March is Multiple Sclerosis Awareness Month. Dr. Corey Ford, director of UNM's Multiple Sclerosis Specialty Clinic, sheds light on a disease that debilitates, but doesn't generally shorten life. Dr. Ford is always searching for new and better MS therapies.

Learning Curve
Dr. Ford earned a Ph.D. in biophysics at the University of Texas Health Sciences Center at Dallas before earning his MD at the University of Virginia. He went on to the University of Rochester for neurology training, and stayed an additional two years as a fellow in the MS program.

In 1988, Ford joined the UNM neurology faculty and established the MS specialty clinic. The MS program at UNM is very active in clinical studies of new treatments and research in novel imaging techniques. UNM's MS clinic is a longstanding member of the Consortium of Multiple Sclerosis Centers and is an affiliated clinic of the National Multiple Sclerosis Society. His clinical practice is limited to MS and his research interests are in the applications of imaging technologies to a better understanding and treatment of multiple sclerosis.

Dr. Ford is also assistant dean for research at UNM and medical director of the UNM pharmacy department and serves on several other university committees.

Clinical Trials
"When I first started working with MS, there were no drugs to treat the disease," Dr. Ford said. In 1991, UNM's clinic was one of 11 sites nationally selected to participate in clinical trials with the drug glatiramer acetate. "We enrolled patients and followed them for three years. The drug was then approved by the FDA," he said. The medication, taken by injection once daily, helps keep the disease from getting worse, he said.

The clinical trials program has successfully performed more than 25 studies that led to new, approved treatments for MS as well as extending understanding of the disease. The MS clinical and research program supports a team including two physicians, an advanced practice nurse, a nurse coordinator, a research coordinator and several work study students.

Another trial was with the drug glatiramer acetate, now marketed as Copaxone. The trial started with 250 patients, 100 of whom are still being followed in the long-term study. The drug is used to treat relapsing forms of multiple sclerosis.

UNM's MS clinic, located at Pete and Nancy Domenici Hall, is the only one of its kind in the state. "The clinic is getting better. We are a resource in the Southwest. We have served more than 2,000 patients from around the state and from East Texas, Southern Colorado and Western Arizona. Almost every drug used to treat MS was studied here," Dr. Ford said.

What Causes MS?
Dr. Ford said he isn't sure if MS is on the rise or if the use of magnetic resonance imaging (MRI) and general practitioners' knowledge of the disease is resulting in more people being accurately diagnosed. However they come to him, they come. UNM's clinic has 700-800 active patients per year.

Although the UNM MS Specialty Clinic studies treatment options, they are not engaged in research behind the causes of MS. Dr. Ford said, "The actual cause of MS is not known, but we do know there is a genetic predisposition to it. Yet, even with identical twins, if one gets MS, there is still a greater chance – 75 percent – that the other will not get it."

He said that someone can have the gene, but that there has to be a "trigger." "It is something they likely encounter pre-puberty – a virus, or an antigenic trigger that primes the immune system to attack the nervous system," he said.

Dr. Ford said that incidences of MS increase with distance from the equator. "Higher Vitamin D, levels perhaps related to increased sunlight, correlates to a lower incidence of MS. Increasing Vitamin D in MS patients may not be therapeutically helpful and perhaps it has something to do with getting enough of it growing up.

Dr. Ford said that toxins, pets, food, pesticides and other things have been examined for connections to the disease, with no objective connections to disease risk or onset.

Even genetic connections are hard to follow. "Some genes are more common in MS, but of the array of thousands of genes, the number is still low." He added that through sophisticated DNA analysis people in the future might learn if they are susceptible and help to determine therapy.

MS Symptoms
Dr. Ford said that MS symptoms are "highly variable," with problems walking, vision and balance generally noted. "Anything that is served through the brain and spinal cord – balance, bladder, bowels – and cognitive issues, like short term memory, finding the right word or processing information quickly," he said.

What Dr. Ford does is help people who are diagnosed. "We can modify the natural history with good treatment. We help most live with it with fewer symptoms and disabilities," he said. He said that symptoms can be innocuous, such as numbness in a hand that goes away in a couple days, or it can take the form of sudden blindness in one eye. "The person with a dramatic symptom goes to the doctor. The impact of disabilities varies with occupation. For example, vision problems would be disabling for a pilot or surgeon; motor weakness or coordination for an athlete.

For most, onset of the disease is in the 20s – 40s, although it's been seen in children and others are diagnosed in their 50s or 60s, but they likely had the disease longer, but without symptoms.

"A patient may have onset with weak legs or blurry vision and yet have 20 or more lesions in the brain," he said. Those lesions are found through MRIs. "Some patients have silent attacks while in others, he said, the disease strikes eloquent areas with obvious, concerning symptoms." "Half the body goes numb or they lose vision in one eye." Relapses of neurological symptoms are a hallmark of MS.

Treating for the Long-Term
Dr. Ford said that at the clinic, they initiate MS treatment for the long-term. "Although we can't repair the damage that's already been done, when we start early, we can prevent further damage," he said.

The disease can be arbitrary. "In retrospect, some patients don't need treatment and for perhaps 10 percent, they have severe disabilities that shorten their lives. For about 80 percent, life isn't shortened, but disabilities occur that they need to learn to adapt to," he said. Dr. Ford said that although many are discouraged by the diagnosis, symptoms progress gradually, especially with treatment and so patients incrementally adjust to the changes in their abilities. "They still enjoy a quality of life," he said.

There's shock at receiving the diagnosis, but because the clinic is in it for the long haul for their patients, they have a team of doctors, therapists, nurses and pharmacists. "The nurse helps them deal with the emotional shock. It's a serious diagnosis but not a death sentence, life will go on and we want to help the patients to deal with the issues without making the disease the center of their lives," he said. "We deal with everything from the emotional impact of divorce to insurance companies not paying for a drug," he said.

Built Ford Tough
After two decades of work in MS, Dr. Ford is still passionate about it, both scientifically and clinically. He said, "Here in New Mexico, there are many opportunities where we can make a difference. It's important to build these programs here. Some larger cities have multiple institutions and more extensive resources, but patient needs remain the same. I enjoy supporting patients with MS and collaborating with colleagues across the country, both the research and clinical side of my work. It was definitely the right career choice for me."