Multiple Sclerosis (MS) is a chronic autoimmune disease in which the immune system mistakenly attacks the protective coating around nerve fibers, called myelin, in the brain and spinal cord. Myelin plays a crucial role in allowing nerve signals to travel smoothly and efficiently. When MS damages this protective layer, it disrupts communication between the brain and the rest of the body, leading to a wide range of unpredictable and potentially disabling symptoms. These may include muscle weakness, coordination and balance issues, vision problems, numbness, fatigue, and cognitive difficulties. The severity and progression of MS vary from person to person, making early diagnosis and proper management essential for maintaining quality of life.  

At CTNC’s Neurology, our providers have been recognized by the National Multiple Sclerosis Society as Partners in MS Care for their expertise in treating patients with MS.

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)

Our experienced staff is dedicated to helping you access patient assistance programs to ensure you receive the care and treatment you need, making healthcare more affordable and accessible. We’re here to guide you through the process and connect you with the resources that can support your treatment journey.

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.

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

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. 

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 CTNC, 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.