Jennifer S. Graves, MD, PhD
Dr. Jennifer Graves is a board-certified neurologist at the Multiple Sclerosis Center at UCSF Medical Center and UCSF Benioff Children's Hospital. Her expertise includes adult and pediatric demyelinating disease, which are disorders of the nervous system such as multiple sclerosis in which the myelin sheath of neurons are damaged, and neuro-ophthalmic disorders, or visual disorders related to the nervous system.
Graves earned a medical degree and doctorate in biophysics at the University of Texas Southwestern Medical School in Dallas. She completed a residency in neurology as well as a fellowship in neuro-ophthalmology at the University of Pennsylvania in Philadelphia. She completed additional fellowship training in multiple sclerosis at the UCSF adult and pediatric multiple sclerosis centers. In research, her studies include modeling the interactions between genetic, environmental, and sex-related risk factors for developing demyelinating diseases and the effects of these risk factors on relapse rate and disability. She has received awards from the National Multiple Sclerosis Society, the Race to Erase MS and Foundation for the Consortium of Multiple Sclerosis Centers. She is currently Assistant Professor of neurology and ophthalmology at UCSF.
Q: What kind of research is being done right now?
While nearly all aspects of MS are being studied across the globe, there has been a call to action by most funding agencies to study the progressive phase of the disease. Halting disability progression is a key step to eventually curing people of the disease. Approaches include stimulating cells to replace the damaged myelin covering of nerves, developing treatments to prevent nerve cell death, and finding early aggressive treatment of the disease.
Q: My MS specialist offered me a new infusion that’s due to gain FDA fast track approval. How is this new drug different from the others?
This medication targets a type of cell called the B cell, distinguishing it from other types of MS medications. Unlike other medications that have been tested, there’s evidence of mild reduction of disability progression in primary-progressive MS (PPMS). There are currently no FDA-approved treatments for PPMS. This infusion is anticipated to be reviewed by the FDA in December 2016.
Q: How do you decide if you should stay with your current treatment or switch to a new one?
If you feel well, have stable findings on your physical exam and MRI scans, and have no side effects from your current medication, there would be no immediate reason to change medications. However, if one of the statements is not true (you don’t feel well or have side effects or new disease activity), it would be appropriate to discuss other therapies with your doctor.
Q: What is the “waiting period” after switching treatments to see if the new one is working?
This varies, depending on the medication. For the injectable therapies and for dimethyl fumarate (Tecfidera), we would typically give the drug at least 6 months to work. Fingolimod (Gilenya) and natalizumab (Tysabri) typically work more quickly.
Q: What new developments or improvements in treatments can we expect to see within the next few years?
I think we will have some type of re-myelination-promoting medication in the next few years available for patients. The key question, however, is how well this type of medication will work to truly alter the course of the disease.
Q: What MS treatments and medications are safe for women who wish to become pregnant?
This topic requires a careful, personalized consultation with a doctor. Many women may be able to safely stop medications during pregnancy, as pregnancy itself is protective against relapses. However, there’s a risk of relapse in the post-partum period.
Although this decision must be tailored to the patient’s clinical needs and health history, some general rules are:
- the injectables are likely safe in pregnancy based on registry data,
- all 3 oral agents should not be used in pregnancy,
- and with certain precautions, natalizumab (Tysabri) may be appropriate for some women to continue in the first to second trimesters of pregnancy.
Q: One of my symptoms is constant, debilitating dizziness. What treatments or remedies should I consider?
The first thing to establish with your doctor is what type of dizziness you’re having: “room-spinning” sensation, rocking sensation, visual abnormalities, or light-headedness. It’s important to provide your doctor with very specific descriptions of what you’re experiencing. A thorough neuro-ophthalmological and vestibular exam can be helpful. There are medicines that can reduce room-spinning sensations and vestibular therapy can also be used. We would review carefully your medications to see if any are likely contributors to the dizziness symptoms.
Q: What is being studied for secondary progressive MS?
Some of the current and in-development medications for MS are being evaluated for efficacy in secondary progressive MS (SPMS). Unfortunately, no large effects have been seen to date.
Q: Besides the National MS Society, what other organizations are working on research for the disease?
The federal government invests in MS largely through the National Institutes of Health and the Department of Defense. Additionally, pharmaceutical company investigator grants, individual philanthropic donors, and individual research institute grants also make research possible.
Other organizations include:
- Race to Erase MS
- Accelerated Cure Project
- Conrad N. Hilton Foundation
- The Consortium of Multiple Sclerosis Centers
This list isn’t exhaustive, but it shows that several other organizations are investing in MS research.
Q: Is there any new hope for a cure for MS?
We are living in a period of rapid development in the field of MS, and I am optimistic that within the next 5 to 10 years, we will have achieved significant advances, and maybe even have identified the cause or found a cure for the disease.
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