Understanding Multiple Sclerosis & Autoimmune Neurological Disorders

Understanding Multiple Sclerosis & Autoimmune Neurological Disorders

Autoimmune disorders occur when your immune system attacks your body instead of defending it. Your immune system automatically detects substances like viruses that should not be in your body and deploys white blood cells to remove them before they cause damage to your body. However, with an autoimmune disease, the immune system is overactive and with nothing to attack, it turns on your body, damaging healthy tissue.

Autoimmune neurological disorders treated at Cleveland Clinic’s Mellen Center include:

Why Choose Cleveland Clinic?

As one of the world's largest MS and autoimmune neurological disorders care centers, the Mellen Center for Multiple Sclerosis helps over 8,000 patients each year. Our doctors are known worldwide for their excellence in care, research and training, as they’ve been on the forefront of developing the latest diagnosis tools and treatment therapies for several decades. Most importantly, our doctors and care team work together to support every person's journey, focusing on both their physical and emotional well-being. We take time to understand each person's needs and create treatment plans that work best for them. This starts with a careful review of medical history, followed by testing and, once the diagnosis is made, we have a subspecialized team ready to treat each patient based on their individual autoimmune neurological disease.

Our team includes a variety of healthcare experts who work together to help with all parts of living with autoimmune neurological disorders, including:

  • Help with daily activities
  • Support for mental health and stress
  • Ways to improve thinking and memory
  • Resources for family members
Next: Multiple Sclerosis
Multiple Sclerosis

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disorder that affects the brain and spinal cord. In MS, infection-fighting white blood cells cause inflammation in the brain and spinal cord, damaging the myelin sheath that normally protects nerves. When this damage occurs, the nerves cannot function properly, and the symptoms of MS occur. MS can affect almost anyone, and it is a lifelong condition.

Types of Multiple Sclerosis

The effects of MS range from minimal to severe. Some people have such mild cases that they never even know they have MS, while others are debilitated by the disorder. Most neurologists use the following international classification system to define individual cases:

  • Relapsing-remitting: Patients have attacks, or relapses, during which symptoms worsen, or new symptoms appear. Patients may or may not recover but, in the interval before the next relapse, their symptoms do not worsen. Most patients start with this type of MS.
  • Secondary Progressive: The pattern switches from relapsing-remitting, with the disease now progressing between relapses, usually with fewer relapses.
  • Primary Progressive: The disease worsens gradually from onset, with or without subsequent relapses. Approximately 10% of patients have this type of MS.
  • Fulminant: This rare form is very severe, rapidly progressive MS.

Symptoms

Diagnosis

Establishing a diagnosis of MS and excluding other possible causes requires expert assessment by a neurologist. The diagnosis of MS is based on an array of clinical information, imaging data, and other testing because there is no single test for MS and symptoms vary widely among individuals. In addition, other diseases may have similar symptoms as MS, further complicating a diagnosis. Therefore, a diagnosis should always be made by a neurologist with training in MS.

If your doctor suspects that you have MS, they will take a thorough medical history and perform a neurological examination using tests for nervous system function. It’s important that the doctor asks the right questions, conducts a complete neurological examination, and comprehensively evaluates the symptoms of a malfunctioning nervous system.

Often, the doctor will order a series of imaging tests to obtain an accurate diagnosis. The most useful of these tests is magnetic resonance imaging (MRI).

Though not always necessary, additional tests are sometimes performed to confirm an MS diagnosis. These tests may include:

Treatment

People often think of MS as a rapidly disabling disorder, but that is not true in most cases, particularly with earlier diagnosis and treatment. Starting effective disease therapy early is thought to prevent or lessen the risk of long-term disability. Our team of experts across medicine, psychology and rehabilitation can help you manage your symptoms, reduce relapses, cope with emotional challenges, and often slow the condition’s progression. Your personalized treatment may include:

  • Disease-modifying therapies: There are FDA-approved medications that can help reduce how often relapses happen, while also helping to prevent damage to your central nervous system.
  • Relapse management medications: Steroids can aid in reducing inflammation.
  • Physical therapy: A physical therapist can help with walking, strength and balance. They can also teach you how to use a cane, scooter or wheelchair if needed.
  • Occupational therapy: An occupational therapist can teach you new, easier ways to do things around the house, at work or school. They can suggest products that can help make you feel better, like a cooling vest if you’re heat-sensitive.
  • Speech therapy: A speech-language pathologist can assist with voice, speech, and swallowing changes caused by MS.
  • Neuropsychology/cognitive therapy: A neuropsychologist can better define cognitive difficulties, such as attention, language and memory problems. An occupational or speech therapist can assist in strategies to help manage difficulty in cognition.
  • Behavioral medicine/health services: A psychologist and/or psychiatrist can provide support for depression, anxiety, mood swings and feelings of being overwhelmed.
  • Lifestyle changes: Eating a healthy balanced diet, regularly exercising, managing stress, not smoking and limiting alcohol can sometimes help lessen your MS symptoms and contribute to overall well-being.
Previous: Understanding Multiple Sclerosis & Autoimmune Neurological Disorders Next: Autoimmune Encephalitis (AE)
Autoimmune Encephalitis (AE)

Autoimmune Encephalitis (AE)

Autoimmune encephalitis (AE) is when your body's immune system attacks the proteins of healthy nerve cells and neurotransmitters in your brain. When this happens, your brain becomes swollen and inflamed.

