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Multiple Sclerosis View Time: 26 mins

touchEXPERT BRIEFING Symptom Management in MS Care

Watch this activity discussing the importance of managing symptoms in multiple sclerosis, their impact on patients and evidence for currently available treatment strategies.

Gain insights into these topics with leading experts, Drs Aliza Ben-Zacharia and Barry Singer.

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Dr Aliza Ben-Zacharia
The Mount Sinai Medical Center & Hunter College, New York, NY, USA
The importance of managing symptoms to improve the quality of life of persons with multiple sclerosis

Dr Aliza Ben-Zacharia provides an overview of the importance of symptom management in multiple sclerosis, common multiple sclerosis symptoms and their impact, challenges in symptom management and how shared decision-making can help optimize symptom management.

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Interview Questions

In this interview we asked Dr Aliza Ben-Zacharia the following questions:

  • Why is it important to talk about symptom management in MS? 00:27
  • What are the common symptoms associated with MS? 02:31
  • Why is it important to manage symptoms in people with MS? 04:57
  • What are the challenges in the management of symptoms in MS clinical practice? 07:25
  • What is shared decision-making? 09:50
  • How can shared decision-making help to optimize the management of MS symptoms? 11:27
About Dr Aliza Ben-Zacharia

Aliza Ben-Zacharia, PhD, DNP, ANP-BC, FAAN, MSCN and Assistant Professor at Mount Sinai Nursing, is a dual board-certified, acute care nurse practitioner (NP) by ANCC & adult NP by the Academy of NPs. Dr Ben-Zacharia is an NP with experience in acute care, neurology and rehabilitation. Dr. Ben-Zacharia is an Assistant Professor tenure track at Hunter College, Bellevue School of Nursing, NY.

Disclosures: Consultant fees from Biogen, Greenwich Biosciences, and Genentech.

 
Dr Barry Singer
The MS Center for Innovations in Care, St Louis, MO, USA
Management of multiple sclerosis symptoms in clinical practice

Dr Barry Singer outlines how symptom management differs from disease modification in multiple sclerosis care, provides examples of treatments for managing multiple sclerosis symptoms, and describes the future of symptom management in multiple sclerosis.

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Interview Questions

In this interview we asked Dr Barry Singer the following questions:

  • How does symptom management differ from disease modification in MS care? 00:43
  • What is the evidence base for the pharmacologic and non-pharmacologic management of fatigue, spasticity and pain in MS? 02:27
  • Why should clinicians be concerned with symptom management in addition to disease modification? 07:42
  • What is the future of symptom management in MS? 10:27
About Dr Barry Singer

About Dr Barry Singer

Barry Singer, MD is the Director and founder of The MS Center for Innovations in Care at Missouri Baptist Medical Center in St. Louis. He is an Associate Professor of Clinical Neurology at Washington University School of Medicine. He has been an investigator in greater than 35 multiple sclerosis trials focused on new therapeutic options including remyelination.

Disclosures: Research grant support from AbbVie, Alkermes, Bayer, Biogen, MedImmune, Novartis, Roche, and Sanofi Genzyme. Consulting and/or speaking fees from AbbVie, Alexion, Bayer, Biogen, Bristol Myers Squibb (Celgene), EMD Serono, Genentech, Greenwich Biosciences, Novartis, Roche, Sanofi Genzyme, Teva and TG Therapeutics.

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Overview & Learning Objectives
Overview

Despite advances in disease modifying treatments, persons with multiple sclerosis (MS) experience a variety of often progressive and disabling symptoms, which impact many aspects of daily living, social relationships, jobs and health-related quality of life (HRQoL)1-12 Symptomatic treatments are used for the amelioration of MS symptoms affecting functional abilities and HRQoL.2

Watch two leading experts discuss the importance of managing symptoms in multiple sclerosis,13-16 the impact of symptoms,1-12 how to optimize symptom management and challenges17-27 and the evidence for various treatment strategies.28-41

Learning Objectives

After watching this activity you should be able to:

