Infusion Care for Neurology: What Patients Should Know

Why would a neurologist recommend an infusion instead of a pill, and what should patients expect when they arrive for treatment? Neuro infusion therapy can be used for conditions including multiple sclerosis, myasthenia gravis and Alzheimer’s disease, but the process can feel unfamiliar or intimidating at first.

In this episode of Baptist Health Talk, host Dr. Anthony Gonzalez speaks with Janisse Marin and Leah Marcelin about how neurological infusion therapy works, why it may be recommended, and how care teams help patients through treatment.

•  What neuro infusion therapy is and how it differs from chemotherapy 
•  Why an infusion may be chosen instead of an oral medication 
•  What happens before, during and after an infusion appointment 
•  Common side effects and how patients are monitored for reactions 
•  How infusion therapy is used for multiple sclerosis, myasthenia gravis and Alzheimer’s disease 
•  Why some treatments are designed to slow disease progression rather than immediately relieve symptoms 
•  How education and a coordinated care team can make treatment less overwhelming

Host:
Anthony Gonzalez, M.D.
Chief of Surgery, Baptist Health Baptist Hospital
Medical Director of Bariatric Surgery, Baptist Health

Guests:
Janisse P. Marin RN, MSN
Chief Nursing Officer/Assistant Vice President 
Baptist Outpatient Services

Halena Leah Marcelin, PharmD
Assistant Vice President, Pharmacy Business Affairs & Development
Baptist Health

If you found this episode helpful, we recommend the following for additional information:

Infusion Care for Osteoporosis: What Patients Should Know

The Power of Infusion Therapy: What You Need to Know

Transcript

SPEAKER_02 0:00

Chemotherapy is one type of infusion therapy, but there are many others. For neurology, we may be providing infusion therapy to reset the autoimmune system, maybe provide antibodies to rebalance and regulate the immune system. So when patients hear of infusion therapy, I don't want them to automatically think it's chemotherapy. I just want them to think this is just another way of my medication being delivered to me.

SPEAKER_00 0:25

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_03 0:35

Hello, everyone. I'm your host, Dr. Anthony Gonzales, and welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today we're talking about infusion therapy for the most common neurological conditions. Infusions are used to treat conditions like multiple sclerosis, myasthenia gravis, and Alzheimer's disease. So why would a doctor recommend an infusion instead of just a pill? And can these treatments really make a difference? From managing symptoms to, in some cases, slowing the progression of the disease, we'll cover what patients and families need to know. We are joined today by Janice Marin, Chief Nursing Officer and Assistant Vice President of Baptist Outpatient Services. And Leah Marcelin, Assistant Vice President of Pharmacy Business Affairs Development at Baptist Health. Thank you both for being here.

SPEAKER_01 1:35

Thank you. Thank you for having us.

SPEAKER_03 1:37

All right. So, Janice, let's start with you. What are the basics of neuroinfusion? What is that?

SPEAKER_02 1:43

A neuroinfusion is just a way of delivering medication through an IV into the bloodstream. For neurology, we have several types of different infusions, and infusion therapy has really changed the landscape for diseases that were very difficult to manage over the last 10 years.

SPEAKER_03 1:59

And how is that like chemotherapy, similar or not similar to chemotherapy?

SPEAKER_02 2:04

Absolutely. We get that question from patients all the time. Chemotherapy is one type of infusion therapy, but there are many others. For neurology, we may be providing infusion therapy to reset the autoimmune system, maybe provide antibodies to rebalance and regulate the immune system. So when patients hear of infusion therapy, I don't want them to automatically think it's chemotherapy. I just want them to think this is just another way of my medication being delivered to me.

SPEAKER_03 2:32

All right, Leah. So why wouldn't my doctor just give me a pill? Why is he recommending an infusion for me?

SPEAKER_01 2:39

So sometimes pills are absolutely okay and needed, but with infusion, there may be additional benefits that you get to it. For example, it could be something like it's a more targeted therapy. And so the way the medication works in the patient's body, it's going after the exact mechanism that's causing the underlying uh disease state. It can also be that maybe a pill form doesn't work. You have to take it daily or maybe multiple times a day versus an infusion you could receive once every couple of weeks to every couple of months.

SPEAKER_03 3:10

All right, Janice. So I've been prescribed an infusion therapy by my doctor for my neurological condition. Can you walk me through what I can expect as a patient at one of your centers?

