MS Living Well: Key Info from Multiple Sclerosis Experts

Many people with multiple sclerosis say fatigue is their most disabling symptom, and one of the hardest to explain. Unlike sleepiness, it often doesn't lift after a night's rest, and medications have offered limited help. In this episode of MS Living Well, we explore what the research says actually works: why a popular strategy for rationing energy may hold people back, why small, steady changes to routine matter more than big ones, and how a new digital program aims to help people rebuild their energy.

We also look at the sleep disorders that can hide behind fatigue, especially sleep apnea, which often shows up as low energy rather than sleepiness. The conversation covers how to tell MS fatigue apart from a sleep problem, how poor sleep can affect thinking and memory, what to expect from a sleep study, practical tips for making CPAP work with MS, and where medication fits when other approaches fall short.

Dr. Jamie Holloman, neurologist at the MS Center for Innovations in Care at Missouri Baptist Medical Center, interviews:

Dr. Rona Moss-Morris, Professor of Psychology as Applied to Medicine at King's College London

Dr. Tiffany Braley, MS neurologist at the University of Michigan and founder of its Multidisciplinary MS Fatigue and Sleep Clinic

Dr. Ronald Chervin, Michael S. Aldrich Collegiate Professor of Sleep Medicine and Director of the Sleep Disorders Center at the University of Michigan

Few conversations in the MS clinic generate as much anxiety as the one about cancer. Disease-modifying therapy labels can carry explicit malignancy warnings, and patients understandably arrive asking whether the drug meant to protect their brain might be putting the rest of their body at risk. What often goes unsaid is the other half of the story: several medications now used in MS started out as cancer drugs. Rituximab was a cornerstone of treatment for B-cell lymphoma, and cladribine was first approved for hairy cell leukemia. The relationship between MS therapy and cancer runs in both directions, and the warning labels tell only one side of it.

This episode works through what the evidence actually shows. We discuss the mechanisms behind cancer risk with common MS therapies and how a country that has tracked its entire MS population since 1956 can answer questions no three-year trial could. What do 34,000 patients followed for life reveal now that most are on high-efficacy therapy? The conversation also covers why absolute numbers change the discussion, which screenings belong on the calendar for different drug classes, and which symptoms are too easily written off as MS. We also explore why oncologists often advise staying on B-cell therapy after a cancer diagnosis and long-term data showing newly diagnosed patients keeping their mobility and their jobs far longer than the generation before them.

Jameson Holloman MD, neurologist at The MS Center for Innovations in Care, interviews:

Esther Melamed MD, PhD, Associate Professor of Neurology, and Associate Chair for Research in the Department of Neurology at Dell Medical School, University of Texas, Austin

Melinda Magyar MD PhD, a senior consultant neurologist at the Danish Multiple Sclerosis Center at Rigshospitalet, Associate Professor of Neurology at the University of Copenhagen, and Director of the Danish Multiple Sclerosis Registry

Maintaining a healthy weight may be particularly important in multiple sclerosis, as excess fat tissue can promote inflammation and contribute to other health conditions that may complicate MS. GLP-1 medications such as Ozempic and Mounjaro have transformed weight management, but could their benefits extend beyond weight loss? We explore emerging evidence that these medications may reduce inflammation, protect nerve cells, and possibly promote myelin repair, as well as clinical trials investigating their potential impact on MS progression.

Exercise can also do much more than build muscle. We explore how targeted movement may harness neuroplasticity—the brain's ability to adapt and find new pathways around areas damaged by MS. Practical strategies are shared for improving fatigue, spasticity, core strength, balance, and mobility, even for people with significant disability.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Olaf Stuve MD PhD, Professor of Neurology and Head of the Multiple Sclerosis and Neuroimmunology Section. UT Southwestern Medical Center, Dallas, Texas

Trevor Wicken, Founder of The MS Gym, a global online platform for exercise and mindset training for people living with multiple sclerosis

When multiple sclerosis enters a family, it doesn't just change the life of the person diagnosed. It reshapes the daily routines, roles, and futures of the people who love them. A spouse steps into new responsibilities, a child learns to help in ways their peers never will, and an entire household begins to adapt. These changes occur quietly, and often without recognition. Caregiving is one of the most essential pillars of the MS journey, and also one of the most invisible.

