Yale's new center has the latest therapies and imaging technology. Consolidating visits and getting results the same day can be just as important.
Daniel Pelletier, MD, and a Kristi Dondlinger, RN, talk to a patient in the infusion room.
(July 2013) When you have multiple sclerosis, you can feel like you’re spending your life traveling from one office to the next on different days to visit four or five different specialists. If you use a cane, walker or wheelchair, just getting out of the car is difficult.
Making life easier was a top consideration in moving the Yale Multiple Sclerosis Center to North Haven, about a 10 minute drive from the main Yale Medical Center campus.
“The plan was to create a one-stop shop for MS,” said Daniel Pelletier, MD, chief of the center and an internationally recognized expert in neuroimaging. He and his colleagues treat local patients from out of state and beyond, at various stages of MS, a chronic
central nervous system disease that causes symptoms ranging from numbness in the limbs to paralysis. In the new building, patients see all of their specialists—and go for imaging tests and lab work—in one building. All of their specialists are onsite and can collaborate on the best course of treatment.
Visits start in a spacious waiting room, where a receptionist greets each patient immediately and begins to access all of that patient’s appointments. The visit will typically begin with an MRI, using a new 3T MRI scanner, located on the lower level. Patients learn the results of their MRI before they go home.
Imaging is key to tracking the progression of MS. But because MRI protocols are not always standardized, physicians have often found themselves evaluating scans so different that it is difficult to discern changes. “You were comparing oranges to apples,” said Dr. Pelletier. The Yale MS Center uses an imaging protocol that has been standardized and tested in studies. Now doctors can get a definitive view of the disease’s progression, which provides better information on whether a given treatment is effective.
The center works with community neurologists to provide this advanced imaging service to their patients as well. “Our goal isn’t to treat every MS patient in Connecticut,” said David Hafler, MD, chair of the Department of Neurology at Yale, who has done extensive research on the disease. “But we want every MS patient in Connecticut to benefit from what we’ve learned.”
Mary Bailey, MD, watches a patient walk down a hallway to track her gait.
Dr. Pelletier refers to his colleagues at the center as “MSologists,” meaning they are focused on multiple sclerosis whether they are clinical neurologists, neuro-ophthalmologists, immunologists, or experts in MS imaging or neuropathology. Patients see them in seven exam rooms, arranged behind the reception area so that a patient can progress from one to the next in a short loop. There is a procedure room for procedures commonly called for in MS, such as spinal taps or bladder ultrasounds. Visual testing specific to MS will be offered at the center. An infusion room with wall-to-wall windows with a view of the woods outside, recliners and individual televisions is available for patients receiving intravenous therapy. An onsite pharmacy supports the infusion program.
The center will soon add a social worker and offer support groups and other services to help patients cope with the disease’s effects on their careers and personal lives. About 10 percent of MS patients are diagnosed before the age of 18, and the disease has different effects in these younger patients whose brains are still developing. So the center also has a new pediatric neurologist, Naila Makhani, MD, focused on MS.
Dr. Pelletier hopes patients will enjoy the amenites. One is free parking right outside the building. Another is the drypoint etchings in the waiting room by a friend of his, artist Elizabeth Jameson, who attended the center’s opening who attended the center’s opening. “Maybe the fact that these beautiful pieces of art are associated with a center that is at the cutting edge of knowledge and technology can provide MS patients some reassurance,” Dr. Pelletier said. “We are really here to help them.”
May 15, 2013
Photos by Robert A. Lisak and Terry Dagradi
Interventional Immunology Center
6 Devine Street
North Haven, CT 06473
Yale School of Medicine is a leading center for MS research. World-renowned neurologist David Hafler, MD, was involved in the discovery of many genetic links to MS. He began researching the disease as a college freshman in the 1970s. “It seemed like a solvable problem in my lifetime,” he recalls. It still does.
Today researchers know the fundamental basis of MS—that it is an autoimmune disease that is related to other autoimmune diseases. “The treatment that works in one disease can work in another,” Dr. Hafler said. With the help of genetics, the next step will be to ascertain which patient should get which treatments. “We’re finally beginning to learn about how to treat this disease,” he said.
Because of Yale’s large and growing involvement in clinical trials, patients at the Yale Multiple Sclerosis Center can often access innovative therapies before they are generally available. Physicians from the MS Center collaborate with those who specialize in other immunological diseases, such as rheumatoid arthritis and inflammatory bowel disease. The genetic similarities to MS of these seemingly unrelated diseases suggest that there may be common therapies.
In addition to standardizing imaging, Daniel Pelletier, MD, and colleagues in his laboratory used image-processing software to quantify and track disease progression. He has also standardized every part of the clinical experience, from the way that blood is drawn to the questionnaires that patients fill out. Patients can choose to let that information be used in research, which will create one of the richest databases available in MS research.
For information about participating in Yale MS clinical trials, visit the MS research page on Yale’s neurology website.