SPEAKER_02 3:20

Sure. So the first visit begins way before the patient even comes to the infusion center. Our team of nurses and pharmacists review the physician order. We review lab work and to ensure that the patient is appropriate to receive care the day of their appointment. When they arrive at the center, the nurse will bring the patient back to the infusion suite. The nurse will review medications, allergies, perform vital signs, and narrowweight care for the patient and letting them know what they can expect before doing and after the infusion. Some of our infusions do require pre-medications to be given, and those are given to lessen the chance of an infusion reaction. Then we start an IV and we hang the medication. But our nurses are not just hanging on a medication and walking away. Our nurses are consistently and constantly monitoring the patient, whether it's through vital signs or through nursing assessments, and they're watching for those potential infusion reactions. Most of our patients require also an observation period after the infusion therapy. It can be anywhere from 30 minutes to an hour. And this is again where we take the opportunity to educate patients on signs and symptoms to watch out for when they should report to their healthcare provider, when to seek additional care. And the goal of this education while they're in this observation period is for patients to really understand what we're doing to them and why we're doing this for them.

SPEAKER_03 4:46

Well, Leah, it sounds like we're doing a lot. I mean, what Janice is describing is a lot. So explain to our viewers what does this treatment look like in regard to time? Am I spending an hour with you? Am I spending the whole day? Do I have to come every day?

SPEAKER_01 4:59

What is it like? So that's a great question. It really depends on the therapy and the patient themselves. Um, some of the therapies can be anywhere, as Janice said, from 30 minutes of infusion and then may or may not have an observation period afterwards. And then some may be hours long. And it could be something to where you're coming once every few weeks. It could be once every few months. And then sometimes there are loading doses that are needed. And so you may come every day for a couple of days. And then once you get those initial doses in, then you come back maybe every few weeks or a few months, as I mentioned earlier.

SPEAKER_03 5:34

All right, Janice, you mentioned that there's an observation period afterwards because we got to watch out and watch the patient. So side effects. What are some of the common side effects that we worry about at these infusion centers?

SPEAKER_02 5:46

Yes, absolutely. So most of our infusions are tolerated very well. But in some cases, patients may experience rash, itchy, itchiness, um, nausea, changes in blood pressure. And sometimes patients will just tell the nurse, I just don't feel right. Something doesn't feel right. This is why monitoring of the patient is such an important part of infusion nursing. The nurse has the ability to stop or start the uh stop or start or slow down the infusion based on the medication protocol. And in the event that the patient's symptoms do not resolve, we also have emergency medications on site. But for the most part, patients can report headache, lingering, fatigue right after the infusion, up to a few days. But some patients leave the center feeling completely normal.

SPEAKER_03 6:32

Right. Wow, great. So, Leah, let's focus a little bit on multiple sclerosis. What is multiple sclerosis? Because obviously these are one of the neurological conditions for neuroinfusion.

SPEAKER_01 6:42

Yeah, so multiple sclerosis is a chronic disease of the central nervous system where the patient's immune system is attacking the myelin sheath, which is the covering over your nerve fibers. And when that happens, it causes inflammation and damage. And so there are infusions out there that help uh reduce that inflammation and the damage that's caused to slow the progression of that disease state.

SPEAKER_03 7:08

So, in regard to these infusions, is these infusions going to be daily, weekly? Uh, am I gonna have to do this for the rest of my life?

SPEAKER_01 7:16

So there are a couple of infusions that are available out there for multiple sclerosis. And so some may be weekly or every few weeks, and others may be um every few months. So it really depends on the therapy that's decided between you and your provider. Um, as far as how long do I have to do it for the rest of my life? Yeah, as far as whether or not you have to do it for the rest of your life, this would be something that would slow the disease progression and you know, bring back the quality of life. And so typically you would continue that therapy unless a new therapy comes out or you can no longer tolerate it.

SPEAKER_03 7:49

All right. So as a newer or neuroinfusion center, we've talked about uh multiple sclerosis. What about myasthenia gravis? Uh, Janice, talk to us about myasthenia gravis.

SPEAKER_02 7:58

So myasthenia gravis is an autoimmune neurologic condition that interferes with communication between the nerves and the muscles. Normally, nerves send signals to muscles to move. In this disease, the immune system mistakenly produces antibodies that interfere with that communication. So the nerves are trying to send messages to the muscles to move, but the message is not getting across. So one of the hallmark symptoms that we see is muscle weakness that worsens with activity and gets better with rest. Some patients may present with droopy eyelids, double vision, issues with speaking, swallowing, chewing. Um, and in severe cases, patients may experience difficulty breathing because those muscles can be affected.

