Please arrive 20 minutes prior to your appointment time with the following items:

• Radiology reports
• Office notes from your previous doctors: neurologist, primary care physician, etc.
• Test results: Lab, CT, EEG, VEP, EMG/NCV, Echocardiogram, Lumbar Puncture, etc.
• Insurance Cards
• Photo ID
• Patient forms (that we send to you prior to your appointment) filled out by you

Multiple sclerosis symptoms vary significantly from person to person depending on which nerves are affected and the extent of myelin damage. Common symptoms include:

• Vision problems: Blurred vision, double vision, partial or complete vision loss (often in one eye), pain with eye movement (optic neuritis) 
• Numbness and tingling: Unusual sensations in the face, arms, legs, or trunk 
• Muscle weakness: Weakness in the limbs that can affect walking, balance, and coordination 
• Fatigue: Overwhelming tiredness that is disproportionate to activity level and one of the most common and disabling symptoms 
• Difficulty walking: Problems with gait, balance, dizziness, and coordination 
• Cognitive changes: Problems with memory, concentration, attention, information processing, and multitasking 
• Bladder and bowel dysfunction: Urgency, frequency, incontinence, or difficulty emptying the bladder; constipation or bowel incontinence 
• Pain: Chronic pain, including neuropathic pain (burning, tingling sensations) and musculoskeletal pain 
• Spasticity: Muscle stiffness and involuntary muscle spasms 
• Speech difficulties: Slurred speech or changes in speech patterns 

Symptoms may appear suddenly during a relapse or develop gradually. Some symptoms may be temporary, while others persist or worsen over time. 

The cause of multiple sclerosis is unknown. Research points to a combination of genetic and environmental factors playing a role. Possible risk factors include:

• A family history of MS
• Obesity
• Smoking
• Vitamin D deficiency
• History of infectious mononucleosis
• Past concussions
• Where you live
• Multiple sclerosis occupational therapist helps a patient in the MS clinic

MS occurs more often in women than in men. Most people are diagnosed with MS between the ages of 20 and 50 years. It can also occur in children and older adults.

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Diagnosing multiple sclerosis can be complex because there is no single definitive test for MS. Instead, MS diagnosis relies on a combination of clinical evaluation, medical history, neurological examination, and diagnostic tests to rule out other conditions and confirm the presence of MS.

The diagnostic process typically includes:

• Medical history and symptom review: Your neurologist will ask detailed questions about your symptoms, when they started, how long they lasted, and whether they've come and gone 
• Neurological examination: A comprehensive exam to assess vision, coordination, balance, reflexes, sensation, and cognitive function 
• MRI (Magnetic Resonance Imaging): The most important diagnostic tool, MRI can reveal lesions (areas of damage) in the brain and spinal cord that are characteristic of MS. Multiple lesions in different locations and occurring at different times support an MS diagnosis 
• Lumbar puncture (spinal tap): Analysis of cerebrospinal fluid can detect abnormalities such as elevated immune proteins (oligoclonal bands) that suggest MS 
• Evoked potential tests: These measure the electrical activity in the brain in response to stimuli, helping detect slowed nerve signals caused by myelin damage 
• Blood tests: Used primarily to rule out other conditions that can mimic MS symptoms

Commonly called “attacks,” “exacerbations,” or “flare-ups,” MS relapses happen when new symptoms suddenly appear or old symptoms worsen for more than 24 hours. Relapses can last from several days up to several weeks.

MS symptoms can come and go. You may feel worse than normal if you do too much, get too hot, get overtired or sick, or have surgery. This doesn’t necessarily mean you’re having a relapse. You will likely improve.

Contact your provider, who may want to order blood tests or imaging and prescribe steroidtreatment

Currently, there is no cure for Multiple Sclerosis (MS), but there are several effective treatment options to help manage the disease. Multiple sclerosis treatment options fall into three main categories: disease-modifying therapies (DMTs), treatments for relapses, and symptom management.

Disease-modifying therapies can improve function after an attack, reduce the frequency of new attacks, slow multiple sclerosis progression, and reduce disability accumulation. MS medications are available in several forms:

Infusion Therapies: 

• B-cell depleting therapies: Ocrevus® (ocrelizumab), Briumvi® (ublituximab), Rituxan® (rituximab) 
• Monoclonal antibodies: Tysabri® (natalizumab), Lemtrada® (alemtuzumab) 
• Complement inhibitors: Ultomiris® (ravulizumab) for NMOSD

Oral Medications: 

• Tecfidera® (dimethyl fumarate) 
• Gilenya® (fingolimod) - Mayzent® (siponimod) 
• Zeposia® (ozanimod) - Aubagio® (teriflunomide) - Mavenclad® (cladribine)

Injectable Therapies: 

• Beta Interferons: Avonex® (interferon beta-1a), Plegridy® (peginterferon beta-1a), Betaseron®/Extavia® (interferon beta-1b), Rebif® (interferon beta-1a) 
• Copaxone®/Glatopa® (glatiramer acetate) - Kesimpta® (ofatumumab)

Having MS means a lifetime of treatment. This can include both medication and other approaches, like rehab to reduce or manage your symptoms.
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Medication reduces inflammation in the brain and spinal cord by targeting your immune system.
This approach:

• Lessens the number of MS attacks
• Can slow the worsening of the disease

We’ll work with you to create a treatment plan that takes into account your unique history and needs. When choosing a treatment, we’ll discuss:

• Effectiveness. How well does the therapy work, both as you begin therapy and over time?
• Side effects. Nearly every medication has some kind of side effect. Review the side effects of each treatment option with your medical provider.
• Lifestyle. Consider how the treatment will fit with your responsibilities (work, travel, family).
• Medication type. Which delivery method works best for you? Options include injection, oral medications and infusions through an IV.

Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (CNS), including the brain, spinal cord, and optic nerves. In MS, the immune system mistakenly attacks the myelin sheath (the protective covering of nerve fibers), causing inflammation, scarring (sclerosis), and disrupted nerve signaling.

Four disease courses have been identified in multiple sclerosis:

Relapsing-remitting MS (RRMS) RRMS — the most common disease course — is characterized by clearly defined attacks of worsening neurologic function. These attacks — also called relapses, flare-ups or exacerbations — are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely and there is no apparent progression of disease. Approximately 85% of people with MS are initially diagnosed with relapsing-remitting MS.

Secondary-progressive MS (SPMS) The name for this course comes from the fact that it follows after the relapsing-remitting course. Most people who are initially diagnosed with RRMS will eventually transition to SPMS, which means that the disease will begin to progress more steadily (although not necessarily more quickly), with or without relapses.

Primary-progressive MS (PPMS) PPMS is characterized by steadily worsening neurologic function from the beginning. Although the rate of progression may vary over time with occasional plateaus and temporary, minor improvements, there are no distinct relapses or remissions. About 10% of people with MS are diagnosed with PPMS.

Progressive-relapsing MS (PRMS) PRMS — the least common of the four disease courses — is characterized by steadily progressing disease from the beginning and occasional exacerbations along the way. People with this form of MS may or may not experience some recovery following these attacks; the disease continues to progress without remissions.

At The MS & Neuromuscular Center of Excellence, our providers have been recognized by the National Multiple Sclerosis Society as Partners in MS Care for their expertise in treating patients with MS.

While medical treatment is essential for managing MS, lifestyle changes for ms and self-care strategies can significantly improve symptoms and overall well-being:

Exercise and Physical Activity: 

• Regular exercise can improve strength, balance, flexibility, and reduce fatigue 
• Low-impact activities like swimming, yoga, tai chi, and walking are often well-tolerated 
• Exercise also helps maintain bone density, improves mood, and supports cardiovascular health

Diet and Nutrition: 

• A balanced, anti-inflammatory diet rich in fruits, vegetables, whole grains, lean proteins, and omega-3 fatty acids may help 
• Some people follow specific diets like the Mediterranean diet or Wahls Protocol, though evidence varies 
• Maintaining a healthy weight reduces stress on joints and improves mobility
• Adequate vitamin D levels are important; supplementation may be recommended

Stress Management: 

• Chronic stress can worsen MS symptoms and may trigger relapses 
• Stress reduction techniques include meditation, mindfulness, deep breathing exercises, and progressive muscle relaxation 
• Adequate sleep (7-9 hours nightly) is crucial for symptom management

Heat Management: 

• Many people with MS experience worsening symptoms with heat exposure (Uhthoff's phenomenon) 
• Stay cool using air conditioning, cooling vests, cold drinks, and avoiding hot baths or showers

If you're experiencing symptoms that could indicate multiple sclerosis, the first step is scheduling a consultation with a neurologist who specializes in MS. At the MS & Neuromuscular Center of Excellence, the diagnostic process includes:

1. Initial Consultation: During your first visit, your neurologist will conduct a thorough medical history, review your symptoms in detail, and perform a comprehensive neurological examination

2. Diagnostic Testing: Based on your initial evaluation, your doctor may order: 

• Brain and spinal cord MRI scans to look for characteristic MS lesions 
• Blood tests to rule out other conditions 
• Lumbar puncture (spinal tap) if needed to analyze cerebrospinal fluid 
• Evoked potential tests to measure nerve signal speed

3. Follow-up and Diagnosis: Once test results are available, your neurologist will review them with you and determine whether the findings meet the diagnostic criteria for MS

4. Treatment Planning: If diagnosed with MS, your care team will work with you to develop a personalized multiple sclerosis management plan, including selecting appropriate disease-modifying therapy, symptom management strategies, and ongoing monitoring

Early diagnosis and treatment are crucial for slowing disease progression and maintaining quality of life. If you're concerned about MS symptoms, don't wait—contact us to schedule an evaluation.

The multiple sclerosis prognosis varies significantly from person to person, making it difficult to predict the disease course for any individual. Several factors influence prognosis:

Factors Associated with Better Outcomes: 

• Younger age at onset 
• Relapsing-remitting disease course (as opposed to primary progressive) - Longer time between first and second relapse 
• Complete recovery from early relapses 
• Sensory symptoms (numbness, tingling) as initial presentation rather than motor symptoms 
• Female gender 
• Starting disease-modifying therapy early

Factors Associated with More Challenging Outcomes: 

• Primary progressive MS from onset 
• Older age at diagnosis 
• Multiple relapses in the first year 
• Incomplete recovery from relapses 
• Motor symptoms or difficulty walking as initial symptoms 
• Early development of disability

While MS is a chronic condition, advances in treatment have dramatically improved the outlook for people diagnosed today compared to previous generations. Working closely with an experienced MS specialist and adhering to your treatment plan offers the best chance for positive long-term outcomes.