MS Compass: Guiding Clinical Care

MS Compass: Guiding Clinical Care
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MS Compass: Guiding Clinical Care is a NeurologyLive podcast led by Lindsay Ross, MD, a board-certified neurologist specializing in multiple sclerosis and neuroimmunology at the Cleveland Clinic’s Mellen Center. The series centers on the unique clinical considerations facing women with MS, from emerging research and evolving treatment strategies to gaps in care that are gaining renewed attention. Through conversations with expert guests across neurology and related disciplines, Dr Ross examines how science, advocacy, and real-world practice are shaping the next era of MS care for women.

Episodes

  1. Sep 25

    Cognitive Dysfunction in MS: Rethinking Assessment and Management

    Welcome to the MS Compass: Guiding Clinical Care podcast. A clinician-focused podcast led by Lindsay Ross, MD, of Cleveland Clinic, exploring the research, care decisions, and evolving conversations shaping MS treatment for women. In this episode of MS Compass: Guiding Clinical Care, host Lindsay Ross, MD, is joined by Rachel Galioto, PhD, a Cleveland Clinic neuropsychologist focused on neuroimmunology, to explore how clinicians can better recognize, assess, and manage cognitive concerns in people with MS.  Galioto discusses evolving evidence suggesting that the cognitive profile of MS may be changing in the modern treatment era, with memory and language difficulties potentially playing a greater role than historically appreciated. Ross and Galioto also examine how disease burden, sleep, mood, medications, pain, and other secondary factors can interact to affect cognition, emphasizing that cognitive dysfunction is rarely attributable to a single cause. The conversation concludes with practical guidance on medication review, addressing sleep problems, determining when formal neuropsychological testing is worthwhile, and using cognitive rehabilitation and compensatory strategies to reduce the impact of cognitive difficulties on everyday life.  Episode Breakdown:  0:00 – Introduction to cognitive dysfunction in MS and its impact on patients 1:00 – Defining cognitive dysfunction: brain fog, memory, word-finding problems, and processing speed  5:45 – Rethinking processing speed and limitations of the Symbol Digit Modalities Test  9:20 – How cognitive dysfunction changes across the MS disease course  11:20 – Lesion burden, brain atrophy, and the relationship between MRI findings and cognition  13:30 – Distinguishing MS-related cognitive dysfunction from secondary contributors  17:50 – How stress, mood, and other factors may amplify cognitive difficulties in MS  19:55 – Medication burden, polypharmacy, and therapies that may affect cognition  22:00 – Balancing cognitive effects with the need to effectively manage MS symptoms  23:00 – Sleep as an overlooked contributor to cognitive dysfunction and opportunities for intervention  26:00 – When clinicians should consider formal neuropsychological testing  28:45 – Using neuropsychological testing to guide rehabilitation, accommodations, and future care  30:15 – Key takeaways: addressing modifiable contributors and reducing the daily impact of cognitive dysfunction Thanks for listening to the NeurologyLive® MS Compass: Guiding Clinical Care podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

