better over time, and sometimes people with MS use the same term of "relapse" to describe those symptom fluctuations. As neurologists, when we're thinking about relapse, we're really trying to think about symptoms that can be attributed to new focal inflammatory events somewhere in the central nervous system. Typically, these are accompanied---if you were to get an MRI at the same time---by a new lesion or MS spot, as I like to call them, on MRI scan. And so, it's important to distinguish when somebody is talking about symptoms, whether they are true new symptoms that could be mapped to a place in the central nervous system. Because alternatively, a lot of people who've had attacks or relapses in the past can have what we call pseudo-relapses, and these are essentially recrudescence of old symptoms, typically in a similar pattern as what had occurred in the past. And these can be brought out by things like fever or infection, sometimes stress. And pseudo-relapses are not thought to be due to new development of immune system-induced injury and therefore would be less likely to respond to treatment; and in fact, treatment may be contraindicated for those events. We also talked a little bit in that article about how relapses are treated, talking about the use of high-dose steroids for true new relapses, but also kind of cautioning that those are not necessarily free of concerns, especially if you have a pseudo-relapse or there could be an infection going on. And that ultimately, the decision as to whether to treat a relapse really is a shared decision-making because it's thought that although the steroids can speed up recovery from a relapse, they may not have a major impact on ultimate recovery. And so, a lot of the shared decision-making comes in here because for a mild relapse, you might choose to forego a course of high-dose steroids.  Dr. Monteith: Daniel, any other main points?  Dr. Ontaneda: Yeah. On the side of treating relapses, I think one of the other things that probably has changed a lot, at least during the course of my training, is that in the past, whenever we had identified a relapse, as Dr. Mowry has clearly defined, we would typically treat with intravenous high-dose corticosteroids, typically with methylprednisolone. And that was kind of our go-to. We would either do it in an infusion center or we would set it up with home care. And I think one of the things that our field learned over, I would say, the last five or ten years is there's an abundance of studies that show that you can give that same dose of methylprednisolone. Rather than giving it IV, you can give it orally. No pun intended, as I tell my patients, a lot of pills to swallow because we use fifty-milligram prednisone pills, and they have to take 1,250 a day. The pharmacy always pushes back on that many pills, but really the advantage of being able to take steroids orally that way for three to five days is really, I think, one, better for people with MS because they can do it in the comfort of their own home, and two, I think also when you look at the costs associated with that treatment, it is the most cost-effective option. Dr. Monteith: And what are some of the latest developments that you're really excited about that weren't in the article?  Dr. Mowry: A lot of the article focused on the approach to treatment of people with what we've traditionally called relapsing/remitting multiple sclerosis. So, this is the kind of MS that traditionally presents with a relapse or an attack initially, although some of that nomenclature is changing, actually. And the article focused a lot on the strategies surrounding treatment of somebody with newly diagnosed relapsing MS, and thinking about this vast number of disease-modifying therapies that are available to people with MS and their clinicians, and how to think about the strategy with respect to largely centered around the efficacy class of the medication, whether people should take an approach of using a higher-efficacy therapy---meaning a medicine that in clinical trials was more likely on average to suppress relapses as well as new lesions---or whether there's still a good argument for the case of using an escalation approach, using some of the more modest efficacy medications that also probably in general have lower risks, monitoring for response to treatment and changing if the medication isn't working. And so, there's still a lot of debate in the field, I would say, even though many people have moved towards a one-size-fits-all kind of approach. I think there's still a lot of debate in the field about the evidence underlying that. And, you know, full disclosure, Dr. Ontaneda and I are each running parallel and very complementary clinical trial programs to address this very question, the results of which should be available within the next year, year and a half.  Dr. Monteith: Well, we can't wait that long. Give me some clinical pearls to how we initiate these modifying therapies. Like, what are the pearls that we need to have in our mind?  Dr. Ontaneda: Yeah. I think when we think about starting the disease-modifying therapy in an individual who has an active form of multiple sclerosis, I think, you know, one of the cornerstones I would say of making that decision is shared decision-making. I think we tend to sit down with the patient and analyze the data that we have at hand, what we know about their multiple sclerosis, and we use several factors to inform how likely we think their disease is gonna be active or potentially might not respond to the initial treatment you give. And we look heavily at the MRI. The MRI is really a useful marker because it shows us, one, how many lesions a person might have---both, you know, where those lesions are and also kind of the amount of lesions. Lesions, certainly, that are in the spinal cord, a very large burden of diseases. A lot of active lesions, which we determine by the presence of contrast-enhancing lesions, really helps us inform on disease severity. I would say that was our number one tool that we use to decide and help us decide how we think that person's MS is gonna do over time. And then the second thing that we put into the equation also is, you know, how well do we think this person is going to tolerate our medications? All our disease-modifying medications act through suppression of the immune system, and we know that that carries some risks associated with it. Some of those risks are stuff like infections. Some of those can be simple infections that really don't have major consequences, but some of them can be quite serious, including the need for hospitalizations or prolonged antibiotic treatment courses. And so, we also look at what, you know, the underlying risk of a person has for infection. This kind of is determined by, one, A, how many infections they've had up to date, and also how much disability they had. I would say in our average patient who when we see them, they're probably typically pretty young, in their twenties, thirties, forties, they typically don't have a lot of infectious risks. And therefore, I think there's kind of a move to saying, "Well, actually their risk of infections is quite low." And we put that together with, you know, also what the preference of the patient might want. So, do they prefer to take a pill, for example? Do they prefer a medication where they receive that via infusion every six months and they don't really have to think about it? There are some people that don't like going into a hospital, and they might prefer an injection type of those medications. And so, after a complex discussion of all those factors, we take into consideration how much risk the patient wants to take as well, and we come up with a rational choice of a couple of medication options. So, I think it's challenging sometimes because we have over two dozen medications. There's the risk of you saying, "There are these twenty-four medications, you can pick one." And I think our job as neurologists is to kind of pare those down, talk about, in a person like yourself, these are the two or three medications that I would recommend using. Why don't you review them? And then we bring them back, and we kind of make a final decision with, one of the key factors that I think is important to remind people is that you're gonna start this medication, and we are gonna monitor to make sure it's working. We're gonna monitor to make sure you're tolerating it well. And although it's an important, the first decision you make, I think one key theme that we tell people is, we can revise our strategy whenever we like. We just have to think about it and do it in a way that we think is gonna make sure that their MS is under the best control. And then we think about the ultimate goal of treatment, which, in multiple sclerosis, is the absence of any attacks and also the absence of any new lesions on MRI. And that's where whether you are offering more of the high-effective medications or more moderate- or low-efficacy medications, that's where there's a little bit of controversy still in our field, and that's what our trials are trying to answer.  