Our mission is to reduce the progression of MS-related disability and improve quality of life of patients and families living with MS.  We offer an integrated wellness approach using multidisciplinary care. This includes assessing patients to determine whether novel therapies can be used to reduce brain lesions.  Our infusion center offers all FDA-approved intravenous therapies.

We participate in MS research to help create new and better therapies.  And we offer educational seminars to patients and families about MS therapies

Multiple sclerosis is a chronic disease affecting the central nervous system (the brain and spinal cord). MS occurs when the immune system attacks the covering of the nerve fibers called the myelin sheath. This attack causes inflammation, which destroys nerve cells, interrupting the electrical messages in the brain.

MS is unpredictable and affects each patient differently – some individuals may be mildly affected, while others may lose their ability to walk early on. They may also have problems writing and speaking.

MS is unpredictable and affects each patient differently – some individuals may be mildly affected, while others may lose their ability to walk  early on the disease   they may  have problems to write, speak.

There are several types of multiple sclerosis:

Relapsing-Remitting Multiple Sclerosis (MS)

85% of MS patients have this type. These patients have attacks of symptoms that can last for several weeks and may get better spontaneously or with treatment. If the relapses are untreated, patients can accumulate disability. Common symptoms of a relapse may include fatigue, dizziness, numbness, tingling, blurred vision, double vision unsteady gait or weakness.

Secondary Progressive Multiple Sclerosis (MS)

If the relapsing-remitting condition changes to a point where a patient does experience discernable relapses and remissions, the disease has transitioned to secondary progressive MS. Now MS symptoms accumulate and worsen, causing disability.

Primary Progressive Multiple Sclerosis (MS)

About 10-15% of patients will have gradual worsening from the start of their MS disease. People with primary-progressive MS do not experience any specific relapses. Their condition worsens over time, often in their ability to walk. They often describe heaviness and stiffness in the lower limbs.

People with primary-progressive MS almost never have a relapse. If they do relapse after a primary progressive course is well established, the pattern is known as Progressive-Relapsing MS.

Benign Multiple Sclerosis (MS)

Benign MS is a mild type where an individual will continue to have mild symptoms after having MS for about 15 years. This occurs in about 5-10% of patients. There is no good way of predicting which patients will follow this course. The only way to identify benign MS is after someone has had the diagnosis of MS for at least 15 years and has had no evidence of worsening, both in functional ability and as evidenced on the MRI.

Symptoms and Causes of Multiple Sclerosis

Symptoms vary greatly from person to person, over time and in intensity.

They can include:

+ Bladder problems (frequent urination, urgency)

+ Depression

+ Dizziness or vertigo

+ Fatigue

+ Impaired coordination (ataxia)

+ Sensory symptoms (numbness, pain)

+ Spasticity (muscle stiffness or spasms)

+ Temperature sensitivity – worsening of MS symptoms by heat

+ Tremors

+ Trouble with short-term memory and concentration

+ Visual symptoms (optic neuritis, association with pain and eye movement, double vision)

+ Weakness

Causes of Multiple Sclerosis (MS)

The exact cause of MS is unknown. It appears to be an autoimmune disease in which the immune system is stimulated to attack myelin in the central nervous system.

MS can be triggered by viral infections, low vitamin D, environment, and genetic predisposition. People with family members diagnosed with MS and other autoimmune diseases are at a slightly higher risk.

It’s not always easy to make a confirmed diagnosis of multiple sclerosis because early symptoms can mimic other diseases. 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.

During the neurological evaluation blood tests will be done to exclude diseases that mimic multiple sclerosis.

Tests performed to diagnose MS are:

MRI of the brain and/or spinal cord –

The MRI often shows plaques or scars typical of MS.

Cerebrospinal fluid (CSF) evaluation –

Using a lumbar puncture or spinal tap, the CSF evaluation may show immunological abnormalities that help in the diagnosis.

Evoked potential tests –

Done by measuring 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.

Treating Multiple Sclerosis (MS)

A coordinated, comprehensive, interdisciplinary approach to MS care is the best approach for the long-term management of multiple sclerosis.

These treatment approaches fall into three categories.

abortive therapies,

A relapse, flare-up, or episode is defined as new or returning neurological symptoms that have evolved over at least 24-48 hours.  We treat this with intravenous steroids, hoping to accelerate recovery, Steroids, IV solumedrol, or Acthar are prescribed to shorten the duration and severity of an attack.

preventive therapies

Over the past 17 years, several preventive treatments have been FDA- approved to reduce the frequency and severity of MS symptoms.

Interferon betas all work by the same mechanism, which is to inhibit certain immune system cells and processes so that the inflammatory process known to occur in MS is reduced.

+ Interferon beta-1a is a beta interferon that is given once a week by intramuscular injection, or a beta interferon that is given 3 times a week by injection under the skin.

+ Interferon beta-1b is another form of beta interferon that may be given every other day by injection under the skin. The frequency will depend on the specific therapy.

Interferon betas are known to cause various side effects. Usually these include redness and mild discomfort at the injection site and flu-like symptoms including fever, chills, achiness, and fatigue. Changes in liver function, depression, and changes in menstrual cycle may also occur.

Glatiramer acetate is a synthetic protein that is structurally similar to a component of myelin. This is given daily by injection under the skin. Glatiramer acetate is thought to work by inducing the immune system to produce more anti-inflammation immune cells, which will then help to reduce the inflammation seen in MS.

It produces various side effects including injection site redness, itching, and swelling. Also a small number of people may experience a brief “post-injection reaction” that includes flushing, racing of the heart, a feeling of faintness, and shortness of breath.

Natalizumab is a monoclonal antibody that is given intravenously once every 4 weeks. Natalizumab works by blocking the ability of immune cells known as lymphocytes from entering the central nervous system (brain and spinal cord).

Natalizumab has been associated with a rare, serious and potentially fatal infection of the brain known as progressive multifocal leukoencephalopathy or PML.

Lemtrada is a monoclonal antibody that works in a novel way against B cells and T cells. It reprograms your immune system and reduces the overall number of immune cells that could be causing inflammation in MS.

Oral therapies

Gilenya, Aubagio, and Techfedera are breakthrough prescription drugs used to treat MS.

Gilenya is the first oral therapy approved for relapsing remitting MS. It’s taken once a day. While it’s not exactly clear how GILENYA works, it is thought to keep lymphocytes from attacking your central nervous system by lowering the number of lymphocytes circulating in your blood.  Clinical trials have demonstrated that Gilenya has significantly reduced relapse rate, new brain lesions, and disability progression.

Aubagio is an FDA-approved novel oral therapy for relapsing remitting MS.  It inhibits rapidly dividing cells, including activated T cells, which are thought to drive the disease process in MS. Aubagio may decrease the risk of infections compared to chemotherapy-like drugs because of its more-limited effects on the immune system.

Techfedera is an oral therapy for relapsing remitting MS taken twice a day. Results from two clinical trials showed that those taking Techfedera had fewer MS relapses compared to people taking an inactive pill (placebo). One of the trials also showed that those taking Techfedera experienced a worsening of disability less often than patients taking a placebo.

Symptomatic Therapies

Rehabilitation strategies such as physical therapy and occupational therapy are very helpful in improving and maintaining normal function. Consultation with specialists such as urologists, psychiatrists, and pain management specialists may be extremely helpful. Changes in mobility may require a specialist in orthotics as well as the physical and occupational therapist.