Multiple Sclerosis: A Physician’s Perspective

BEN THROWER, MD, is a clinical instructor of neurology at Emory University and participates actively in clinical research. He serves on the board of directors of the Georgia Chapter of the National MS Society and has served on the board for the Consortium of Multiple Sclerosis Institutes. Combining his professional interests with his love of motorcycles, he founded the nonprofit organization HAMS, Hogs Against Multiple Sclerosis (MS).

BSTQ: What drew you to the specialty of neurology and then to the treatment of MS?

Dr. Thrower: I found the brain and spinal cord interesting, and I focused on neurology. My wife and I met in medical school. She’d taken an Air Force scholarship, so we were at the mercy of the Air Force as to where we’d live. They sent her to San Antonio, and I got a training slot in neurology and completed four years of residency there. The Air Force then sent us to Spokane, Wash. I was in private practice, and that part of the country has a high rate of MS. And, I found I really enjoyed working with MS patients.I also realized it took more than just a neurologist to manage them. I started envisioning a comprehensive center for MS in Spokane. The Providence Health System there gave us space and some therapists to start this comprehensive approach. Later, I got a call about a position at Shepherd Center. I wanted to get closer to family, so I joined the medical staff at Shepherd in June 2001.

BSTQ: What are some of the most common medical misperceptions surrounding MS?

Dr. Thrower: In spite of an explosion in our knowledge about MS and treatment options, misperceptions still exist. Some of the common ones are: 1) Everyone with MS will end up in a wheelchair. With early and appropriate treatment, this is frequently not the case. 2) People with MS are fragile and should not exert themselves. Not true. Exercise is not only tolerated, but has numerous benefits specific to MS. 3) Women with MS should not have children. False. Pregnancy is typically associated with a quieting of MS symptoms and a low risk of relapse. There is a slightly higher risk of relapse after delivery, but overall, the effects of pregnancy and delivery are not a significant risk to women with MS.

BSTQ: How has treatment evolved since you started working with MS patients?

Dr. Thrower: In 1993, we saw the first U.S. Food and Drug Administration (FDA) approval of a medication that could alter the course of MS. In March 2017, with the approval of Ocrevus (ocrelizumab), we now have 16 FDA-approved treatment options.

BSTQ: What have you found most challenging when it comes to treating MS patients?

Dr. Thrower: MS is a complex disease, and sometimes it feels like there is just not enough time to deal with all of the issues that a person is struggling with. In addition, it is frustrating to see some people with MS fail to progress even when they are on the appropriate treatment. As much as we have learned about MS, we still don’t have a cure.

BSTQ: Where are we in terms of finding a cure?

Dr. Thrower: Cure means different things to different people with MS. For some, it may mean preventing MS in the first place. For others, it means having a treatment that halts progression in 100 percent of those affected. For those with MS-related disability, it may mean neural repair and a reversal of that disability. For many with MS, we are able to achieve the second option, stopping all MS progression. I do think we are closer to neural repair and a reversal of disability via numerous research avenues.Preventing MS in the first place may be the most difficult given the complex genetic and environmental factors at play.

BSTQ: Are there any promising therapies in the pipeline?

Dr. Thrower: I expect we will see more and more disease-modifying therapies. Some may be improvements on existing ideas. The approval of Ocrevus represented a milestone in that it is the first therapy approved for primary progressive MS. Research on mesenchymal stem cells for neural repair appears promising, as does the search for biomarkers. The latter would be tests to help predict the course of an individual’s MS, select the perfect therapy or help determine the effectiveness of his or her therapy.