Symptoms

Diagnosis

AE is diagnosed based on symptoms and test results showing inflammation in the brain. There are a variety of conditions that present similar symptoms to AE, so it’s important to have a team of healthcare providers with experience in AE and other autoimmune disorders. Providers may request several tests, including:

The results of each test serve as a “piece” of the diagnostic “puzzle.” Your care team has special expertise in analyzing all the available data to make sure we know exactly what’s going on.

Treatment

Your personalized treatment will focus on getting you back to your daily activities.

The main treatment goals for autoimmune encephalitis include immunosuppression and tumor removal (if applicable).

Rehabilitation is important to help you maintain or regain your physical, mental and emotional health as you begin your recovery. Depending on your symptoms, your rehab plan may include:

  • Occupational therapy: An occupational therapist can help you improve your ability to perform daily tasks, like dressing or cooking.
  • Neuropsychology: We offer comprehensive mental health programs to help with how your brain processes information.
  • Physical medicine and rehabilitation: Our team will help improve how your body moves overall.
  • Physical therapy: A physical therapist can help you move better, gain strength or improve balance.
  • Neuropsychology/cognitive therapy: A neuropsychologist can better define cognitive difficulties, such as attention, language and memory problems. An occupational or speech therapist can assist in strategies to help manage difficulty in cognition.
  • Behavioral health/medicine services: A psychologist and/or psychiatrist can provide support for AE diagnosis and cope with symptoms.
  • Sleep medicine: Our specialists treat insomnia (trouble sleeping) and other sleep-related disorders.
  • Social work: Social workers guide and support you and your family throughout your diagnosis and treatment.
  • Speech therapy: A speech-language therapist can work with you on speech, memory and cognitive issues, like thinking and reasoning.
Previous: Multiple Sclerosis Next: Demyelinating Diseases
Demyelinating Diseases

Demyelinating Diseases

Demyelinating diseases occur when the protective coating on your nerves, or the myelin sheath, is attacked by your nervous system. When this happens, your nerves can't send messages properly throughout your body and brain.

Types of Demyelinating Diseases

These diseases develop when your immune system attacks part of the nervous system which affects the eyes, spinal cord and/or brain.

Symptoms

Diagnosis

Based on a physical exam and other symptoms, a primary care provider may refer you to a neurologist, a doctor who specializes in nervous system conditions. The neurologist will conduct a neurological exam and may use one or several of the following tests:

Treatment

Treatment will depend on which type of demyelinating disease you have. Your doctor will work with you to find a plan to manage your symptoms. In many cases, treatments can also help slow down how quickly the disease worsens.

Your care plan might include:

  • Disease-modifying therapies: There is an expanding array of medications available to slow or stop disease progression.
  • Relapse management medications: There are several medications that can be used to quickly reduce inflammation and make you feel better.
  • Physical therapy: A physical therapist can help with walking, strength and balance. Depending on your situation, they can also help you learn how to use a cane, scooter or wheelchair.
  • Occupational therapy: An occupational therapist can teach you new, easier ways to do things around the house, at work or at school.
  • Speech therapy: A speech-language therapist can help with changes in your voice, speech and swallowing.
  • Neuropsychology/cognitive therapy: A neuropsychologist can better define cognitive difficulties, such as attention, language and memory problems. An occupational or speech therapist can assist in strategies to help manage difficulty in cognition.
  • Behavioral medicine/health services: A psychologist and/or psychiatrist can provide support for depression, anxiety, mood swings and/or feelings of being overwhelmed.
  • Lifestyle changes: Getting enough exercise, eating healthy foods, managing stress, limiting alcohol and not smoking are good lifestyle changes to make anytime and can especially help if you have a demyelinating disease.
Previous: Autoimmune Encephalitis (AE) Next: Stiff Person Syndrome (SPS)
Stiff Person Syndrome (SPS)

Stiff Person Syndrome (SPS)

Stiff Person Syndrome (SPS) is a rare condition that affects your muscles as a result of your immune system attacking your nerves. It causes your muscles to become very tight and stiff, usually beginning in your stomach or back and eventually spreading to your legs and other muscles, making it difficult to walk.

