Dealing with MS
Assistant professor helps pioneer a new way to treat multiple sclerosis.
While multiple sclerosis may be among the most studied neurological disorders, much about the debilitating disease remains a mystery still to be unlocked. The disease tends to strike people in early adulthood to middle-age, three times more women than men. There is no cure and the root cause is unknown. It is not even known how many in this country carry the diagnosis, with the best estimate about 400,000.
Dr. Léorah Freeman is an assistant professor of neurology at the McGovern Medical School at UTHealth with a research specialty in MS who also sees patients. She has helped pioneer a new take on treatment, marrying traditional pharmacology with a more holistic approach that includes a unique, customized exercise program that is beginning to show startling results.
She sat down with the Houston Chronicle to talk about her work and her vision. Here are her comments, edited for space.
Q: Why MS?
A: I got into the field of MS as a medical student in Paris. For me, there is something about the disease. People with MS are young. This disease often occurs right at a time when they are building their lives, trying to live their dreams and I’ve always wanted to be there for them to help them achieve their goals with the disease.
Q: How is the research evolving?
A: MS is probably one of the most advanced neurological fields in terms of research. When I first started getting interested in MS, we were very focused on the lesions (patches of inflammation in the central nervous system) and what occurs within the lesions. Now, we understand that it is a much more diffused process and there are a lot of things to discover about the process and how the brain tries to repair itself — and sometimes fails to do so.
Q How close are researchers to finding a cure?
A: I often say that I’m not sure we are close to finding an overall cure but we are getting closer and closer to finding the right cure for the right person at the right time.
Q: What is the focus of your research?
A: It is on understanding the mechanism leading to tissue damage, particularly damage to the nerve cells. I am also focused on developing innovative strategies that prevent damage and promote repair. If we identify these processes, we can develop therapies. In a recent study, we showed that decreased blood flow in the brain was associated with greater brain atrophy down the road. Now we are working to test medicine that increases blood flow in the brain in the hope to prevent damage and slow the disability progression.
Q: Isn’t there a new drug that is showing promise?
A: Ocrevus was recently approved by the federal Food and Drug Administration and has brought a lot of hope. It is an infusion every six months.
Q: Aren’t you, though, looking beyond just pharmaceuticals?
A: I think MS patients are not just lesions on the brain scan. They are people. They have dreams and goals and families and most of all, they have incredible stories. The key to my practice is to provide patientcentered care. And that includes finding the right medication for the right person. But it also means meeting their needs outside of just medication. Something that is very important to me is to try to empower my patients to do what they can to live their healthiest life. That is done through a great deal of education on things like diet, exercise, sleep. I believe it all plays a part in our biology.
Q: What is behind your specialized exercise program for MS patients?
A: This is something I am very proud of. This is unique to Houston. This past April we piloted the Moving Stronger program, a 12-week, twice-a-week exercise program developed specifically for people with MS that we designed in partnership with the YWCA of Greater Houston and the national MS Society. It is designed for people of all ability levels, meaning that we may have people who are able-bodied as well as people who are using a wheelchair. We try to meet them where they are.
Q: What kind of exercise and how is it different from physical therapy?
A: It combines different kinds of exercise, such as aquatics, yoga, strength training, aerobic training as well as education on a healthy lifestyle. The classes are between 6 and 12 participants, ages from early 20s to 70. Physical therapy and exercise are two different things. Physical therapy is very helpful for one particular deficit, one particular process. Exercise has the potential to improve deficits but also by doing it day in and day out it can impact the body’s biology.
Q: What kind of results are you seeing?
A: We have graduated two groups of students so far. The pilot results have been very promising. They have showed that we have been able to improve endurance by about 30 percent, fatigue has decreased by 35 percent, and patients’ perception of their symptoms have decreased by about 22 percent.
Q: Do you have any favorite success stories?
A: There are two stories that have really stood out in my mind. One was a patient, an older woman, who had a lot of difficulty with her right leg. She had started dragging her leg. We were discussing a change in therapies but she was not keen on going on stronger medication. She enrolled in the Moving Stronger program and within 12 weeks she got her strength back. She was not dragging her leg anymore and can walk without aid and feels much more hopeful about her future. The other one is a younger patient in her 30s, who was depressed. She didn’t even know if she would show up for the program. She was feeling bad, aching everywhere. At the end of the program she’s much less depressed, her doctor is taking her off some of her anti-depressant medication and she has laid it all out to continue exercising because she does not want to give up.
Q: That must be satisfying — is it?
A: This is why I do this. These people are awesome. The resilience and the strength you need to have to overcome this, not just the disease and the physical deficits, but the emotional impact it has on your life. To help them fills me with joy.