From access to the latest FDA-approved therapies to patient education and symptom management, the Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital provides the full spectrum of multiple sclerosis care.
Four years ago, Nyack Hospital started a comprehensive multiple sclerosis center staffed by Jai S. Perumal, MD, Assistant Professor in the Department of Neurology and Neuroscience at Weill Cornell Medical College and Director of the Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital, with the expectation that it would meet a community need throughout Rockland County. Since that time, the center has grown exponentially.
An additional provider, Jennifer Reardon, CNRN, certified multiple sclerosis nurse and advanced nurse practitioner, joined the Nyack Hospital team soon after its inception. The center now serves a population of roughly 500 patients from Westchester, Rockland, Sullivan, Orange and Dutchess counties, as well as from Pennsylvania and Northern New Jersey, and it continues to grow. A provider is available on-site four days a week, and both Dr. Perumal and Reardon are available 24/7 to address any urgent issues.
In 2014, the center received designation as a Center for Comprehensive MS Care through the National Multiple Sclerosis Society’s Partners in MS Care program.
“We have built this center from the ground up, and it was an honor to receive recognition from the National Multiple Sclerosis Society,” Dr. Perumal says.
“Prior to coming to Nyack Hospital, I worked at a hospital in Manhattan that had a well-established multiple sclerosis center,” Reardon adds. “I’m now giving the same quality care I provided in Manhattan, but in an environment that is much more convenient and accessible to patients.”
In October 2015, the center moved into a new space on the Nyack Hospital campus. Now known as the Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital, the center is planning for further growth, including the launch of a clinical research program.
An All-encompassing Treatment Destination
Jennifer Reardon, CNRN, evaluates a patient’s gait and balance by monitoring ambulation down a corridor as part of a complete assessment of the patient’s neurological status.
Indications for referral to the Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital include a confirmed or suspected diagnosis of multiple sclerosis or the presence of other neuroinflammatory diseases, such as transverse myelitis or optic neuritis — which can be presenting signs of multiple sclerosis — and neuromyelitis optica. Presenting symptoms that may warrant a referral for a multiple sclerosis evaluation include fatigue, bowel or bladder dysfunction, paresthesias, blurred and/or double vision, and muscle weakness. The Center for Diagnostic Imaging at Nyack Hospital offers state-of-the-art MRI allowing patients to receive the imaging necessary to diagnose multiple sclerosis and monitor disease progression on-site.
Though there is currently no cure for multiple sclerosis, the number of drugs available to slow disease progression and prevent exacerbations has expanded greatly throughout the last decade. The FDA has approved seven injectable medications, three oral medications and three infusion therapies, with new drugs on the horizon.
“Because we are affiliated with an academic center, we are familiar with the latest drugs on the market,” Dr. Perumal says. “Our knowledge of each medication and its potential adverse effects well equips us to find the drug that will be most effective, depending on the aggressiveness of the patient’s particular disease state, and to monitor patients on treatment carefully.”
Meetings are held regularly to collaborate on optimizing patient care and to discuss new research and developments in the field.
“Multiple sclerosis is not a uniform disease,” Dr. Perumal says. “While some patients have relatively mild symptoms even years into the diagnosis, we see other patients with aggressive disease that causes an irreversible disability soon after disease onset. Emerging data suggests that the earlier we treat the disease, the better the long-term outcomes. Our goal is to identify patients at risk for accelerated disease progression so we can start them on the most aggressive, effective treatments as soon as possible.”
The infusion center at Nyack Hospital is certified to offer all approved intravenous medications, including Lemtrada (alemtuzumab), natalizumab, and also IVIG and IV steroids, which are used in the treatment of MS as well. Dr. Perumal and Reardon have built a collaborative network of neuro-ophthalmologists, urologists, primary care physicians, rehabilitation specialists, and other providers from Nyack Hospital and neighboring institutions. These specialists work together to address symptoms and help patients regain functioning following a relapse. Because of Dr. Perumal’s affiliation with Weill Cornell Medical College, patients can also benefit from consultation with specialists in Manhattan when necessary.
Managing Symptoms, Preserving Quality of Life
One of the challenges of multiple sclerosis management is helping patients regain and retain functional status, as the symptoms of the disease can greatly impact quality of life.
“In medicine, we often focus solely on treating diseases, and in the case of multiple sclerosis, our overall goal is to slow disease progress and decrease the number of exacerbations patients experience,” Reardon says. “However, proper multiple sclerosis care goes beyond managing the disease process. We also need to consider each patient’s current quality of life. At the multiple sclerosis center, we don’t just ask patients, ‘When was your last relapse?’ We look at related factors, such as depression, and work to identify ways we can help patients remain as active as possible.”
“When providers refer to us, they can rest assured that their patients are getting comprehensive care and that they will receive constant communication regarding their patient’s condition. In health care, there is a current push to keep patients out of the hospital, and that is only achieved when patients are thoroughly evaluated and there is a strong relationship between specialists and referring physicians.”