Dr. Monteith: Excellent. So now we've selected a particular option- and I love those points with shared decision-making, using the MRI to guide and then kind of risk tolerance related to infection. But now a patient's still having relapses, and I know the goal is zero, but, you know, there's some margin. What are the pearls to advance to more high-efficacy therapies?  Dr. Mowry: Yeah, that's a great question. Dr. Ontaneda in the article actually talked about the literature surrounding monitoring for breakthrough disease and when to say this much is too much, and there's actually not a definite right answer. It's clear that more active disease early in the course is probably more of concern than, say, developing, you know, a new spot in your fifties or something to that effect. So, different people have different thresholds. I know at our center, we tend to be pretty on top of making changes for breakthrough disease. So, what we typically do is reimage people about six months after they start a medication to establish a new baseline. And sometimes, because of delays in starting or because the medications take a while to kick in, there might be a new spot or two. So, if that's the case, I really only get concerned if the spots are also taking up the dye or enhancing to indicate they're really quite recent, and I think, "Ugh, that's not something I'd like to see six months after starting a medication." And so that otherwise is sort of the reference scan, moving forward, to evaluate the medication, and I have a very low threshold for changing, particularly if somebody is on a moderate-efficacy therapy. To me, I think, well, our goal of trying the moderate efficacy therapy is essentially to see if we could get away with a medicine that is probably, on average, safer and that will still work for your MS. But if the answer is no, I personally don't like to stick around too much on them. One caveat I would say is that if somebody develops what appears to be a new lesion or spot on higher-efficacy therapy, before presuming that that new area of activity is a definite new MS event, I always like to rethink carefully, did I get the diagnosis correct? Or could this be an early infection such as, you know, progressive multifocal leukoencephalopathy in people on natalizumab in particular? Because I see breakthrough activity so rarely in people on higher-efficacy therapies that I just like to rethink my diagnosis and the differential prior to making switches to, typically, another higher-efficacy therapy in that case. But that, again, is a little bit of shared decision-making. It's sometimes contextual. If a person is using a self-administered medication and they have a little breakthrough, sometimes you can solicit some history, saying, "Oh, I actually kind of stopped taking it for a few weeks because something was going on, and I really want to retry." And that's very reasonable as well. Dan, do you have any other thoughts?  Dr. Ontaneda: No, I think I agree. That's really close to how I practice myself as well, and the majority of people at my center. I think that we are learning that when you start a treatment, many times---depending on how deeply you look---you can find evidence of ongoing disease, and that's something that we struggle with. It's almost like we have tools to treat inflammation in terms of new MS lesions and new relapses. And so, when those are present, it's pretty clear that you probably have to switch medication. I think a slightly trickier issue is when, for example, you have a person who might be stable. They don't have an attack. But you notice that they're worsening, and they tell you they're worsening. I think our ability and tools for that is a little bit harder, and we recognize that that can actually happen fairly early in the disease. And that's why we're trying to rethink this mantra that we've had for many years, where we kind of divide MS up into relapsing and progressive, and we see people develop progressive MS 10 to 15 years after they've had a relapsing form of the disease. So, I think that's just a reality of clinical practice. And we don't have as many tools to treat that gradual worsening, which is kind of what the rest of our article spent some time talking about. Dr. Monteith: You've also written about the clinical trial long-term extension studies. And what are the few points that you take away from the emergence of these types of publications over the past few years? Dr. Mowry: Yeah, well, long-term extension studies can be really helpful to understand whether the findings that are evidenced during the randomized portion of trials themselves continue into a longer term. And for people with MS, understanding these data can be really helpful because, particularly when we're looking for impact of a given treatment or a strategy on disability worsening, often it takes longer than the short-term portion of the trial to truly understand if the medication or strategy has an impact on insidious worsening that Dan is speaking about. Many trials have demonstrated a short-term benefit, but we think a lot of times that benefit is probably because of the reduction in relapses, which sometimes leave a permanent mark on neurologic function. But the extension studies are trying to understand a little bit more about whether the effect on disability worsening is sustained, and also to look a little bit more deeply at long-term safety, especially when it comes to medications that do increase the risk of infection. The caveats, though, in interpreting those types of studies are that people drop out, and so probably the people who drop out of those studies are really different. They may be either less disabled and they think, "Oh, you know, I'm done. I feel good." Or potentially more disabled and they think, "Ugh, I have more things to do I've got to take care of. What's going on?" And so that kind of dropout can produce some bias in interpreting the results. Dan, any other thoughts?  Dr. Ontaneda: No, I think that's spot on. I mean, I think that when we're trying to decide on what general philosophy to use, right? Like, you're seeing a patient for the first time. They've recently been diagnosed with MS, and you have... you know, I kind of bin them into three options. You can start a low-efficacy, a moderate, or a high-efficacy medication. And the first piece of information you could use is clinical trials, and Dr Mowry very clearly identified why some of that data might be a little bit biased and isn't, you know, completely applicable to the patient who's in front of you. The second thing that we might look at is observational data, and there's a wealth of observational data that shows that, in general, people on higher-efficacy medications tend to do better over time. But one of the challenges we have is that there's always biases related to those observational study designs. And so, I think you have to interpret them with a little bit of caution because there are reasons people start specific medications in people. And when you look at them in a purely observational study, even if you do some fancy way of addressing those biases, such as propensity, there always is the possibility of some residual bias. You know, that's part of the reason why we're doing the trials that Dr Mowry described, because we really need kind of long-term evidence to show that these medications actually can affect disability ten, twelve years after started. And I think pragmatic clinical trials, like the ones we're running, are really gonna be the key to answer those questions. We all have our favorite approaches right now, but I think that the data to actually demonstrate what's best for people with MS is really needed.  