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First of all, could you please provide a brief sketch of your educational and professional background?
I obtained my Medical Diploma from the American University of Beirut in 1984 and then went to Cleveland’s Case Western Reserve for specialty training in neurology. After my training there, I followed subspecialty training at Harvard Medical School and completed post-doctoral fellowship before I became a faculty member. With time I was promoted to Professor of Neurology. Afterwards, I was awarded an endowed chair at Harvard and served simultaneously as co-director of the Partners Multiple Sclerosis Center. This is basically my professional and educational profile. I took a leave of absence and accepted a visiting professorship at Harvard when I was summoned back to AUB in 2011 as Head of the Abu Haidar Neuroscience Institute (AHNI), which encompasses basic neurosciences, neurology, neurosurgery and psychiatry. Given that both Lebanon and the region lacked specialized Multiple Sclerosis facilities at the time, we decided to establish a Multiple Sclerosis Center at AUBMC within the AHNI. Although I have recently given up my endowed chair at Harvard, I am still involved in clinical multicenter research trials in the US. 
When was the MS center established?
Multiple Sclerosis is a very interesting disease as it is an intersection between two fascinating fields: immunology and neurology. The center is the only one of its kind in the region and was launched in October 2011. I conducted all the interviews and the selection of staff myself. Our clinical staff consists currently of two physicians, Dr. Yammout and myself, two certified MS nurses, a pharmacist, a managing director, a social worker, executive assistant and so forth.  Psychologists also attend the center after hours to run patient support groups. In addition to the clinical staff, we have a research staff including a research coordinator, a laboratory manager and two research fellows.
 
When a patient arrives at the MS center, he/she is seen first by a nurse. Nurses take a history of clinically-relevant information and subject patients to a cognitive processing-speed test, a walking test, and a test on hand function. Then, the pharmacist obtains their medication history and documents all currently and previously prescribed drugs before I step in to elicit and evaluate this information and make the neurological exam and the diagnosis. 

What is MS?
Our immune system usually fights off germs and cancer cells and provides continuous surveillance of the body. The system is designed to recognize antigens- foreign substances on the surface of cells- and react to them. In Multiple Sclerosis, as is the case with all auto-immune diseases, the immune system identifies harmless self-antigens as foreign and attacks them. In the case of MS, the immune system mistakes myelin- the coating that protects nerve fibers and helps messages travel quickly between the brain and the rest of the body- for a foreign body and reacts against it causing inflammation. The loss of the myelin sheath disrupts signal conduction and may ultimately damage the nerve fibers. 

The inflammation can occur either in parts of the brain or spinal cord and the symptoms vary depending on the location of the affected nerve fibers. Therefore, patients with MS may experience different symptoms such as a disturbance of vision, dizziness, tingling or weakness in the limbs, tremors, problems with bladder control, etc. However, these symptoms can also occur with other diseases and therefore cannot be decisive in the diagnosis. This is why it is highly important to obtain a detailed and accurate medical history and look at the age groups and the typical clinical presentations. MRIs are helpful but the diagnosis remains a clinical one. 

What about treatment?
MS sufferers have now access to numerous treatment options  and  medications. Treatment is an individualized long-term process and patients should be monitored carefully. Regular visits are recommended and if we find that the prescribed medications have failed to control symptoms and stop the disease’s activity, we may need to change the doses or even change the course of treatment. Luckily, the Ministry of Public Health realizes that many patients cannot afford their prescriptions and helps them out by covering the cost of their medications. We also extend assistance to economically disadvantaged patients through the proceeds generated from fundraising activities by the “Friends of MS”, a lay group of individuals who support our center. 

Is Multiple Sclerosis curable?
MS is incurable, but this is the case with many diseases. There is currently no treatment that can cure cardiovascular diseases or hypertension or diabetes. But there are efficacious treatments that can relieve the symptoms, prevent progression and improve quality of life. Unfortunately, people hold and pass on the misconceptions that MS patients are doomed to death or debilitation and this is one of the long-standing myths that we are trying to dispel through our awareness campaigns and educational seminars. We have even made a video in collaboration with the Ministry of Public Health in order to impart a true and positive image of the disease but the video is not being aired regularly on TV.

If symptoms are properly managed, people with MS can lead a normal and productive life, start a family and get around without assistance. 

What is the peak age of diagnosis?
Generally, patients are most likely to manifest symptoms in their twenties and thirties but MS can occur in people as young as six years of age or as old as sixty. 

What are the possible causes of MS?
MS is caused by a combination of genetic and environmental factors. Genetic factors account for 30% of the risk and no single gene is causative but rather a combination of genes.  If one identical twin has MS, the other has only a 30% chance of developing the condition. If MS was completely genetic, then the other twin would have a 100% chance of having it, because the pair have the same genetic makeup. 

On the other hand, environmental factors account for 70% of the risk. Research into environmental factors has uncovered a role for vitamin D deficiency and exposure to a virus called EBV and smoking as risk factors for MS.  

How hard was it for you to balance between work and family?
Now that the kids have grown up, it is not as tough as before. Some things do not come easy but eventually you do what you have to do and a supportive spouse is a key. 


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