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

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

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

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