Dr. Monteith: Great, and there's so much in this article. I mean, we didn't even touch on radiological isolated syndrome, monitoring MS therapeutically, and treatment of progressive MS. Any final take-home points?  Dr. Ontaneda: Yeah. Maybe I will touch a little bit on the side of progressive MS, because it has been, you know, the MS that we historically have not been able to treat as much. So, we described there's over two dozen therapies approved for relapsing forms of MS. For purely progressive forms of MS that don't have any evidence of activity, we really only have one approved therapy, and it appears that that therapy actually does work through active inflammation anyway. And in the article, we highlighted examples of studies that have been negative, but also some recent examples of studies that have been positive, specifically with a new class of medication called BTKI, or Bruton tyrosine kinase inhibitors. We just recently heard of a second molecule that also had positive results in this realm. So, we're excited that, you know, in the next four to five years-  Dr. Monteith: I'm sorry. Can you just go ahead and say what that molecule...You're leaving people hanging.  Dr. Ontaneda: One molecule is tolebrutinib, which already has a positive study in secondary progressive MS in individuals without activity. And then the second compound that has been studied with positive trial results, we only have summary results from that, is a medication called fenobrutinib. And we think these two compounds that are part of a single class, the hope is that maybe they can address some of that gradual worsening that occurs in MS. And then the question comes whether we should use those from the get-go or if we should just use them later. So, a whole sort of variety of different questions. But I think important to call out for clinicians that this area where we had no available treatments for so many years might be changing.  Dr. Monteith: Well, thank you both. I really loved this conversation. I learned a lot listening to both of you, and I look forward to your clinical trial results.  Dr. Mowry: Thank you so much for having us. Dr. Ontaneda: Thanks so much. It was our pleasure. Dr. Monteith: Again, today I've been interviewing Doctors Ellen Mowry and Daniel Ontaneda about their article on treatment of multiple sclerosis, which they wrote with Dr. Darin Okuda. This article appears in the April 2026 Continuum issue on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr. Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

“Is it ever enough… or are we always waiting for the next breakthrough, the next voice, the next reason to hope?” We found ourselves in an unexpected place for this episode: talking about Multiple Sclerosis (MS) through the lens of the NFL Draft. Of course, the #1 overall draft pick and Heisman Trophy winner Fernando Mendoza was making lots of headlines, but the stories went way beyond his leadership on the football field. Mendoza also was gaining attention for championing efforts to raise awareness and funding for research to end MS, the disease which his mom, Elsa, has lived with since 2008. So when a high-profile moment shines a spotlight on MS, whether it's with the #1 NFL draft pick or a celebrity diagnosis, it raises a bigger question: What do we actually want from that attention? Visibility definitely opens the doors for MS advocacy and research, but it can also create comparisons that don't reflect the reality of living with MS. As with everything in MS, there is more than one answer. In this episode, we explore the complicated mix of MS awareness, expectations, frustration, and hope that comes with seeing Multiple Sclerosis represented in the public eye and across media. We talk about: The impact of celebrity MS stories on awareness and perception Why increased visibility doesn't always lead to a cure for MS How different voices shape the narrative around chronic illness and disability Why “control what you can control” matters when living with MS We also reflect on how far the MS community has come—from just a few disease-modifying therapies to more than two dozen today—and why, even with that progress, it still can feel like we're waiting. Here are the links that offer further insights into our conversation: Listen to the MeSsy podcast with Christina Applegate and Jamie-Lynn Sigler Learn more about our Walk MS team, Team MonsterS, and how you can support us Check out the powerful video from Max the Dollar Kid and consider making your $1 donation *** We'd love to hear from you What do you expect when celebrities or public figures talk about MS? Share your thoughts in the comments or email us at acoupletakesonms@gmail.com. Remember to rate, review, and subscribe to A Couple Takes on MS Podcast for two insightful perspectives on this one multifaceted disease

Why does healthcare suddenly feel more expensive at the beginning of the year?In this episode of Brain Chat, Dr. Mitzi sits down with , Patient Billing Expert ,Carol Coleman from Joi Life Wellness Group to break down what patients need to know about insurance resets, deductibles, and prior authorizations.They discuss why costs increase in January, common insurance misconceptions, and practical tips to help patients better navigate their coverage—especially for those managing chronic conditions like Multiple Sclerosis.Subscribe for more conversations on brain health, patient education, and navigating neurological care.

In this episode, we sit down with Grammy-winning singer/songwriter Chad King, one half of the hit-making duo, A Great Big World. While millions know him for the global anthem "Say Something," few realize that Chad's journey to the stage has been defined by a quiet, parallel battle with Multiple Sclerosis. Chad opens up about the day his world changed with an MS diagnosis and how he transformed fear into a catalyst for intentional living. We dive into the physical realities of touring with a chronic illness—from the specific accommodations he makes to protect his voice and energy to the ways he's adapted his performance style. Above all, his legendary optimism shines through as he discusses why he believes a diagnosis doesn't have to be an ending, but a new way to sing.  Chad shares the physical symptoms he first noticed and why he urges everyone—no matter how busy their career—to stop ignoring the "small" things before they become big problems. It is a conversation filled with kindness, humor, and  infectious positivity – a vital reminder that your health is your most important instrument. This episode is a  masterclass in resilience, kindness and finding joy in every moment! Also – Don't miss Chad's most personal work in his new solo EP—a project born directly from the pages of his private journals! To listen to Chad's new album: The Road Ahead - click here Follow Chad on Instagram: @itsmechadking Follow Chad on Facebook: Chad King Follow A Great Big World on Instagram: @agreatbigworld Follow us on Instagram: @every.body.talks @jenngiamo @schully Subscribe to our YouTube channel! Don't forget to subscribe to the podcast for free wherever you're listening. Apple Podcasts Spotify Be sure to leave a 5 star rating! It really helps grow the show. If you like the show, telling a friend about it would be amazing!

