Melanie Ursell, M.D., M.Sc., FRCPC Neurology

Dr. Melanie Ursell, Consulting Neurologist, South Muskoka Medical Centre, Bracebridge, Ontario; Assistant Professor, Northern Ontario School of Medicine.

Dr Ursell holds an M.Sc. in Biochemistry from the University of Toronto where she carried out basic research into abnormalities in the myelin of people with MS. She also completed a clinical research fellowship at the University’s St Michael’s MS Clinic where she was involved with one of the initial dose finding studies looking at Vitamin D3 and its role in the treatment of MS. Most of Dr. Ursell’s practice is centered around the management of patients with MS and MS related research activities. She offers a weekly clinic dedicated to MS serving a broad geographic area of MS patients in Northern and Eastern Ontario regions.

“… there is great optimism for patients with MS in the workforce today.”

1. What is Multiple Sclerosis (MS)? What is its impact on patients?

Multiple Sclerosis (MS) is an “autoimmune” disease where a person’s immune system attacks its own body tissues – in the case of MS, this abnormal attack is thought, at least initially, to be directed against the fatty insulating sheath of nerve cells (called myelin) of the brain and spinal cord, which comprise the central nervous system (CNS). Overall, MS impacts patients at two major points: during a “relapse” when the immune system is attacking the CNS; and during a chronic period when symptoms arise from previous damage and scar tissue. It is important to prevent relapses with effective therapies because at least 40% of relapses can cause residual and permanent disability which can accumulate over time.

2. How is MS Managed?

There are three aspects to managing MS:

• Prevention – Disease Modifying Therapies (DMTs):  DMTs are the mainstay of MS treatment. They prevent relapses. By decreasing the chances that the immune system can attack the CNS, they prevent the formation of scar tissue and resulting permanent disability.


• Relapses: Relapses occur unexpectedly. Patients have no control over when the disease will become active and there is nothing they can do to prevent disease activation when it occurs. A debilitating relapse is usually treated for three or four days with high doses of steroids. Patients need a few days off work for treatment and recovery.  


• Symptoms:  Even patients who are stable on DMTs have symptoms that can fluctuate from day to day due to past inflammation and previous scar tissue.  Certain medications and therapies, such as physiotherapy, occupational therapy, massage therapy and acupuncture, help manage the day-to-day episodic symptoms of MS.

3. How has the treatment landscape changed?

Early aggressive therapy with DMTs can keep patients neurologically normal – that is our ideal goal. The original DMTs from the 1990s could stop about one third of relapses which would otherwise occur on average once every two years without treatment. Today’s therapies are stronger, have fewer side effects and can suppress anywhere from 50% to 80% relapses. Some can even put patients into remission for many years. 

MS is most active in its first two to five years after initial onset – when the immune system seems most aggressive and causes relapses and lesions in the CNS monitored by MRI imaging.  Because most of our treatments are only effective in the inflammatory stage of the disease, it is very important to treat MS with the most efficacious therapy as early in the disease course as possible.   It is now believed that early and aggressive therapy in this stage can delay or even prevent transition into a progressive, or more neurodegenerative phase of the illness that is more difficult to treat.

Fortunately, for the first time in MS treatment history, a new drug has shown efficacy in progressive MS which worsens without remissions.  This is a very exciting development that could keep patients with more advanced or progressive MS productively in the work force.

4. How will these changes impact the workplace?

When the new, stronger treatments are used early, patients do much better and the impact of MS on the workplace is greatly reduced. Fewer patients are absent due to relapse, and because the scar tissue left by each relapse is what leads to the day to day symptoms of MS, patients will feel better and be on fewer symptomatic medications. With effective therapy, most can live normal productive lives.

5. What can employers do?

Employers can ensure their benefit plans assist with the cost of the new, highly effective DMTs. The investment has huge pay offs in reductions in absenteeism, disability claims and early retirement. Funding support for non-pharmacologic treatments is also very important. They do not have the side effects that are associated with medications, and help keep MS patients well.   

Finally, it is important to educate employers and colleagues. Perceptions of MS must change. Canes, walkers and wheelchairs should no longer be symbols of MS – most patients started on the stronger new therapies may never need them. People with MS can now work as effectively and as long as their colleagues without MS. With the proper therapies and support, there is great optimism for patients with MS in the workforce today.bh