By Dr Agne Straukiene, Consultant Neurologist, Torbay and South Devon NHS Foundation Trust.

Dr Agne Straukiene

Dr Agne Straukiene is an MS Brain Health 2022 award-winning neurologist with a special clinical interest in MS for 14 years. With a focus on helping patients live a long, healthy, and present life, she is passionate about taking an integrative approach to promote a healthy lifestyle. Dr Straukiene is a founder and host of the BeewellwithMS podcast. She has pioneered a number of digital technology projects and regularly consults NHS, pharmaceutical and digital technology companies. She is also leading on number of research projects in MS.

Like an orchestra, the connection between the body and brain is a beautiful thing, with no individual organ or emotion playing the composition alone. When one instrument is out of sync, inharmonious chaos can reign and what the musicians are trying to communicate gets lost. For patients with Multiple Sclerosis (MS), symptoms can be experienced across many instruments simultaneously, resulting in the intricate connection between mental and physical health being disrupted and the person feeling helpless and ‘out of tune’. 

Mental health disorders, such as depression and anxiety are common accompaniments to the physical symptoms of MS, negatively impacting an individual’s quality of life.[i] In a study by Marck et al. (2016), it was shown that 32% and 29% of respondents with MS reported living with depression and anxiety, respectively.[ii] In an orchestra, the interconnectivity of the instruments to produce a harmonious tune can be influenced by external factors, from a noisy crowd to bad acoustics. The same can be said for a person’s mental and physical health being greatly influenced by lifestyle factors including diet, smoking and physical activity.[ii][iii]  
 
One of the greatest challenges we as healthcare professionals face is encouraging patients with MS to be proactive in adopting coping mechanisms that will help them with any mental health issues they may experience. By withdrawing from co-therapies and MS support services, and not engaging with the full suite of mental health support available to them, patients can experience exacerbated mental and physical symptoms.[iv][v]

That’s exactly why I strive to follow three steps, ‘Listen, Learn, Lure’, to ensure a holistic approach during consultations – to not only focus on the instruments playing the wrong notes, but to help the whole orchestra get back in tune.
 
Listening intently to what patients are telling us comes naturally to many of us in the healthcare profession, although looking for what the patient is not telling us may provide an equally important insight on their mental and physical condition. In today’s world where many appointments are carried out virtually, it is crucial for us to treat video consultations as a window into a patient’s life. By observing body language, tone of voice and surroundings it can help to determine the patient’s emotional state, if they are feeling frustrated or anxious due to their condition, and overall, help to assess their level of engagement with treatment and everyday life.
 
Learn through the consultation to understand where patients are in their medical journey and assess their readiness to receive support for their mental health. The time constraints of consultations often increase focus on physical symptoms as these can be easier to explain and address. However, by directly asking patients to assess, on a scale of 1-10, their need or readiness to gain help for their mental health, it is possible to identify other therapies adjunct to medicinal treatment that may support their disease management. Asking this question regularly will help determine when to offer these therapies – for example, offering weekly MS exercise sessions to an individual may not be effective if they are in a busy or stressful period of their life as they may not feel ready for a weekly commitment.
 
Lure patients into positive change by taking time to explain the rewards of self-referral and the benefits that complimentary therapies can have on both mental and physical wellbeing. For example, mindfulness, physical activity, and social connection.

  • Research exploring the neuronal explanation of the stress-reducing effects of Mindfulness Based Stress Reduction (MBSR) over 8 weeks demonstrated that MBSR led to changes in the amygdala consistent with improved emotional regulation.[vi]
  • The effect of combined exercise training was shown to improve Brain-Derived Neurotrophic Factor (BDNF) levels, a molecule shown to play a key role in depression and cognitive impairment, along with balance, functional exercise capacity and fatigue in patients with MS.[vii][viii][ix]
  • Additionally, in a study looking at healthy ageing across 600 older MS patients (between ages 55-88), respondents identified social connections, including engagement with support groups and community organisations, as key to helping them live a long and healthy life with MS.[x]

Most crucially, we must encourage patients to fully engage and share the full story of how each instrument is ‘playing’. By understanding the full picture, we can then provide the highest level of holistic support, in accompaniment to medical treatment, to help keep all instruments in tune and the orchestra playing in harmony.

This feature has been funded by and developed in conjunction with, Janssen-Cilag Ltd. The views expressed in this article are the author’s own.
CP-368048
February 2023

References

  1. Hadgkiss, E.J., Jelinek, G.A., Weiland, T.J., Pereira, N.G., Marck, C.H. and van der Meer, D.M., 2013. Methodology of an international study of people with multiple sclerosis recruited through web 2.0 platforms: demographics, lifestyle, and disease characteristics. Neurology Research International, 2013.
  2. Marck, C.H., Neate, S.L., Taylor, K.L., Weiland, T.J. and Jelinek, G.A., 2016. Prevalence of comorbidities, overweight and obesity in an international sample of people with multiple sclerosis and associations with modifiable lifestyle factors. PloS one, 11(2), p.e0148573.
  3. Hadgkiss, E.J., Jelinek, G.A., Weiland, T.J., Pereira, N.G., Marck, C.H. and van der Meer, D.M., 2015. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutritional neuroscience, 18(3), pp.125-136.
  4. Ackerman, K.D., Heyman, R., Rabin, B.S., Anderson, B.P., Houck, P.R., Frank, E. and Baum, A., 2002. Stressful life events precede exacerbations of multiple sclerosis. Psychosomatic medicine, 64(6), pp.916-920.
  5. Chwastiak, L.A. and Ehde, D.M., 2007. Psychiatric issues in multiple sclerosis. Psychiatric Clinics of North America, 30(4), pp.803-817.
  6. Gotink, R.A., Meijboom, R., Vernooij, M.W., Smits, M. and Hunink, M.M., 2016. 8-week mindfulness based stress reduction induces brain changes similar to traditional long-term meditation practice–a systematic review. Brain and cognition, 108, pp.32-41.
  7. Ozkul, C., Guclu-Gunduz, A., Irkec, C.E.Y.L.A., Fidan, I.Ş.I.L., Aydin, Y., Ozkan, T.A.Ş.K.I.N. and Yazici, G.Ö.K.H.A.N., 2018. Effect of combined exercise training on serum brain-derived neurotrophic factor, suppressors of cytokine signaling 1 and 3 in patients with multiple sclerosis. Journal of neuroimmunology, 316, pp.121-129.
  8. Zhang, J.C., Yao, W. and Hashimoto, K., 2016. Brain-derived neurotrophic factor (BDNF)-TrkB signaling in inflammation-related depression and potential therapeutic targets. Current neuropharmacology, 14(7), pp.721-731.
  9. Prokopova, B., Hlavacova, N., Vlcek, M., Penesova, A., Grunnerova, L., Garafova, A., Turcani, P., Kollar, B. and Jezova, D., 2017. Early cognitive impairment along with decreased stress-induced BDNF in male and female patients with newly diagnosed multiple sclerosis. Journal of Neuroimmunology, 302, pp.34-40.
  10. Wallack, E.M., Wiseman, H.D. and Ploughman, M., 2016. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Multiple Sclerosis International, 2016.