  • Discuss the importance of symptom management in MS care.
  • Explain how shared decision making can be used to optimize the management of MS symptoms.
  • Analyze evidence for the management of MS symptoms
References
References
  1. Buzaid A, Dodge MP, Handmacher L, et al. Activities of daily living: evaluation and treatment in persons with multiple sclerosis. Phys Med Rehabil Clin N Am 2013; 24(4): 629-38.
  2. Filippi M, Bar-Or A, Piehl F, et al. Multiple sclerosis. Nat Rev Dis Primers 2018; 4(1): 43.
  3. Gil-González I, Martín-Rodríguez A, Conrad R, et al. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020; 10(11): e041249.
  4. Hakim EA, Bakheit AM, Bryant TN, et al. The social impact of multiple sclerosis--a study of 305 patients and their relatives. Disabil Rehabil 2000; 22(6): 288-93.
  5. Raggi A, Covelli V, Schiavolin S, et al. Work-related problems in multiple sclerosis: a literature review on its associates and determinants. Disabil Rehabil 2016; 38(10): 936-44.
  6. Brass SD, Duquette P, Proulx-Therrien J, et al. Sleep disorders in patients with multiple sclerosis. Sleep Med Rev 2010; 14(2): 121-9.
  7. Ehde DM, Gibbons LE, Chwastiak L, et al. Chronic pain in a large community sample of persons with multiple sclerosis. Mult Scler 2003; 9(6): 605-11.
  8. Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci 2002; 205(1): 51-8.
  9. Krupp L. Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease. Mult Scler 2006; 12(4): 367-8.
  10. Rizzo MA, Hadjimichael OC, Preiningerova J, et al. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 2004; 10(5): 589-95.
  11. Sammarco A. The Bladder in MS: A Review. Neurol Neurophysiol 2014; 5: 3.
  12. Silveira C, Guedes R, Maia D, et al. Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art. Psychiatry Investig 2019; 16(12): 877-88.
  13. Baird JF, Sandroff BM, Motl RW. Therapies for mobility disability in persons with multiple sclerosis. Expert Rev Neurother 2018; 18(6): 493-502.
  14. Berger JR. Functional improvement and symptom management in multiple sclerosis: clinical efficacy of current therapies. Am J Manag Care 2011; 17 Suppl 5 Improving: S146-53.
  15. Conradsson D, Ytterberg C, von Koch L, et al. Changes in disability in people with multiple sclerosis: a 10-year prospective study. J Neurol 2018; 265(1): 119-26.
  16. Zwibel HL, Smrtka J. Improving quality of life in multiple sclerosis: an unmet need. Am J Manag Care 2011; 17 Suppl 5 Improving: S139-45.
  17. Cohen BA. Identification, causation, alleviation, and prevention of complications (ICAP): an approach to symptom and disability management in multiple sclerosis. Neurology 2008; 71(24 Suppl 3): S14-20.
  18. Ben-Zacharia AB. Therapeutics for multiple sclerosis symptoms. Mt Sinai J Med 2011; 78(2): 176-91.
  19. Armstrong MJ, Shulman LM, Vandigo J, et al. Patient engagement and shared decision-making: What do they look like in neurology practice? Neurol Clin Pract 2016; 6(2): 190-7.
  20. Forbes A, While A, Taylor M. What people with multiple sclerosis perceive to be important to meeting their needs. J Adv Nurs 2007; 58(1): 11-22.
  21. Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med 1999; 17(4): 285-94.
  22. Lorefice L, Mura G, Coni G, et al. What do multiple sclerosis patients and their caregivers perceive as unmet needs? BMC Neurol 2013; 13: 177.
  23. Crabtree-Hartman E. Advanced Symptom Management in Multiple Sclerosis. Neurol Clin 2018; 36(1): 197-218.
  24. D'Amico E, Haase R, Ziemssen T. Review: Patient-reported outcomes in multiple sclerosis care. Mult Scler Relat Disord 2019; 33: 61-6.
  25. Fernández Ó, Costa-Frossard L, Martínez-Ginés M, et al. The Broad Concept of "Spasticity-Plus Syndrome" in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms. Front Neurol 2020; 11: 152.
  26. Gafson A, Craner MJ, Matthews PM. Personalised medicine for multiple sclerosis care. Mult Scler 2017; 23(3): 362-9.
  27. Tintoré M, Alexander M, Costello K, et al. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction. Patient Prefer Adherence 2017; 11: 33-45.
  28. Amatya B, Khan F, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019; 1(1): Cd012732.
  29. Collin C, Davies P, Mutiboko IK, et al. Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. Eur J Neurol 2007; 14(3): 290-6.
  30. Cutter NC, Scott DD, Johnson JC, et al. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil 2000; 81(2): 164-9.
  31. Murphy K. Multiple Sclerosis: Perspectives in Treatment and Pathogenesis [Internet]. Brisbane (AU): Codon Publication; Chapter 4.; 2017.
  32. Nourbakhsh B, Revirajan N, Morris B, et al. Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: a randomised, placebo-controlled, crossover, double-blind trial. Lancet Neurol 2021; 20(1): 38-48.
  33. Novotna A, Mares J, Ratcliffe S, et al. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol 2011; 18(9): 1122-31.
  34. Svendsen KB, Jensen TS, Bach FW. Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial. Bmj 2004; 329(7460): 253.
  35. van den Akker LE, Beckerman H, Collette EH, et al. Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. J Psychosom Res 2016; 90: 33-42.
  36. Vollmer TL, Robinson MJ, Risser RC, et al. A randomized, double-blind, placebo-controlled trial of duloxetine for the treatment of pain in patients with multiple sclerosis. Pain Pract 2014; 14(8): 732-44.
  37. Mueller ME, Gruenthal M, Olson WL, et al. Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch Phys Med Rehabil 1997; 78(5): 521-4.
  38. Otero-Romero S, Sastre-Garriga J, Comi G, et al. Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Mult Scler 2016; 22(11): 1386-96.
  39. Hyman N, Barnes M, Bhakta B, et al. Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. J Neurol Neurosurg Psychiatry 2000; 68(6): 707-12.
  40. Snow BJ, Tsui JK, Bhatt MH, et al. Treatment of spasticity with botulinum toxin: a double-blind study. Ann Neurol 1990; 28(4): 512-5.
  41. Zajicek J, Fox P, Sanders H, et al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet2003; 362(9395): 1517-26.
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