— Jennifer Reardon, CNRN, certified multiple sclerosis nurse and advanced nurse practitioner at the Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital
Dr. Perumal provides care focused on slowing disease progression and minimizing symptoms, while also working closely with staff to address patients’ quality-of-life issues.
A variety of medications is available to address multiple sclerosis-related bowel and bladder dysfunction, fatigue, spasticity and tremors, gait disturbances, dizziness, depression, and anxiety. Reardon also encourages other measures, such as lifestyle modifications, physical activity and counseling.
The expanded Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital provides the space necessary to hire additional providers. Plans are in place to bring in a research coordinator and a social worker in the near future. Having a social worker who provides case management services ensures patients receive assistance with disability paperwork and insurance claims. Even more important, however, an on-site social worker will mean greater access to psychological support for underlying depression and anxiety.
Compared to the general population, the 12-month incidence of major depressive disorder is nearly doubled in patients with multiple sclerosis, according to a literature review published in Psychiatric Clinics of North America. Patients with multiple sclerosis also have an increased risk of clinically significant depressive symptoms and anxiety disorders and may be more likely to attempt suicide. Addressing depression and anxiety by connecting patients with therapists who can recommend behavioral modifications to cope with depressive symptoms can improve quality of life and treatment compliance.
Jennifer Reardon, CNRN, performs a thorough neurological examination of a patient.
Physical activity is also an important aspect of improving functional status and quality of life and may enhance mood. Reardon frequently connects patients with resources provided by the New York City – Southern New York Chapter of the National Multiple Sclerosis Society, which include yoga classes that can be modified as needed for nonambulatory patients. The team also frequently collaborates with rehabilitation professionals from Helen Hayes Hospital to arrange speech, physical and occupational therapy and equipment evaluations to see if patients could benefit from adaptive equipment, such as a walker or wheelchair. They hope to be able to offer some rehabilitation services at the center soon.
The Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital team also works with patients to coordinate supportive services, such as smoking cessation classes and home health. If symptoms such as fatigue or muscle stiffness and weakness are interfering with a person’s ability to stay active or perform his or her job, Reardon commonly works with employers to arrange for schedule and disability accommodations.
“Some patients feel more fatigued or experience greater stiffness at certain times of the day,” Reardon says. “Identifying peak energy levels, for example, allows us to help patients tailor their schedules so they can perform activities when they feel the most alert.”
At the Forefront of New Treatments
Mrs. Madlyn Borelli, for whom the Madlyn Borelli Multiple Sclerosis Center is named
Dr. Perumal is heavily involved in multiple sclerosis research, including the investigation of new clinical therapies. Her specific research interests include the influence of ethnicity on disease presentation and course and defining multiple sclerosis disease phenotypes — two areas she is currently investigating through ongoing projects at Weill Cornell Medical College.
To that end, Dr. Perumal is studying populations of patients to determine how to recognize patients with aggressive disease early in its course so effective treatment can be started to prevent long-term disability. Dr. Perumal is also researching the influence of ethnicity on multiple sclerosis in terms of disease presentation and susceptibility-specific treatments.
“We know that African-American patients with multiple sclerosis present differently than Caucasians with multiple sclerosis,” Dr. Perumal says. “Our current research is focused on comparing newer treatments in African-American and Caucasian patients to see if the treatments affect the disease process differently.”
Dr. Perumal is also involved in the multicenter SPRINT-MS trial, which is being conducted through the National Institutes of Health-funded NeuroNEXT (Network for Excellence in Neuroscience Clinical Trials) and a private-public partnership between the National Institutes of Health, MediciNova and the National Multiple Sclerosis Society. The SPRINT-MS trial is investigating the safety, tolerability and efficacy of ibudilast in 250 male and female participants between the ages of 21 and 65.
Dr. Perumal has already begun preparations for a clinical research program to be offered at the new center.
Nyack Hospital currently doesn’t participate in clinical research programs because of space limitations, which will no longer be a problem in the expanded center. A database to host clinical research projects is currently in development, and although the clinical research program will run independently of Weill Cornell Medical College, Dr. Perumal plans to structure the program similarly. Capabilities will be in place to host Institutional Review Board-approved site-specific research projects, as well as participation in multicenter phase 3 and 4 clinical trials. While enrollment for the SPRINT-MS trial has closed, Dr. Perumal is positive that Nyack Hospital will be able to participate in similar trials.
“Our goal is to be a center of excellence for multiple sclerosis and other diseases that cause inflammation of the central nervous system,” Dr. Perumal says. “When patients are diagnosed with multiple sclerosis, physicians want to refer their patients to an expert, but they need the experts to be accessible. We provide top-level, high-class care that is close to home. Looking to the future, our capabilities will only continue to grow. We will not only house more personnel and additional services, but also accommodate a greater number of patients and offer access to the latest trials and innovations.”
For more information about the Madlyn Borelli Multiple Sclerosis Center at Nyack Hospital, visit nyackhospital.org.