Although rare, recognizing NMOSD is crucial for improving patient outcomes through correct diagnostic and treatment approaches. Reports of atypical forms and increasing knowledge of clinical, imaging, and laboratory-specific features are fundamental for the accurate recognition of this condition. Research on targeted therapies and biomarkers measuring and predicting disease activity will improve NMOSD management. In this episode, Gordon Smith, MD, FAAN, speaks with Sara Mariotto, MD, PhD, coauthor of the article "Neuromyelitis Optica Spectrum Disorder" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Mariotto is a neurologist in the Neurology Unit in the Department of Neurosciences, Biomedicine, and Movement Sciences at the University of Verona in Verona, Italy. Additional Resources Read the article: Neuromyelitis Optica Spectrum Disorder Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @GordonSmithMD Full episode transcript available here Dr Smith: Neurology is an increasingly therapeutic specialty, and across many of our subspecialty areas, lots of new drugs are being approved. Are you interested in learning more about a historically disabling disorder for which we now have a spectrum of new therapies that, if used appropriately and promptly in the right clinical situation, promise to dramatically improve patient outcomes? If so, keep listening. My name's Dr Gordon Smith. Today I'll be talking with Dr Sara Mariotto about her article on neuromyelitis optica spectrum disorder or NMOSD, which she wrote with Dr Romain Marignier. This article appears in the April 2026 Continuum issue on multiple sclerosis.  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Smith: This is Dr Gordon Smith. Today, I'm interviewing Dr Sara Mariotto about her article on neuromyelitis optica spectrum disorder or NMOSD, which she wrote with Dr Romain Marignier. This article appears in the April 2026 Continuum issue on multiple sclerosis. Sara, welcome to the podcast, and maybe you can start by introducing yourself to our audience.  Dr Mariotto: Yes. Thanks, Gordon. I'm Sara Mariotto. I'm a neurologist, and I work at the Neurology Unit, University of Verona, where I do both clinical diagnosis and research into neuroimmunology---so, in particular, autoimmune encephalitis, NMOSD, and MOGAD.  Dr Smith: Well, this is a super exciting area. Whenever I hear about NMOSD, I think of one specific patient I had, and I always think of her when I come across something like your article, which is really fantastic. So, before we dive into the details, I wonder if maybe you can just explain to our listeners who aren't up to speed on what NMOSD is, what the disorder is, and maybe why it's so important that all of our listeners learn how to recognize it quickly and get people started on therapy.  Dr Mariotto: Yes, sure. So, neuromyelitis optica is an inflammatory autoimmune CNS disorder usually associated with aquaporin-4 antibodies, although there are a few cases, around 10%, who can be antibody-negative. And I think it's very much important to have in mind this disease and recognize it because it can be severe, as you pointed out; can present with very severe optic neuritis, myelitis, the brain stem, or area postrema syndrome. So, it can be really severe, affect quite young people around 40 years of age---although it can affect also the pediatric population and elderly people---and, importantly, it can be treated. It's very much important to treat this patient in the acute stage very quickly with steroids or plasma exchange in addition, and then to start a chronic treatment. So, we have treatment for this condition. So, it's very much important to, to recognize it quickly and treat the patient properly.  Dr Smith: So, I wonder if we can talk a little bit about the diagnostic criteria and boundaries of NMOSD, right? So, someone who comes in with bilateral op- severe long segment optic neuritis or long segment myelitis, we think about it. But what are the boundaries? Should we be looking for this, for instance, in someone who comes in with a unilateral optic neuritis or looks like typical multiple sclerosis? Is it important to get aquaporin-4 antibodies in those patients? What do the diagnostic criteria say about this?  Dr Mariotto: So, I wouldn't test aquaporin-4 antibodies in all patients with demyelinating conditions because although aquaporin-4 antibody assay is very specific, as for all assay and all antibody testing---also for MOG antibodies, for example---some false positive results can come out. So, I would suggest to test aquaporin-4 antibodies not in typical MS cases but in those who could be suggestive for not being MS, so in all those cases with atypical optic neuritis and myelitis or other syndromes. For those cases, it's important to test aquaporin-4 antibodies, but I wouldn't test them in all typical, classical MS cases. As I said, it's quite specific, the assay, so it's uncommon to have false positive results, but it can be.  Dr Smith: Serum, CSF, both?  Dr Mariotto: So, for aquaporin-4 antibodies, they're usually present in serum. They can be positive also in the CSF. And there are a few reports of isolated CSF positivity. But if we analyze larger samples volume, then it becomes clear that isolated CSF positivity is so, so rare that it's not recommended to test them in the CSF when serum is negative. So, for aquaporin-4 antibodies, the recommended matrix of testing is serum, which is different for MOG, which is not the topic of our article but is important to mention because MOG antibodies should be tested in serum and CSF. But aquaporin-4, I would recommend to test serum.  Dr Smith: What are the boundaries between MOGAD and NMOSD? And you talked about the differential testing of antibodies, which I was going to ask about. But when should we think of NMOSD relative to MOG? Dr Mariotto: Yeah. There are aspects which are the one mentioned in the criteria, highly suggestive for NMOSD. But the clinical spectrum can be similar to that of MOGAD. Usually, although there are some clinical aspect---like, for example cortical encephalitis or ADEM, which is more typical for MOGAD, or others like area postrema syndrome, which are more typical of NMOSD. The spectrum can be similar among the two conditions, so that's why in our clinical experience, usually they ask both aquaporin-4 and MOG antibodies in patients. It's- for experts, it can be easy to differentiate the two conditions, but for nonexperts can not be so easy.  Dr Smith: Can you define area postrema syndrome? I think not all of our listeners see that every day.  Dr Mariotto: Yeah, sure. This is a syndrome which is highly suggestive of NMOSD. That's why I mention it. And it's characterized by nausea, vomiting, hiccups are known as the syndrome. And it is very, very suggestive because of the expression of aquaporin-4 in that area of NMOSD. That's why I strongly recommend for all patients who comes out to have this syndrome to test for aquaporin-4 antibodies. MOGAD is hardly ever positive for that, so I think that whenever you see a patient with that syndrome, you should think about NMOSD.  Dr Smith: I'm just curious, aquaporin-4 is a water channel, which is kind of an interesting concept. Our conversation, I really want to make sure we give clinically important information to folks, but it's so curious to me at least, how does this actually result in a inflammatory demyelinating syndrome? For a simple neuromuscular guy, what's the immunopathogenesis of this?  Dr Mariotto: Yeah, the immunopathogenesis is quite complicated, as in all CNS disorders. And of course, aquaporin-4 antibodies are the main focus, but they are not the only one. As you said, aquaporin-4 antibodies have a target, this water channel, which is at the basis of the disease, and they are produced by the interplay between T cells, B cells, and plasma cells. But then also eosinophils, macrophages, cytokines, and chemokines are involved, enter the CNS, and then another important component is complement, which is highly activated in this disease. At the end, we have astrocyte damage because astrocytes are the main target of the disease, but also axon and myelin are involved. So, it's a quite complex pathogenesis based on the antibodies, but not only on that.  