Expert Q&A: Multiple Sclerosis

Answers provided by Stanley L. Cohan, M.D., Ph.D., director, Providence Multiple Sclerosis Center at Providence St. Vincent Medical Center.

Q: People in the Pacific Northwest seem much more likely be diagnosed with multiple sclerosis than people in other parts of the country. Why is that?

Dr. Cohan: The Pacific Northwest has among the highest incidence of multiple sclerosis in the United States – well above the national average. The reasons are not specifically known. However, we know that the risk of MS is higher both in temperate climates and among people of northern European descent, so the very high incidence here probably has to do with our geographic latitude combined with our ethnic population, which is largely Caucasian with northern European heritage.

We think that infectious agents – particularly certain viruses – in some way start this disease and that the behavior of the viruses may be affected by the climate or geographic location.

Q: What is multiple sclerosis?

Dr. Cohan: Multiple sclerosis is a degenerative disease in which a person's immune system mistakenly attacks the brain and/or spinal cord as if it's a foreign substance, and in the process, does damage to nerves and the protective sheaths, called myelin, that cover them.

Q: What are some of the symptoms?

Dr. Cohan: There are many symptoms of multiple sclerosis. They include visual loss, double vision, dizziness, loss of sensation, weakness, impaired balance or coordination, impairment of urinary bladder function, and impairment of memory and concentration. Most commonly, these symptoms initially appear as sudden attacks of impaired function. In a small number of people, the illness starts as a gradual, progressive worsening of strength, sensation, vision and so on.

Q: Are there different levels of multiple sclerosis?

Dr. Cohan: Some patients have relatively mild disease for many years. Other patients get into difficulty very quickly, either with attacks in locations that produce major disabilities early on, or many attacks occurring over a short period of time. Most people with MS initially experience what we call "relapsing-remitting" disease, in which, at least early in the disease, they experience repeated symptom flare-ups every few years, each attack lasting a few weeks to a few months to several years, followed by periods of remission.

Q: What does Providence Health & Services offer to people with this disease?

Dr. Cohan:
 We have built a multiple sclerosis treatment center here at Providence St. Vincent Medical Center that we hope will provide the full range of services that a person with multiple sclerosis might need. That includes not only medication therapy, but also specially trained physical and occupational therapists who are sensitive to the particular needs of people with multiple sclerosis; specialized urology services; and psychological counseling when needed.

In addition, we are actively involved in clinical research in the quest for new and better medications to further improve therapy for multiple sclerosis patients in the future. We are dedicated to patients with multiple sclerosis, and we will do everything we can to help them defeat this disease and better their lives.

Q: What are some of the new medications you're researching?

Dr. Cohan: Useful therapies are available for virtually every patient with multiple sclerosis. The medications currently in use have major beneficial impact on disease activity, but we must do better. Thus the need for clinical trials in many patients, using new agents.

For more information: 
Multiple Sclerosis: Hope Through Research (National Institute of Neurological Disorders and Stroke) 
Multiple Sclerosis Foundation  
National Institute of Neurological Disorders and Stroke  
National Multiple Sclerosis Society 

Last updated: January 2008