This episode explores the caregiver experience from the inside out. We discuss why the uncertainty of MS can be one of the hardest parts of caregiving, how stepping into a care partner role can unexpectedly foster maturity, closeness, and personal growth, and why a caregiver's own well-being is inseparable from that of the person they support. The conversation also dives into practical tools for building resilience including Acceptance and Commitment Therapy, the READY for MS program, and the everyday strategies one husband relies on to stay connected to his wife as they navigate life with MS together.

Jameson Holloman MD, neurologist at The MS Center for Innovations in Care, interviews:

Kenneth Pakenham PhD, Emeritus Professor of Clinical and Health Psychology at the University of Queensland who pioneered the use of Acceptance and Commitment Therapy in chronic illness and developed the READY for MS resilience program.

Dan Shaul, care partner to his wife, Kim, who lives with MS. An Air Force veteran and former Missouri state representative, he serves on the board of MS Bright Spots of Hope in St. Louis.

Employment is about more than a paycheck. It can provide purpose, community, and independence. But MS symptoms like fatigue, cognitive changes, and mobility issues often raise difficult questions about whether to stay in a current job, request accommodations, or eventually consider disability benefits.

In this episode of MS Living Well, we hear from two experts who help people navigate these complex decisions with employers and benefit agencies every day. The conversation covers how to stay in the workforce longer, when and how to disclose a diagnosis, the workplace accommodations people actually use most, and how to plan ahead for a disability claim including FMLA, private disability insurance, and Social Security Disability.

Dr. Jamie Holloman, neurologist at the MS Center for Innovations in Care at Missouri Baptist Medical Center, interviews:

Phillip Rumrill Phd, CRC, Professor at Michigan State University and a certified rehabilitation counselor with roughly 35 years of research on employment, vocational rehabilitation, and workplace accommodations for people with MS.

Jamie R. Hall, Esquire, attorney and founder of the Law Office of Jamie R. Hall, who has focused on Social Security and long-term disability claims for 17 years and works extensively with the MS community.

MRI scans can reveal far more than just "white spots." New imaging techniques are uncovering hidden inflammation, silent disease activity, and smoldering lesions that may continue damaging the brain even when someone feels stable and routine MRI scans appear unchanged. This episode explores how MRI is evolving from a diagnostic tool into a window into the underlying biology of multiple sclerosis.

We discuss why spinal cord imaging can sometimes reveal disease missed in the brain, how the "central vein sign" may help prevent MS misdiagnosis, and why brain shrinkage remains difficult to measure reliably in individuals living with multiple sclerosis. The conversation also dives into some of the most exciting frontiers in MS imaging including myelin repair, functional MRI, and how artificial intelligence could dramatically improve the speed and precision of MRI scans in the future.

Barry Singer, MD, Director of The MS Center for Innovations in Care, interviews: Anthony Traboulsee, MD, Professor of Neurology, University of British Columbia and Director of the UBC MS/MRI Research Group in Vancouver Frederik Barkhof, MD, PhD, Professor of Neuroradiology, Amsterdam UMC and University College London

Cognitive changes are a common part of living with multiple sclerosis, but they can be confusing and frustrating. Many people feel like their memory is slipping, when in reality, the challenge is often with accessing information—especially in the moment. Forgetting why you walked into a room or struggling to find the right word in conversation are very real experiences in MS, and they're more about how the brain processes and retrieves information than a loss of intelligence or knowledge. New insights are helping us better understand why this happens, including the role of inflammation and how today's treatments may be helping keep cognition more stable over time.

In this episode, Dr. James Sumowski breaks down what's happening in the brain, including why word-finding problems are so common and what "working memory" really means in everyday life. Speech-language pathologist Dr. Marissa Barrera then shares practical, easy-to-use strategies to support memory and communication from simple ways to make information more memorable, to talking around a missing word, and creating routines that reduce mental overload. Together, they offer both clarity and actionable tools to help you think more clearly, communicate more confidently, and navigate cognitive challenges day to day.