Dr Smith: And this will become important when we start talking about treatment. There seems to be a recurring theme of long segment demyelination, right? Optic neuritis is typically a large percentage of the length of the optic nerve, and obviously the myelitis se- more than three segments. Do you see other long segment areas of CNS demyelination, corpus callosum or things like that? Any ideas why that is, if that's true?  Dr Mariotto: Of note, this is quite interesting because usually when we have NMOSD, we have a longitudinal involvement, especially of the optic nerve and spinal cord, while brain lesions are quite different. Like, we usually do not have the typical Dawsen fingers-like lesions that we have in MS, for example, or the classical periventricular or subcortical extensive lesions that we can see and we have in mind when we think about MS. In some cases with NMOSD, the brain is completely negative, so we do not see anything. And Dawsen lesion's quite suggestive of NMOSD. So, you're right. I mean, this is related partially to the expression of aquaporin-4, and that's why we have this typical involvement also for area postrema, for example, and maybe also our other examples of clinical aspect that we can see in these conditions. But it's basically linked with the expression of aquaporin-4, which is the main target of the disease. And that's why usually the brain doesn't show so much involvement as we can see in MS, for example.  Dr Smith: I was actually really interested in some of the unusual manifestations or phenotypes, and I don't want to get into arcadia, really, but which of these should our listeners be familiar with that would really suggest that they should be thinking about NMOSD beyond the area postrema and other features that we've already talked about that are part of the core criteria?  Dr Mariotto: Yeah. I mean, I think that the encephalic syndromes or also ADEM, which is most typical of MOGAD but can be observed also in NMOSD or PRES, for example, are syndromes that can be considered in patients with NMOSD. There are the typical ones, which are the ones showed in the criteria, but whenever we have a brainstem involvement or, like, these encephalic syndromes or also PRES, we should think about NMOSD also.  Dr Smith: Another area I was interested in are red flags. In your article, you talk about red flags that might suggest an alternative diagnosis, right? And then this presumably is particularly important in seronegative patients, which 10% is not a reasonably high number, I suppose. What are red flags we should be thinking about for some other diagnosis?  Dr Mariotto: Yeah. I would here mention two very important red flags. The first one is a very hyperacute onset. Usually these conditions, these inflammatory conditions have a subacute onset, so whenever you have a very, very acute onset, you should think about something else. This can occur sometimes also in NMOSD, but hardly ever occur. Like, a very acute myelitis, the first thing we should think about is a vascular origin, for example, with a lot of pain and not about NMOSD, although sometimes the differential diagnosis is not so easy. The second thing is a progression independently of relapses, which hardly ever occur in NMOSD. Usually in NMOSD, we have the onset, and then we have a relapsing disease course. That's why we have to treat patients always and not to stop treatment. But we do not have progression in the meanwhile, while we can have, for example, this in MS. Same thing is for MOGAD. So, these are two things that I think is very much important to keep in mind.  Dr Smith: I want to pivot to talk about treatment because that's been super exciting. But rumor has it there are new diagnostic criteria coming for NMOSD in the next year. I bet you know a bit about those. Can you give our listeners any indication about kind of where the puck is going on this? Not so much what the criteria are specifically, but what sort of diagnostic challenges are the new criteria going to help us with once they come out?  Dr Mariotto: Yeah. So basically, we are working on that, so you will read them in the next future. This is the good point of the conversation on the new criteria. And we work a lot on the definition, on the new definition and nomenclature of NMOSD; on the definition of seronegative NMOSD, which is also quite tricky; and then on the assay we should use to test aquaporin-4 antibodies, and also on potentially new syndromes which should be included into the main feature of the disease. But hopefully you will read about this very soon.  Dr Smith: Looking forward to it. And Continuum Audio listeners, you heard it here first, so thank you. Let's pivot to treatment. This has been super exciting, and I wonder if the way to approach this is to start with acute management and then sort of chronic management. Would that make sense?  Dr Mariotto: Sure.  Dr Smith: Let's say I go on service on Friday, and I have a patient who comes in with positive aquaporin-4 and bilateral optic neuritis. What's the acute approach to managing that patient?  Dr Mariotto: So, the first approach is to administer intravenous steroids, but I would not wait to escalate to plasma exchange. There is quite good evidence that we should treat the patient with additional plasma exchange very quickly, and every day of delay of plasma exchange can cause increased disability. So, we should treat patients with steroids first, and then if we are not satisfied by the recovery, soon start with a plasma exchange. There is also some evidence, although less, for IVIG, but it's important to try to treat them very quickly, even if it's Friday, you know, there is the weekend and so on. But I think it's very much important to start with steroids after excluding other infectious causes or so on, and then to start quickly with plasma exchange. The main problem could be that we do not have the results of the antibody yet.  Dr Smith: Right. So, let me ask that question. You know, let's say my patient comes in on Friday, and clinical syndrome that really looks like NMOSD, and we're waiting for the aquaporin-4. There are many places where it's hard to get plasma exchange over weekends. And so, in that setting, are you better off doing the steroids over the weekend then PLEX on Monday, or should we just give IVIG because maybe it's as good as PLEX? What's your advice there? I'm trying to get ready for Friday because I know one's coming in.  Dr Mariotto: That's true, that's true. Usually they come on Friday or Saturday. I think it's acceptable to have three days of steroids and see how the patient improves, and then after three days to start with plasma exchange. Actually, we have a very good improvement if we start between three and five days after onset. So, I think waiting for three days is acceptable just because we can see if the steroids work properly or not, and then we can quickly start to plasma exchange. But I would not wait, like, 10 days, you know, before starting with a plasma exchange, and I would not wait for antibody results.  Dr Smith: Got it. Super helpful. And I'm actually not joking around, I learned recently that I have a reputation among our residents for having lots of optic neuritis when I'm on service, which I think is sort of karmic justice for being a peripheral nerve expert. But let me ask another question. So, let's say we do that, and the patient gets three or five days of pulse methylprednisolone and five courses of PLEX, and they're not doing well. Do you then just move right along into another agent B cell depletion therapy? I mean, what's your next step in escalation in the acute setting?  