    Cognitive Dysfunction in MS: Rethinking Assessment and Management

  2. May 8

    Sexual Dysfunction in MS: Practical Strategies for Assessment and Management

    Welcome to the MS Compass: Guiding Clinical Care podcast. A clinician-focused podcast led by Lindsay Ross, MD, of Cleveland Clinic, exploring the research, care decisions, and evolving conversations shaping MS treatment for women. In this episode of MS Compass: Guiding Clinical Care, host Lindsay Ross, MD, is joined by Tammy Kaplan, MD, assistant professor at Harvard Medical School and vice chair of education for neurology at Mass General Brigham, for a comprehensive discussion on sexual dysfunction in patients with multiple sclerosis. The conversation opens with an overview of the scope and prevalence of sexual dysfunction in MS, emphasizing its impact on quality of life and its frequent underrecognition in clinical practice. Kaplan outlines a practical framework for understanding sexual dysfunction through primary, secondary, and tertiary contributors, before shifting into strategies for integrating sexual health discussions into routine clinical care. The episode also explores common barriers clinicians face, including time constraints and uncertainty around management, while offering actionable approaches to assessment, communication, and treatment. Additional discussion highlights symptom-specific management strategies, indications for referral, and emerging areas of research, including neuromodulation and hormonal considerations. Episode Breakdown:  0:00 – Introduction to sexual dysfunction in MS and its impact on quality of life 2:05 – Defining sexual dysfunction: desire, arousal, and orgasm across the sexual cycle 4:20 – Prevalence of sexual dysfunction in MS and variability across studies 5:45 – Primary, secondary, and tertiary sexual dysfunction framework in MS 8:15 – How to assess sexual dysfunction: normalizing conversations and building it into routine care 10:35 – Practical communication strategies and discussing intimacy with patients and partners 16:30 – Identifying underlying causes: bladder dysfunction, medications, and secondary contributors 20:45 – Managing decreased libido: medication review and role of SSRIs vs alternatives 22:10 – Addressing vaginal lubrication: medication effects, lubricants, and vaginal estrogen 24:20 – Orgasmic dysfunction and the role of SSRIs and upstream symptom management 26:05 – When to refer: mental health, gynecology, endocrine concerns, and complex cases 29:30 – Emerging research: neuromodulation and posterior tibial nerve stimulation 32:40 – Hormonal considerations and limitations in current clinical practice 34:50 – Key takeaway: sexual dysfunction in MS is multifactorial and requires routine, normalized assessment Thanks for listening to the NeurologyLive® MS Compass: Guiding Clinical Care podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

    Sexual Dysfunction in MS: Practical Strategies for Assessment and Management

  3. Jan 26

    Managing Postpartum MS: Safety Data, Relapse Risk, and Real-World Practice

    Welcome to the MS Compass: Guiding Clinical Care podcast. A clinician-focused podcast led by Lindsay Ross, MD, of Cleveland Clinic, exploring the research, care decisions, and evolving conversations shaping MS treatment for women. In this initial episode of MS Compass: Guiding Clinical Care, host Lindsay Ross, MD, is joined by Edith Graham, MD, assistant professor of neurology at Northwestern University Feinberg School of Medicine, for an in-depth discussion on managing multiple sclerosis during breastfeeding. The conversation examines how postpartum care decisions are evolving as more safety, pharmacokinetic, and infant outcome data become available, particularly around the use of disease-modifying therapies during lactation. Drs Ross and Graham discuss the growing comfort with anti-CD20 monoclonal antibodies, how relapse risk and breastfeeding physiology factor into treatment timing, and the practical considerations clinicians weigh when counseling patients during this critical phase of MS care. Episode Breakdown:  0:50 – How frequently clinicians continue disease-modifying therapy during breastfeeding 2:15 – Shifting from interferons to monoclonal antibodies in postpartum MS care 3:30 – Lactation physiology and what it means for monoclonal antibody transfer into breast milk 5:50 – Safety data for anti-CD20 therapies including ocrelizumab, ofatumumab, and rituximab 8:15 – Practical differences across anti-CD20 agents and how they influence treatment selection 13:50 – Adjusting infusion premedications to reduce infant exposure during breastfeeding 16:50 – The unique challenges of natalizumab use during the postpartum period 20:10 – Weaning physiology, premature infants, and remaining gaps in breastfeeding safety data 24:30 – Balancing breastfeeding-related relapse protection against postpartum relapse risk 26:55 – Why many clinicians are moving toward a “why not treat” mindset during breastfeeding 28:40 – Recent relapses drive postpartum DMT restart decisions 29:30 – Postpartum prophylactic steroids discouraged; COP-MS shows none 31:15 – Anti-CD20 postpartum outcomes still lack robust data 33:40 – LactMed-guided symptom meds: gabapentin, baclofen, Botox, PT Thanks for listening to the NeurologyLive® Inside MS: A Clinician's Compass podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

  • 3 Episodes

About

MS Compass: Guiding Clinical Care is a NeurologyLive podcast led by Lindsay Ross, MD, a board-certified neurologist specializing in multiple sclerosis and neuroimmunology at the Cleveland Clinic’s Mellen Center. The series centers on the unique clinical considerations facing women with MS, from emerging research and evolving treatment strategies to gaps in care that are gaining renewed attention. Through conversations with expert guests across neurology and related disciplines, Dr Ross examines how science, advocacy, and real-world practice are shaping the next era of MS care for women.

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