Multiple Sclerosis: Managing Comorbidities

Amit Bar-Or, MD, FRCP, FAAN, FANA: In addition to multiple domains that can be affected by multiple sclerosis [MS], it’s important to recognize that people living with MS can experience other medical problems. This raises the important spectrum of comorbidities. There are many different comorbidities that coexist in people with MS, especially as they go through life. And MS, being a chronic illness that affects someone throughout their lifespan, can be superimposed in addition to other conditions. Common conditions include obesity, hypertension, and heart disease. There are different interactions by which the experience with MS can worsen those other conditions, and similarly those other conditions can make living with MS a much more complicated and troubling experience. Identifying the comorbidities, understanding that people with MS can have symptoms that are not necessarily related to MS but to other conditions, is very important, so that those conditions can be identified and be proactively addressed just as the person’s MS is.

Comorbidities that affect the central nervous system—especially vascular disease with risk factors including high blood pressure, heart disease, high levels of sugar, and so on—will affect the brain in people who don’t have MS but also in people who do have MS. So you then have 2 superimposed conditions affecting the central nervous system that can contribute to damage over time. So not everything that is progressing in a person with multiple sclerosis is necessarily their MS. Add that to normal aging, which is dependent to some extent on reserves that may have taken a hit from MS or other comorbidities earlier in life, and how to separate which of these contribute to people’s worsening experience—is it aging, is it a comorbidity, or is it the actual active course of multiple sclerosis—becomes a very important challenge, especially as we’re following patients from their 20s and 30s at the time of presentation through the decades thereafter.

To manage all of the features of both multiple sclerosis and its comorbidities, an important approach is to have a multidisciplinary team involved whenever possible, so that you can include those who have expertise in multiple sclerosis and in symptomatic management, be it bladder issues, bowel issues, fatigue, energy conservation, occupational therapy, physical therapy, social services, and so on. And have people who patients can be referred to in terms of psychological input, psychiatric input, and addressing the multiple comorbidities that we increasingly appreciate as an important aspect of living with multiple sclerosis.