Dr Mariotto: I would for sure start to, as you said, with steroids, plasma exchange, and in case IVIG, and then quickly move to chronic treatment. And for patients who are not recovering well, I would think of something which has a quick effect so we can really start treating patients very quickly. There are different options. And all over the world, there are different rules for using immunosuppression in NMOSD. Like in Italy, for example, it's different from US or other countries, Germany, for example. There are different approved treatments and different rules of using them before or after rituximab, for example. We all know that there are treatments approved for NMOSD all over the world. But in some countries, like for example in Italy, we should use rituximab first, and then if it doesn't work, escalate to the approved treatment. I know in the US it's different. But anyway, for a patient who does not improve quickly, I would start with something which has a quick effect on the disease.  Dr Smith: And then rituximab versus inebilizumab, you know, CD20, CD19, what's your advice there? Is one preferable to the other, you know, if we have options to do either?  Dr Mariotto: Yeah. So, between rituximab and inebilizumab, we know that the target, well, is different, but is anyway B cells, so CD19 and CD20. With CD19, we can affect both plasma blast, plasma cells, and B cells. That's why the target is broader. And of note, this is an approved drug, while rituximab is, in most countries, used as off-label treatment.  Dr Smith: So inebilizumab would probably be preferable if we're able to do that.  Dr Mariotto: Unfortunately, there are not so many studies comparing rituximab with the approved drug, which is, of course, a pity, but that's the case. While we have clinical trials for all the approved drugs, and although the trials were designed differently, as we mentioned in the Continuum paper, we can argue something of the comparison between the approved drugs. But it is not so clear the comparison between rituximab and the new drugs, which is also something that we should work on.  Dr Smith: And then for chronic suppressive management, what other options are there?  Dr Mariotto: So, in addition to B cells, target can be interleukin-6, as we know with tocilizumab or satralizumab, and then complement with eculizumab. These drugs are both based on the pathogenesis of the disease. That's why we also discuss it in the paper, which shows a clear involvement of complement, and among cytokines of interleukin-6. So, targeting these made clear that could improve the disease quite well, and that's why they designed some clinical trials on these drugs, which are now approved, as we said, for NMOSD.  Dr Smith: Wow, so many options, and a lot of questions, but limited time. Let me just ask a couple of more. I see a lot of myasthenia patients, and there's a lot of variability, as you know, in patients with myasthenia, the extent to which complement is an important mechanism versus other, you know, important mechanisms. To what extent is response to a complement inhibitor kind of uniform across NMOSD? Or there's some patients who just don't respond to a complement inhibitor and others that respond really well. And then just, I'll just give my second question out is, you know, what about combination therapies for patients who have particularly challenging NMOSD?  Dr Mariotto: So usually these patients have a terrific response to complement inhibitors, and this is also shown by the clinical trials where we saw how eculizumab have a very impressive effect on the disease. And also, maybe this is also your experience, a very quick effect. So that's why there are also thoughts on using it in a very acute stage of the disease. That was what I was thinking about before. But then it has a very huge effect on complement, which is a major factor involved in the pathogenesis of NMOSD also in the chronic disease stage, and that's what also we see from clinical trials. Usually, we prefer to switch treatment from one to another and not to combine them. Of course, in very difficult cases, this can be considered, but the recommendation is to switch from one of these approved drugs to the other, or from rituximab to one of the approved drugs, and try to find out the best for our patient before combining them. Dr Smith: The complement inhibitor trials are breathtaking, at least for me. If I'm trying to convince students to go into neurology, I'll say, "Take a look at that paper," because anyone who claims that we're "diagnose and adios" is so wrong. It's so exciting. So, at a high level, this must have fundamentally changed outcomes for patients. I mean, it's still a difficult disease, but what is the kind of prognosis for that patient I described who comes in, gets the therapy you talked about? What does their long-term outcome look like in this modern therapeutic environment? Dr Mariotto: So, NMOSD is almost always a relapsing disease. That's why, as we mentioned, we have to treat patients always. But the prognosis changes a lot since we were also able to use all these drugs for the disease. So, the prognosis changes if we recognize it properly and early, and if we treat NMOSD properly with immunosuppressives. So, whatever we choose it's important to start it quickly, and this is the only way that we have to improve the prognosis of this disease. We have very active cases, but we have also cases who responds quite well to this immunosuppressive treatment, since now we have, as mentioned, these ones which are very impressive and show incredible results. So, the prognosis of the disease change in the last year, thanks also to the improvement of the diagnosis and of the treatment choices for the disease.  Dr Smith: I'm just... I- maybe my last question, you know, just at a personal level, not only for you as an expert who's caring for these patients, but in the patient community, this must have been a pretty exciting period of time, right? I mean, these, these drugs are coming fast and furious, and what a change. What's the kind of zeitgeist in the community, both your professional community and amongst the patient community about where we are? Dr Mariotto: Yeah, you're right. The last years were defined the years of NMOSD and also MOGAD because we had finally approved drugs which is relevant for all the disease that we treat and changed the landscape of the disease for clinicians, but also for patients. And we have more than one, as we said, so we have more options that we can also discuss with patients to try to choose the best one in terms of activity, but also route of administration or time. Some years ago, we just had rituximab, which is not approved in most of the countries, and now we have different approved drugs. And we improved the diagnosis of the disease thanks to the availability of live cell-based assay. And then we are working a lot also on biomarkers like GFAP, for example, which has been shown to be a very attractive biomarker able to mark disease activity and maybe also prognosis on this disease. So, you're right. I mean, in the last years, the landscape of NMOSD changed a lot.  Dr Smith: Sara, thank you so much for talking with me. I could keep going for another half an hour, but I would be in trouble with my editor, so I think we probably need to wrap it up. But thank you so much. This has been very informative.  