The next generation in MS research: An interview with Dr. Megan Langille

Under the mentorship of Dr. Lilyana Amezcua (medical director of the Multiple Sclerosis Comprehensive Care Center at the University of Southern California (USC)), Dr. Megan Langille is working to identify genetic differences that contribute to the disease course in Hispanic children with MS and to improve quality of care by updating how patient symptoms are assessed.

Dr. Langille also treats uninsured and underinsured children with MS – many of whom have barriers to care such as transportation issues, language barriers and decreased social support – at the Los Angeles County USC clinic. She hopes to address the larger questions of how to overcome socioeconomic barriers to MS treatment. We sat down with Dr. Langille to explore how she became involved in MS research, what she’s learning and where she’s headed.

How did you get involved in MS research?

I developed a strong interest in MS during my training as a pediatric neurology resident. One of my first patients was a 16-year-old girl who had recently been diagnosed with MS. With a background in pediatrics, I hadn’t encountered MS frequently, and had thought of it as a disease that affected adults. As I began working with this girl, who unfortunately had a pretty aggressive start to her disease, I consulted with several specialists and educated myself more about the disease.

Throughout the course of my residency – because everyone knew I had an interest in MS – I tended to get referrals of children with diseases potentially involving damage to nerve fiber-insulating myelin, like MS. It was also during this time when I first made contact with Dr. Amezcua, who has become a mentor for me and helped me develop many of my research ideas.

I am continually amazed and inspired by the strength and grace with which my patients overcome the challenges they encounter. They face a diagnosis and illness that no one at any age should have to live with, and they must do so in the midst of their childhood and adolescence. It is an honor to be there to help guide them and their parents. My role as their physician is to develop a partnership with my patients and their families. I strive to be a resource for them, to provide both up-to-date information and compassionate healthcare.

What are the questions you’re trying to answer through your research?

I’m looking at differences in presentation and disease course between Hispanic children and non-Hispanic children. I’m also exploring how the overall course of the disease is affected by disease-modifying therapies.

How are you addressing these questions?

I just started my National MS Society fellowship in July. Currently I am working on a clinical research project compiling data from pediatric cases of MS in Hispanic children from the USC’s, Children’s Hospital of Los Angeles and Kaiser Sunset. My fellowship has allowed me to expand this project with Dr. Amezcua to identify genetic differences that contribute to disease course by exploring demographic characteristics such as time of migration to the United States. 

I am also working on a prospective project assessing the documentation of children and adolescents with MS in our clinic. I’m looking at symptoms, relapse rates, disease modifying therapy, reason for change to subsequent therapies, adverse effects from specific medications, as well as ancestral background, breast feeding history, family history, vitamin D levels and immigration history. I am hopeful that this project will improve our documentation, encourage better communication between our patients and their physicians, and most importantly, provide insights into risk factors and disease course of children with MS.

This research is in the early stages, so I don’t have a lot of data to share yet, but I did present a poster last year at the American Academy of Neurology conference. I reviewed the records of children whom we had seen in our clinic over the past 10 years. The children in this study had a great tendency to have frequent relapses in the first few years after they were diagnosed and often required switching to a second-line treatment. This sparked another research idea – to explore how specific medications affect the disease course of children with MS.

What would you say excites you most about the research you do?

It is an exciting time to be working in MS research. It would be hard to find another condition in which there has been so much progress in such a short period of time. As new treatments are developed and become available, there is hope of gaining ground over this disease and improving the lives of people with MS. Still, with each advance, new questions are raised. Particularly in children with MS, there is so much about the disease and response to medication that is not yet known. I’m excited to learn more and positively impact their lives through better understanding of MS. I’m also hopeful that as we work to clarify the disease process in children and their response to treatment, we may shed light on the disease as a whole and gain a deeper understanding of MS in adults.

Do you have any advice or information for families who are dealing with pediatric MS?

I think it’s important to be aware that there are now 10 approved treatments for relapsing forms of MS. And there is so much work going on, not only to find new and better treatments, but also to find out what is causing this disease and how to halt progression. There’s already so much we can do to modify the disease course, particularly with early intervention. I think it’s important to have hope.

Where are you headed from here?

After completing my fellowship, I would love to stay in Southern California and be involved in a multidisciplinary clinic. I think the best way to take care of patients is through a holistic approach, addressing multiple needs. Long term, I want my involvement in research and education to contribute to knowledge of MS that will ultimately benefit patients and enhance patient care. 
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