SPEAKER_03 8:45

Well, okay, so infusion, how does infusion help them? And what does that treatment protocol look like?

SPEAKER_02 8:51

So for myastina gravis, um, infusion can certainly be primary therapy or as an adjunct therapy. Um, we do have oral medications for myastina gravis, but for those patients who our symptoms still persist, infusion therapy or injectables can certainly be part of their treatment plan.

SPEAKER_03 9:09

All right. So now lastly, Alzheimer's, Leah. Alzheimer's disease. What is that? I mean, obviously we that's common, common in our community and in our society, but explain to our viewers what is Alzheimer's.

SPEAKER_01 9:20

Yeah, so Alzheimer's is a disease where you have cognitive decline. Um, and it could be seen as uh, you know, you have um cognitive decline or dementia that develops. And this is a result of different things like amyloid uh proteins that build up in the patient's brain. And so there's been a lot of therapies that have come out for um uh Alzheimer's disease. And those therapies, what they do is they they uh attack the process with that amyloid build and they try to slow that down.

SPEAKER_03 9:51

All right. And is that something that somebody has to do frequently, uh, you know, in regard to weekly, monthly?

SPEAKER_01 9:59

So just like with all the other infusions, it really depends on the therapy that's chosen. And for those therapies, again, it could be something that is weekly, it could be every few months, um, especially once the patient gets started. The focus here is that it's the right treatment, um, the right dose, and the right um uh administration timing that's happening in a very safe environment.

SPEAKER_03 10:23

Wow, so this seems a bit overwhelming, right? As a patient, you're going to the center, you got a new diagnosis, there's a lot of fear. So, Janice, what can we tell our patients to make them feel more comfortable when they're coming for an infusion?

SPEAKER_02 10:36

So the key here is education. We all know that fear arises when you don't know what's going to happen next. So we really, really try to educate our patients not only on their disease, but signs and symptoms, what they can do, for example, to prevent side effects, how often they need to follow up with their doctor, how often they're going to be here at the center receiving treatment. And, you know, it's very important when patients come to our center that these are not just one-time treatments. Sometimes these treatments last weeks, sometimes months, sometimes even years. So it's very important that we develop, you know, that relationship with the patient and their family to guide them through their care.

SPEAKER_03 11:19

All right, Leah. So I've been a patient and I have this neurological condition and I'm getting an infusion. How do I know that the medication's working? Am I going to feel better right when I get out of your center and going home?

SPEAKER_01 11:30

So you may not always feel better. The medications are not always designed to alleviate the symptoms. A lot of these medications, especially the ones that we discuss, are designed to stop or slow the disease progression. And so you get your infusion, you go home, you may not get complete alleviation of symptoms, especially let's say in the Alzheimer space. You're not going to regain some of the cognitive decline that you may have experienced or your family member may have experienced. But what's important is that we are slowing that disease progression, hopefully keeping that family member with you from a cognitive perspective longer, or at least adding to the quality of life in some of these other neurological conditions.

SPEAKER_03 12:10

All right. So final thoughts from both of you. You know, if a patient just been told that they have an infusion uh therapy that's been prescribed to them, what do you want them to know and what do you want them to remember? Let's start with Janice.

SPEAKER_02 12:21

So I would say don't be scared, don't be frightened. It's important to ask your physician what is the goal of treatment, how long treatment will be, and know that every step of the way, you have a team of physicians, nurses, and pharmacists that are going to work together to ensure that your treatment is safe, comfortable, and personalized to you.

SPEAKER_03 12:42

Leah?

SPEAKER_01 12:43

I I think Janice said it extremely well. Um, I would say that when you find out that you're going to be on an infusion, it can be scary. So take a breath. And then again, as Janice stated, know that you have an entire team behind you making sure from way before your infusion starts, during and then well after that you are being cared for and um that it's the you know appropriate medication that you're on.

SPEAKER_03 13:07

Wow. I mean, obviously for in the world of neuroinfusion, I've become educated and I feel more comfortable. And I think you've made our viewers comfortable in understanding what could be possible at one of these centers. So thank you both for sharing this important information. Thank you. So remember, viewers, be sure to hit that subscribe button on our channel right here to keep up with the latest health and wellness information and tips from our experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to your podcasts. So you can tune in anytime, anywhere. Thanks for watching.

SPEAKER_00 13:43

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