Dr Mariotto: My pleasure. Dr Smith: Mine too. Thank you. Again, today I've been interviewing Dr Sara Mariotto about her article on NMOSD, which she wrote with Dr Romain Marignier. This article appears in the April 2026 issue of Continuum on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues, and thanks to you, our listeners, for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this episode of Beyond The Pain, Leigh Brandon speaks with Dayna Wylder about her transformative healing journey with multiple sclerosis and how it led her into the world of energy medicine, emotional healing, and higher consciousness.Together, they explore the deep connection between the mind, body, emotions, and energy field, and how symptoms may be messages from the subconscious rather than simply problems to suppress. Dayna shares insights into the five koshas, frequency healing, sound therapy, structured water, tapping, gratitude, and the importance of reconnecting with your higher self to support true healing.This conversation offers a thought-provoking perspective on chronic pain, autoimmunity, emotional patterns, subconscious beliefs, and spiritual healing.In this episode, we discuss:Dayna Wylder's healing journey with multiple sclerosisThe shift from physical medicine to information and energy medicineThe five koshas and the role of the bliss body in healingHow energetic imbalances may contribute to pain and illnessSymptoms as subconscious communication rather than random dysfunctionEmotional patterns, secondary gains, and their impact on healthSound therapy, structured water, tapping, and gratitude as healing toolsPurpose, surrender, stillness, and higher self-connection in recoveryFind Dayna Wylder:https://www.energyovermatter.comhttps://www.youtube.com/@energyovermatterConnect with Leigh:Beyond The Pain 14-Day Programme - https://bodychek.co.uk/beyond-the-pain-programme/Pain-Free Plate Free Guide - https://www.bodychek.co.uk/freepainguide/Consult with Leigh - https://www.bodychek.co.uk/consultation

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The annual meeting of the American Academy of Neurology is underway in Chicago this week, and one of the highlights is the presentation of the John Dystel Prize for Research in Multiple Sclerosis, awarded jointly by the National MS Society and the American Academy of Neurology. This year's winner of the Dystel Prize is Dr. Ludwig Kappos, a physician-scientist at the University Hospital Basel in Basel, Switzerland, and the director of the Research Center for Clinical Neuroimmunology and Neuroscience Basel. Dr. Kappos has played a major role in how clinical trials in MS are conducted. He helped establish the Expanded Disability Status Scale, or EDSS, which is the gold standard for measuring disability in people with MS, and Dr. Kappos and his team have advanced our current understanding of a key driver of disability in MS, known as progression independent of relapse activity, or PIRA.  Dr. Kappos will be delivering the Dystel Prize lecture at the American Academy of Neurology meeting this week, and he's joining us to share a preview of that lecture in a conversation you won't want to miss. We're also sharing news about a blood test used to monitor MS disease activity that has just been approved by the European Union. We'll give you the details of a study focused on whether disease-modifying therapies can impact neurodevelopmental birth defects in children born to mothers with MS. We'll explain why yaks and Tibetan antelope may have opened a door to neuroprotection and myelin repair for people living with MS. And we'll tell you where healthcare providers and patients may differ when it comes to defining high-quality MS care. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: The John Dystel Prize for Multiple Sclerosis Research is awarded  :22 A blood test to monitor MS disease activity is approved by the EU  2:28 Researchers determine whether disease-modifying therapies have an impact on neurodevelopmental birth defects among children born to mothers with MS  4:21 Researchers studying yaks and Tibetan antelope may have uncovered a pathway to neuroprotection and even myelin repair  7:24 Healthcare providers and people living with MS share their perspectives on what needs improvement in delivering high-quality MS care  10:01 Dr. Ludwig Kappos reflects on how MS clinical trials need to change  13:33 Share this episode  30:58 Next week  31:19 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/451 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com STUDY: Association of Neurodevelopmental Disorders and Congenital Anomalies with Prenatal Multiple Sclerosis Treatment: Real World Historial Cohort Studyhttps://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.70235 STUDY: A Gain-of-Function Retstat Variant from High-Altitude Adaptation Promotes Myelination Via a Neuronal Dihydroretinoic Acid-RXR-Y Pathway https://www.cell.com/neuron/fulltext/S0896-6273(26)00013-9 ARTICLE: Areas for Improvement for High-Quality Multiple Sclerosis Care: Insights from Interviews with People with Multiple Sclerosis, Providers, and Clinical Educators https://sciencedirect.com/science/article/abs/pii/S1936657426000300 AbleNOW https://ablenow.com JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 451 Guest: Dr. Ludwig Kappos Privacy Policy

Elizabeth Roboz Einstein's life was shaped by the forces of history. She studied bioorganic chemistry at the University of Vienna in the 1920s and then left her home country of Hungary during World War II, before German troops invaded — practically a miracle for a single, Jewish woman. In the U.S., she blazed a trail in the brand new field of neurochemistry; her seminal research into multiple sclerosis (MS) unlocked key findings that would make effective medical treatments for MS possible.  Learn about your ad choices: dovetail.prx.org/ad-choices

What if the anxiety you most want to get rid of is the one you most need to listen to? Existential psychologist Dan Koch and marketing strategist Kristen Tideman join Evan Rosa for a conversation about what anxiety is actually for—and what happens when it turns against you. "To be human is to be unfinished. It is to have constantly limits around you, and your choice is to accept them or pretend they're not there." In this episode, they reflect together on the existential roots of anxiety and what it looks like to confront real limits—from an MS diagnosis to faith upheaval to collective crisis. Together they discuss healthy versus unhealthy anxiety and how to tell them apart, the post-WWII origins of existential therapy, boundary situations and “thrownness,” what denial costs us spiritually and psychologically, and how accepting our limits can paradoxically expand our world. The conversation moves between lived experience of multiple sclerosis and philosophical framework about mortality, between Kierkegaard's "dizziness of freedom" and a three-month-old baby in an emergency room—asking not how to eliminate anxiety, but how to let the right kind of anxiety make your world bigger. Episode Highlights "To be human is to be unfinished. It is to have constantly limits around you, and your choice, among other things, is to accept them or pretend they're not there."—Dan Koch "I was literally in the ER. I'm holding my three-month-old baby who just got here. I'm like, my life just started—and I don't even know what this means. I don't even wanna Google what it means."—Kristen Tideman "Our brains are big enough and our minds are strong enough that unlike deer, plants, and coconuts, we can think about the future. We can imagine our own death."—Dan Koch "There's ways I wanna deny the MS. I wanna deny that that's part of my existence now. I wanna deny even components of my own faith change."—Kristen Tideman "Is my world getting smaller, or is my world getting bigger?"