Dr Mowry

For us as neurologists, a relapse means you have symptoms that develop typically sub acutely. So over hours to days usually are new in some way. Even if you've had prior relapses, there's usually something a little different about this set of symptoms compared to the prior time.

The symptoms persist for more than 24 hours, but typically several days they don't come up in the context of illness or fever. They typically subside, recovering either partially or fully.

Now, when people have had relapses in the past or old areas of damage, what happens, in the nervous system is after the hoopla is over and the inflammation cells in that area, you know, have kind of cleared out all the damage that's been caused. The attack itself, of course, is related to the fact that the immune system strips off a segment of the nerve and it causes a short circuit with variable success.

The original types of cells that were meant to coat that nerve try to go back in and put a new coating around it. But oftentimes that may not be complete. Or it's possible that the underlying nerve wires got a little bit damaged too.

You know, just like if you broke an ankle 10 years ago, things might be like a little more wobbly forever, right? It may not be the perfect ankle. I always give the analogy, like if you've heard of somebody who broke a bone and it healed, and they're like, oh, it, it comes and goes, I still have aching in that area and if it rains, I really feel it.

We know there's not new damage going on. It's an old scar that's like still here, and those old scars can cause, um, even when people day to day aren't noticing symptoms can cause old symptoms to come and go.

I think, this has been, maybe one of the more positive areas of development in my experience of being a neurologist. over the past 20 years or so. long time ago, When only some therapies were available. it was always a very hard decision for women to decide if they wanted to pursue pregnancy. The other thing is that I think, you know, oftentimes we'd see people who said, “my doctor told me I should, you know, make sure my MS is under control before I think about a pregnancy.” So it's, you know. so it's a hard space for most women, I think to think about pregnancy and that journey and all its complexities. But the MS and its treatment definitely offer increased complexity, and it still does, I think. What's a little bit different is that we have found in our clinical practice, which is not necessarily consistent with FDA labeling, medications that some of the longer acting medicines, or one in particular can be used pretty successfully to help women who need treatment whose MS appears not to be quiet enough that they can take the risk of going off treatment. it's long acting enough that we can sort of help people relative to when they receive the medication, and at least in our experience so far appears to be carrying people pretty nicely for the most part through the pregnancy and postpartum period. 

Like most autoimmune diseases, MS appears to affect women more often than men. The ratio seems to be around three to one in MS for women to men.

We know the average age of onset is in the early thirties for multiple sclerosis, but with a pretty wide range where, I mean, I've seen a couple of people who had their onset, you know, before age two.

It's very rare, but certainly pediatric onset MS is more common than was thought to be true 20 years ago. The majority of those people being post pubertal, you know, teenagers because the immune system itself cools off over time.

Diagnosing people with relapsing MS is less and less likely after, you know, say the early fifties, early to mid fifties. If people are diagnosed, you know, above 40, there's a higher chance that they have a more progressive type of MS.