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AMA: The Many Faces of MS with Dr. Annette Okai

Good evening and welcome, My MSAA Community, to our Ask Me Anything with Dr. Annette Okai! We are excited to have Dr. Okai joining us to answer YOUR questions.

Annette Okai, MD is a neurologist in Dallas, Texas and specializes in multiple sclerosis. She is affiliated with Baylor University Medical Center.

For the next hour, please feel free to ask Dr. Okai your questions about diversity and MS as a reply to this post. Don’t forget to keep refreshing the page to see the latest questions and responses.

Bring on your questions!

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41 Replies
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Excited for another AMA.....

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Hi Dr. Okai welcome back!

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To start off, we'd like to share a question from our clients: Are there differences in how MS affects various patient populations?

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in terms of ethnicity, we have observed that MS affects people of color differently from their caucasian counterparts

Hispanics and Afr Americans tend to have a more severe disease course

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Do we know why Hispanic and African American populations tend to have a more severe disease course?

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At this time, we don't know the exact reason why. We see the lesions are more prevalent in the spinal cord and optic nerves of this population. These areas tend to produce more disability. Studies to find out the reason for this are needed

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I have a question about learning there are so many more ppl being dxn with MS now. Are they able to narrow the areas down also?

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can you be more specific? are you referring to geographic areas?

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Yes, sry

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for a long time, the theory was that the further away from the equator, the higher the risk of MS. With a newer and refined diagnostic criteria, we are seeing more people diagnosed in all regions. ie. I practice in Dallas and in that area, the diagnosis rate is robust.

I think we have a better diagnostic criteria that is enabling us to diagnose more people early on

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is ocrevus really rituxan? I know the patent expired for Rituxan

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Ocrevus and rituximab differ in the way they are made. While they may share a common core molecule, Ocrevus has more human protein, while rituximab has more animal protein

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ok

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does biotin affect blood test? If so when should a person stop taking it before their blood work?

Thinking about taking it because I read my hair may fall out with ocrevus

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Biotin normally affects the thyroid test of patients. We advised patients to stop taking supplement about 5 days prior to testing

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Here's another question from our clients: Are specific symptoms more prevalent in some people with MS compared to others?

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Motor impairment including difficulty walking are more prevalent, due to spinal cord lesions. African Americans have a faster rate to use of cane and wheelchairs, likely due to this

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can u tell me about neurcognitive test? what does this test determine?

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Neurocognitive testing is a great way to assess the overall cognitive function of patients, especially since time does not permit during an office visit.

It assesses memory, thought processing speed, eye hand coordination and gives the doctor an idea of how a patient will function under certain conditions

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also can you tell me about neuropsychological evaluation? what does that evaluation determine?

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neurocognitive and neuropsychological evaluation is the same. The terms are interchangeable

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During MSAA’s recent podcast on this topic, we discussed the importance of diversity in clinical trials. Can you talk a bit more about this topic?

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It is important that the clinical trials represent the population that will use the drug.

historically, most trials the majority of patients were caucasians. With more people of color being diagnosed, Afrcan Americans, Hispanics and Asians, it is important that they are included in the trials. This will also inform us if there are any differences in how they respond to therapies as well

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With the double blind studies, often I see that some ppl don't get a DMT, isn't that a risk to the patient?

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In the past, Double blind studies included placebo because

1. to see how the drug worked compared to no treatment and

2. there weren't a lot of approved therapies

Now that is hardly the case, in most of our recent clinical studies, most patients are on therapy in the double blind studies, it is usually an established/ approved therapy and the drug that is being tested

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That clears up Alot! Thank you!

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have you prescribed occupational therapy for fatigue? What would they cover during those sessions?

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usually, physical therapy for fatigue is a good way to build up endurance and improve fatigue.

prioritizing task and energy conservation technique are tools that are used to help with fatigue

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Another question from our clients: Are different treatments prescribed for different patient populations?

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Recent MS medication approval has been indicated for patients with progressive MS and active secondary progressive MS. In the past, it was mainly the relapsing MS population. Now we have therapies that has been shown effective in a variety of patient population

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Another question we're sharing from our clients: Do we know why more women than men are affected with MS?

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We think that women are more affected because of the autoimmune process. They are more susceptible to autoimmune diseases. The hormone factor is another reason that is given for higher number of women being diagnosed with MS

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Is it possible to have started with RRMS move to SPMS then get PPMS? Is this something they are charging?

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Changing*

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Most RMS move to SPMS. PPMS starts from the beginning and continues that way.

In the RMS to SPMS patients, RMS patients have more inflammation and SPMS patients experience more degeneration

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Got it thank you!

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Are there any takeaway messages you would like to share with the Community about MS?

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We are still learning a lot about MS, but what we know so far, is that taking disease modifying therapy, along with a healthy life style including healthy eating and physical activity goes along with a good quality of life

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We do appreciate the time you took to spend with us Dr. Okai! Thank you so much!

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On behalf of everyone here at MSAA, we thank Dr. Annette Okai for her time and expertise, as well as our My MSAA Community members who have participated and asked questions! We would also like to thank Celgene and Novartis for supporting this AMA through an educational grant. For more information about how MS affects diverse populations, we encourage you to check out our latest podcast, The Many Faces of MS: Exploring Diversity Within Multiple Sclerosis, which can be streamed at: mymsaa.org/msaa-podcasts/03...

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It was a pleasure doing another AMA. I appreciate the great interactions.

Looking forward to another one

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