Early Diagnosis and Aggressive Treatment are Key to MS: Amy Gutierrez, MD

Feb 13, 2020 at 11:38 am by pj


 Amy Gutierrez, MD, FAANS

 

This is how it usually starts. A patient appears in the office of Amy Gutierrez, MD; it’s almost always a woman, seemingly healthy, in her twenties. But something is wrong: She’s having strange tingling in one leg.

The young woman adjusts her glasses and mentions that she remembers that a few years ago, she had a similar tingling, but that it had stopped, and she just chalked it up as a running injury. She never mentioned it to her doctor.  Now, however, the tingling is back, and it’s harder for her to run because sometimes she seems uncoordinated. Her doctor was puzzled and referred her to Gutierrez, a neurologist at Orlando Health. Gutierrez asks her about her glasses. The woman smiles and says she needs a new prescription; her left eye feels a little blurry.

When the radiology report comes back, it confirms what Gutierrez suspected. Lesions – little scars – on certain nerves, where the young woman’s immune system has begun to attack her own central nervous system (CNS). It’s the telltale sign of Multiple Sclerosis. She already has two dozen of these lesions, and now it’s a race against time to stop more from forming. If Gutierrez and her team at the Orlando Health Multiple Sclerosis Comprehensive Care Center can stop more lesions from developing, the young woman might be able to manage the disease and mitigate its worst symptoms. Without treatment, she might need to use a walker or a wheelchair by the age of 40.

“Early recognition and diagnosis of MS, and early intervention and treatment are very important,” said Gutierrez.  “Typical early symptoms include numbness, tingling, weakness, incoordination, loss of vision and poor balance.”

MS causes inflammation that damages myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves, and the specialized cells that make myelin. “The disease is always going to attack the central nervous system and that is composed of the optic nerves, the brain and the spinal cord,” said Gutierrez. “But no two patients are going to develop lesions in the same places. Each patient is unique.”

It’s estimated by the MS Society that about a million people in the United States are living with the disease. It strikes women nearly three times as frequently as men, according to the Society, and it usually strikes them between the ages of 20 and 30.

“The disease was described in the 1600s,” said Gutierrez. “So, we have known about demyelinating disorder for hundreds of years, but no effective treatment was available until 1993. As a result, we have natural history data available that shows that patients 10-15 years after diagnosis would need ambulatory assistance, such as a cane or a walker, or in some cases even be in wheelchairs.”

But that changed in 1993 with the development of new treatments that manipulate the immune system in such a way that inflammation and subsequent demyelination around the nerves is stopped without destroying the system’s ability to ward off other diseases.

“Now patients can go many years, 20 or 25 years without having an impairment in their gait,” said Gutierrez. “Now our medicines are much more sophisticated at manipulating the immune system so that our outcomes are much more successful.”

Gutierrez was recruited by Orlando Health in 2018 to step into the leadership role created by Stephen Rosenberg, MD, FAAN, who is transitioning into retirement. After 25 years as co-director of the Orlando Health Brain Injury Rehabilitation Center, Dr. Rosenberg and Victor Robert, MD, and Debbie Chandler, PhD, created what is now the Orlando Health Multiple Sclerosis Comprehensive Care Center, the only comprehensive MS Center in Central Florida as designated by the National MS Society.

“The center is a multidisciplinary center where we have specialist occupational therapists, physical therapists and speech therapists that are all certified in treating patients with MS,” said Gutierrez. “I was recruited down from my previous life in New Orleans where I ran the MS Center there at Louisiana State University. So really my work here has been to grow the clinic, establish avenues of research for the clinic, and to recruit others with MS specialties. We probably have 2,500 patients, because we also serve as consultants to the community and to the hospital for patients who have complicated MS cases.”

One of the factors that attracted Gutierrez to the role is the opportunity to help teach new doctors about MS and how to spot early symptoms. “I’m passionate about teaching other physicians,” she said. “And the transition from academia to Orlando Health has been good, because OH is a very academically minded institution, with more than 200 residents being trained in the OH system, which is amazing. This is a very productive teaching institution for a lot of the residents coming out of Florida medical schools.”

Growing up in New York and Miami, Gutierrez said she always knew she wanted to be a doctor, and she always knew she wanted to study and treat the brain. “I knew I was going to be either a psychiatrist or a neurologist and the nervous system has always been something that just fascinated me.”