Personalized Treatment for MS or Herd Mentality: What Does Your Neurologist Do?

People diagnosed with multiple sclerosis (MS) and their neurologists must make many decisions when it comes to treating the disease. With FDA-approved disease-modifying therapies, it can be challenging to know which one to use, if any.

How do doctors and patients choose? To make an informed decision, neurologists are expected to follow clinical practice guidelines that frequently summarize the available medical evidence. Meanwhile, patients are expected to do their own research and consider lifestyle factors and personal preference, as well as doctor recommendations.

It’s clearly unwise for neurologists to follow outdated clinical guidelines; consider that when the American Academy of Neurology (AAN) published its guidelines in 2002, only four treatment options were available. A less obvious concern is when neurologists ignore current clinical guidelines and instead follow the recommendations of other neurologists they know or experts in the field, a behavior called “herding.”

Herding can be detrimental to patient care, suggests a study published in January 2017 in the journal Patient Preference and Adherence.

What is herding in medicine?

Herding is a phenomenon in which individuals follow the behavior of others rather than making a decision independently. Herding occurs in MS care when one neurologist follows the therapeutic recommendation of a colleague even when this advice is not supported by clinical guidelines.

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Does Your Multiple Sclerosis Specialist Follow the Herd?

Complementary and Alternative Medicine (CAM) and MS

The National MS Society (NMSS) reports that approximately 75% of people with MS use one form or another of CAM, generally in combination with prescribed disease-modifying treatments.  CAM use and MS has not been researched extensively in controlled clinical trials, but there are small studies which show some benefit of specific interventions.   The terms complementary and alternative indicate the way in which these unconventional therapies are used - complementary therapies are used in conjunction with conventional medicine, while alternative therapies are used instead of conventional medicine.  Common forms of CAM include use of exercise, dietary supplements, herbal medicine, mind-body practices, yoga, and acupuncture.

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Living with MS: Complementary and Alternative Medicine

Treatment Decisions: Is Your MS Stable?

New research suggests that it may be safe to stop taking disease-modifying medication if your MS has been stable for an extended period of time.  In a recent study published in the the journal Arq Neuropsiquiatr, researchers in Brazil followed a group of 40 patients with relapsing-remitting MS for whom their disease had been clinically and radiologically stable for more than five years and who voluntarily chose to stop using disease-modifying therapy.

Patients included in the study had continuously used one of the following immunomodulatory disease-modifying drugs - Avonex, Betaseron, Rebif, Copaxone - for more than 5 years and up to 14 years.  To be included in the study, participants had to be disease-free for at least 5 years while on therapy.  Disease-free activity was defined as no clinical relapse, no sustained increase in disability as measured by EDSS (expanded disability status scale) score, and no new gadolinium-enhancing or active lesions as seen on MRI scans.

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MS and Medication Decisions: Can I stop taking my disease-modifying drug and still be okay?