Barry Singer, MD, Director of The MS Center for Innovations in Care, interviews:

James F. Sumowski, PhD, Associate Professor of Neurology at the Icahn School of Medicine, Mount Sinai, New York

Marissa Barrera, PhD, MSCS, CCC-SLP, Assistant Dean of Health Sciences, Katz School of Science and Health, Yeshiva University, New York

Many people living with multiple sclerosis are interested in whether vitamins, supplements, or nutrition can play a supportive role in long-term brain and immune health. Two areas that have received growing research attention are alpha-linolenic acid, a plant-based omega-3 fatty acid found in foods like flaxseed and walnuts, and vitamin D, a hormone-like nutrient involved in immune regulation that is often low in people with MS. With so much information online, it can be difficult to know what is truly supported by research versus what is based on personal stories or assumption. New studies are helping us understand these topics more clearly.

We explore new insights from large-scale cohort studies and randomized clinical trials assessing the potential role of alpha-linolenic acid and high-dose vitamin D supplementation in early MS. Biomarker-based findings show an association between higher alpha-linolenic acid levels and reduced relapse risk and disability progression over long-term follow-up. The D-Lay MS trial demonstrated a reduction in disease activity in people living with MS receiving high-dose vitamin D early in their condition.

Jamie Holloman MD, neurologist at The MS Center for Innovations in Care, interviews:

Marianna Cortese MD PhD, Senior Research Scientist, Department of Nutrition at Harvard T.H. Chan School of Public Health

Professor Éric Thouvenot, Head of the Neurology Department, Nîmes University Hospital, France

CAR-T therapy, short for chimeric antigen receptor T-cell therapy, is already transforming treatment for blood cancers like lymphoma and leukemia and is now being tested in early trials for multiple sclerosis. In this approach, a person's own T cells (or sometimes donor T cells) are collected and reengineered in the lab with a special "chimeric" receptor on their surface. Once infused back into the body, these "designer" T cells can specifically hunt down B cells, including those hiding in the brain and spinal cord that may drive progressive MS. This is a key difference since current B-cell depleting antibody treatments don't reach effectively into the central nervous system.

Like any powerful therapy, CAR-T is not without risks. Side effects can include serious infections, cytokine release syndrome (fever, chills, body aches), and even neurological symptoms like confusion or seizures. Still, the early results in MS patients are remarkable, bringing fresh hope for those with progressive disease. Beyond MS, CAR-T is being explored across autoimmune neurological diseases from myasthenia gravis to stiff person syndrome, opening a promising new frontier in care.

Barry Singer MD, Director of the MS Center for Innovations in Care, interviews:

Jeffrey Dunn MD, Clinical Professor and Chief of Neuroimmunology in the Department of Neurology & Neurological Sciences at Stanford University

Amanda Piquet MD, Professor of Neurology and Céline Dion Foundation Endowed Chair at the University of Colorado Anschutz School of Medicine

The quest to repair the damage caused by multiple sclerosis is gaining momentum, with scientists working to restore lost function and slow progression by rebuilding myelin—the protective coating of nerve cells. Within the brain and spinal cord, immature myelin-making cells called OPCs hold promise, but need the right signals to mature into oligodendrocytes and repair MS lesions. Researchers are also studying the role of microglia, the immune cells that clear debris but can turn destructive, with drugs like BTK inhibitors potentially tilting them toward repair.

Early attempts at remyelination drugs such as opicinumab and elezanumab showed promise in animals but ultimately failed in human trials, underscoring the challenge. Still, reasons for optimism are emerging: clemastine, a common antihistamine, showed signs of remyelination in optic neuritis, while PIPE-307—a compound inspired by green mamba snake venom—is in Phase 2 trials. Even novel approaches like gold nanoparticles are being studied to boost oligodendrocyte energy and repair capacity. The path is complex, but progress is accelerating—bringing remyelination therapies closer to becoming a real option for people living with MS.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Veronique Miron PhD, MS Research Chair at St. Michael's Hospital and Professor of Immunology at The University of Toronto

Robert Glanzman MD, Board-certified neurologist and Chief Medical Officer of Find Therapeutics