—Dan Koch About Dan Koch Dan Koch is an existential psychologist, therapist, and host of Religion on the Mind, a podcast and media project exploring the intersection of psychology, spirituality, and everyday life. His clinical work focuses on religious change—deconversion, deconstruction, reconstruction—and the downstream effects on identity, family, and meaning-making. He draws on the existential tradition from Kierkegaard and Jaspers through Viktor Frankl and Irvin Yalom. Koch has spoken openly about his own fifteen-year experience with panic disorder. Learn more and follow at religiononthemind.com [VERIFY] About Kristen Tideman Kristen Tideman is the founder of Tidy Studios, a marketing strategist and creative consultant. She holds a master's degree in philosophy and has brought that background into her work exploring questions of meaning, anxiety, and faith in public conversation. She lives with multiple sclerosis and is a new mother. Learn more and follow at [VERIFY—need Tidy Studios URL and social handles] Helpful Links and Resources Religion on the Mind https://www.religiononthemind.com/ Religion on the Mind https://religiononthemind.substack.com/ Religion on the Mind https://podcasts.apple.com/us/podcast/religion-on-the-mind/id1448000113 Tidy Studios https://www.tidystudios.com/ Man's Search for Meaning, Viktor Frankl https://www.beacon.org/Mans-Search-for-Meaning-P602.aspx Dan Koch on Patreon https://www.patreon.com/dankoch Show Notes Why tackle anxiety now—geopolitical overwhelm, media firehose, personal crisis converging Kristen's competing anxieties: new motherhood, MS diagnosis, ongoing faith change Dan's path into existential psychology through clients navigating religious change Existential psychology's post-WWII roots—Viktor Frankl, concentration camps, the search for meaning The atomic bomb as psychological turning point—from imagining one's own death to imagining collective annihilation "Our brains are big enough that unlike deer, plants, and coconuts, we can think about the future. We can imagine our own death." Healthy vs. unhealthy anxiety—the central distinction in existential thought Healthy anxiety broadens your world; unhealthy anxiety becomes self-referential spiral The inner critic mistaken for motivation—when unhealthy anxiety masquerades as drive "I was literally in the ER. I'm holding my three-month-old baby. I'm like, my life just started—and I don't even know what this means." Philosophy becoming flesh—studying mortality vs. receiving a diagnosis "There's ways I wanna deny the MS. I wanna deny that that's part of my existence now. I wanna deny even components of my own faith change." Ontological anxiety vs. pathological anxiety—Kierkegaard's "dizziness of freedom" Avoidance vs. acceptance as the fundamental hinge in existential psychology The body carries what the mind tries to bypass—emotions as literal electricity in the nervous system Thrownness—Heidegger's concept of being tossed into unchosen circumstances Jaspers' shipwreck, Sartre's blind man on a raft, Kierkegaard's captain in a storm Boundary situations—MS, new parenthood, AI, sociopolitical chaos, loss of shared reality Kristen on maturity: "Anything that comes at us, we can use as an excuse to weaken our resolve or to strengthen it." "To be human is to be unfinished. It is to have constantly limits around you, and your choice is to accept them or pretend they're not there." "Is my world getting smaller, or is my world getting bigger?" Neurotic anxiety spins us inward; accepting limits pushes us toward collaboration and community Emmy van Deurzen and Irvin Yalom—real problems require more than one person Loving your neighbor as a practical consequence of accepting your own limits #ExistentialPsychology #Anxiety #MentalHealth #FaithDeconstruction #HumanFlourishing #Kierkegaard #ViktorFrankl #ChronicIllness #MSAwareness #ForTheLifeOfTheWorl Production Notes This podcast featured Kristen Tideman and Dan Koch Edited and Produced by Evan Rosa Hosted by Evan Rosa Production Assistance by Noah Senthil A Production of the Yale Center for Faith & Culture at Yale Divinity School https://faith.yale.edu/about Support For the Life of the World podcast by giving to the Yale Center for Faith & Culture: https://faith.yale.edu/give

In this episode, I'm diving into a product review of five popular tools and devices commonly mentioned for managing multiple sclerosis (MS) symptoms—vibration plates, Bioness L300 (and other functional electrical stimulation devices), red light therapy, the Pulse device, and Restural foot pad. I break down the evidence behind each product, share my perspective as an MS-specialized physical therapist, and offer expert tips to help you decide what could truly support your MS mobility, walking, and strength goals. Resources Mentioned In This Episode: The MSing Link Episode 165, Red Light Therapy for Multiple Sclerosis w/ Dr. Alyson Evans - Spotify | Apple The MSing Link Episode 243, MS Red Light Therapy for Nerve Repair & Inflammation – Chiropractor + PhD Explains - Spotify | Apple The MSing Link Episode 273, Ankle Braces vs AFOs for MS: What's the Difference? - Spotify | Apple The MSing Link Episode 274, Fake MS Cures on Social Media: How to Tell What's Real vs. AI Hype - Spotify | Apple Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Have you ever wondered how truly powerful your mind is? We all hear different stories about the “Power of the Mind” but have you experienced that in your own life? Personally, I used my “mind” to heal from a stroke and heart failure, all of which happened in a single year, 2020. And, as I was healing I was searching Youtube for inspirational videos and stories. I had never even taken so much as a prescription until my ordeals and I was wondering and searching for, “How do I heal myself beyond what modern medicine says I can do? I came across a video by a man named Bob Cafaro and it was titled, “The Psychology Of Beating An Incurable Disease.” The title sucked me in immediately and the video did not disappoint. As a far of matter, it was the single most impactful video that I watched. Bob healed himself from an incurable disease, Multiple Sclerosis. You read that right. He headed himself 100% using the power of his mind. I'm ecstatic because I'm visiting with Bob in this episode and he shares the specific activities that healed him. Before I talked to him, I was blown away because as we were talking, he shared how he “did the impossible,” literally. So, how does the interview apply to you and help you live a better life? Easy, if you're in any way physically ill listening to this podcast episode can do one of the most important things you ever do and if you've never been in such circumstances, Bob demonstrates the power of doing the impossible.

Chelsea is joined by bestie Jo Feldman to break down “You with the Sad Eyes,” the memoir of “Anchorman” and “Dead to Me” star Christina Applegate, who unpacks her Multiple Sclerosis diagnosis. Jo and Chelsea recap Christina's childhood growing up in Laurel Canyon, her reluctant rise as a comedic icon on “Married… with Children,” plus wild tales with Brad Pitt and Johnny Depp, and the Pussycat Dolls history we didn't see coming. A content warning: This episode contains discussions of sensitive topics, including domestic violence, childhood sexual abuse, and substance use. Take care while listening and find helpful resources here. Contact us or send us your voice notes: hello@glamoroustrash.com Follow Chelsea: Instagram @chelseadevantez Join the cookie community: Become a member of the Patreon Thank you to our sponsors: Quince  - Go to quince.com/glamorous for free shipping on your order and 365-day returns.  Thrive Causemetics - Get 20% off your first order at thrivecausemetics.com/glamorous  Ritual - Save 25% on your first month at ritual.com/glamorous.  Libro.fm - Click here to get 2 audiobooks for the price of 1 with your first month of membership using code TRASH. Show Notes: Dringo! Card *** Glamorous Trash is all about going high and low at the same time— Glam and Trash. We recap and book club celebrity memoirs, deconstruct pop culture, and sometimes, we cry! If you've ever referenced Mariah Carey in therapy... then this is the podcast for you. Learn more about your ad choices. Visit podcastchoices.com/adchoices

As MS Awareness Month continues, Selma Blair's story underscores the resilience it takes to keep moving forward while living with multiple sclerosis. Blair, the actress known for Cruel Intentions, Legally Blonde and the Hellboy films, has become a leading voice in the MS community since publicly sharing her diagnosis in 2018. In this conversation from October 2025, Blair joins Hoda to discuss her lifelong health struggles, her relationship with her late mother, and the support she has found in her community, including from fellow stars Christina Applegate and Jamie-Lynn Sigler, who are navigating their own MS journeys. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.