Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neurological disease that involves the central nervous system—specifically the brain, spinal cord, and optic nerves. MS can cause problems with muscle control and strength, vision, balance, sensation, and mental functions. People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe.

• Relapsing-Remitting MS: People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks which are called relapses, flare-ups, or exacerbations, are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85 percent of people are initially diagnosed with relapsing-remitting MS.

• Primary-Progressive MS: This disease course is characterized by slowly worsening neurologic function from the beginning, with no distinct relapse or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor  improvements. Approximately 10 percent of people are diagnosed with primary-progressive MS.

• Secondary-Progressive MS: Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50 percent of people with relapsing-remitting MS developed this form of the disease within 10 years.

• Progressive-Relapsing MS: In this relatively rare course of MS (5 percent), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

Diagnosis

Diagnosis of MS can be challenging, especially early in the disease because symptoms may be minor or sporadic. It can also be difficult because other diseases can have similar warning signs, and there is no definitive single laboratory test to confirm MS. The diagnosis is made based on a neurological examination and a history of neurological symptoms. Our providers are fellowship trained, and will work closely with you to understand your symptoms. We will perform a complete clinical assessment and use a variety of neurodiagnostic tests to properly diagnose MS. During the neurological evaluation, our team sorts out even the most complex cases. Other diseases that mimic multiple sclerosis are carefully and systematically excluded. Some of the tests typically used for this evaluation include:

• Magnetic resonance imaging (MRI) of the brain, and sometimes the spinal cord. This is a sensitive imaging technique that often shows plaques or scars typical of MS.
• Evaluation of cerebrospinal fluid (CSF) with lumbar puncture or spinal tap. This may show immunological abnormalities that help in the diagnosis.
• Evoked potential studies, which measure conduction of electrical impulses along the optic nerve (in patients suspected of having optic neuritis) and along nerve pathways in the brain and spinal cord.

Treatment

Treatment involves managing the symptoms of multiple sclerosis as well as treating the disease before permanent damage causes symptoms. We offer the latest treatment techniques and technologies, including Tysabri infusion and intrathecal baclofen pump, to slow down progression of the disease and to improve function.
Medications used may include:

• Immune modulators to help control the immune system, including interferons (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), and glatiramer acetate (Copaxone)
• Steroids to decrease the severity of attacks when they occur
• Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex) or a benzodiazepine
• Cholinergic medications to reduce urinary problems
• Antidepressants for mood or behavior symptoms
• Amantadine for fatigue support

Our team works closely with neurosurgeons, medical specialists, psychologists, psychiatrists, physical therapists, occupational therapists, speech therapists, nutritionists and complementary medicine therapists to provide the most comprehensive care possible.

Surgical Treatment Options

Some patients who have severe pain or spasticity may benefit from having a catheter or pump placed in the lower spinal area to deliver a constant flow of medication, such as baclofen (Lioresal). If necessary, periodic adjustments to regulate the appropriate dosing of baclofen can be done in the office in a routine office visit.

Programs

In addition to medications, we offer an array of programs:

We also offer shared medical appointments (SMA) for MS patients. It is an opportunity to spend 90 minutes with our providers, along with a family member or support person, and other patients in a group setting who share similar concerns and experiences.

Outlook (Prognosis)

The outcome is variable and unpredictable. Although the disorder is chronic and incurable, life expectancy can be normal or nearly so.

Support

Our fellowship trained team works closely with neurosurgeons, medical specialists, psychologists, psychiatrists, physical therapists, occupational therapists, speech therapists, nutritionists and complementary medicine therapists to provide the most comprehensive care possible.