Symptoms

Symptoms can develop at any age but most often they begin in your 30s and 40s. The symptoms take time to develop and can impact different parts of your body and/or worsen with time. Some individuals experience the same symptoms for years. Others experience slow, worsening symptoms over time.

The main symptoms associated with SPS are:

Diagnosis

SPS is diagnosed through a physical exam, neurological exam and the following tests:

  • Antibody blood test: A blood test can check for the presence of antibodies to glutamic acid decarboxylase (GAD65), or other relevant antibodies, and for other signs that might indicate or rule out other diseases.
  • Electromyography (EMG): This test measures electrical activity in your muscles and can diagnose SPS and exclude other disorders.
  • Lumbar puncture (spinal tap): During a lumbar puncture, a healthcare provider uses a needle to draw fluid from your spinal canal to check for the presence of antibodies to GAD65 or other neural antibodies. They’ll also look for other signs that might indicate or rule out other conditions.

Treatment

Treatment strategies include symptom management through medications and therapies.

  • Medications:
  • Immunosuppressive or immunomodulatory therapies
  • Therapies:
    • Physical therapy: A physical therapist can help with walking, stretching and balance. Depending on your situation, they can also help you learn how to use assistive devices if needed.
    • Occupational therapy: An occupational therapist can teach you new, easier ways to do things around the house, at work or at school.
    • Massage
    • Hydrotherapy (water therapy)
    • Heat therapy
    • Acupuncture
    • Behavioral medicine/health services: A psychologist and/or psychiatrist can provide support for depression, anxiety, mood swings and/or feelings of being overwhelmed.
    • Neuropsychology/cognitive therapy: While not typically as predominant of a symptom with this diagnosis, if needed, a neuropsychologist can better define cognitive difficulties if present, and an occupational or speech therapist can assist in strategies to help manage difficulty in cognition.
Previous: Demyelinating Diseases Next: Wellness
Wellness

Wellness

People with MS and other autoimmune neurological disorders sometimes get so caught up in treating the disease that they neglect other aspects of their health. At Cleveland Clinic's Mellen Center for Multiple Sclerosis, we encourage patients to use a variety of wellness strategies:

  • Avoid behaviors that negatively impact your health. Research from Mellen Center for MS scientists shows that smoking seems to hasten the progression of MS and other autoimmune neurological disorders. We strongly urge smokers to quit. Also, people with these disorders have more problems tolerating excess alcohol or drugs than people with no health issues do. Plus, medications may interact negatively with alcohol. Control of these habits is key.
  • Make a health maintenance management plan. Poorly controlled diabetes and high blood pressure have a negative impact on MS and other autoimmune neurological disorders. Like everyone else, people with these disorders need regular checkups, immunizations and routine screening tests such as pap smears, mammograms and prostate exams. Due to a greater likelihood of osteoporosis, these patients should also get bone density scans.
  • Follow a healthy diet. No one knows if diet has an effect on MS and other autoimmune neurological disorders, despite internet claims to the contrary. At the Mellen Center, we recommend a heart-healthy diet with little red meat, lots of fruits and vegetables, and fewer carbohydrates and fatty foods. If you are overweight, we suggest you look at reasonable ways to slim down.
  • Stay active. If possible, follow an exercise program. Aerobic activities such as walking, swimming, running and pedaling a stationary bicycle are beneficial. A resistance program with light weights may help you build muscle. Regular exercise reduces fatigue and depression and can make you feel better in general.
  • Do what you love to do. Pursue hobbies and activities that you most enjoy — anything from gardening to stamp collecting to therapeutic horseback riding. You might consider yoga, tai chi or simple relaxation exercises, all of which are good for reducing stress and improving well-being.

Symptom Management

Managing existing or chronic symptoms of MS and other autoimmune neurological disorders, and minimizing their impact on your life, is an important component of care. Some of the most common symptoms of these diseases can include fatigue, depression, spasticity, weakness, sensory disturbance, balance problems, and bladder or bowel dysfunction. Treatments for these symptoms exist and it is important that you talk to your care team about how to get your symptoms under control. A multidisciplinary approach to care for symptoms may involve rehabilitation, medications to minimize the symptoms, psychological support, and alternative medicine approaches.

Previous: Stiff Person Syndrome (SPS) Next: Appointments & Locations
Appointments & Locations

Appointments & Locations

Make an Appointment

To make an appointment with a multiple sclerosis or autoimmune neurological disorder specialist in:

Virtual Visits

Whether you're a new or existing patient, you can get an initial evaluation or follow-up care from a specialist using your phone, tablet or computer. This means there's no travel or parking, less waiting and significant time savings. Call 216.636.5860 to schedule a virtual visit for you or a loved one and get details on cost and set-up instructions.

Learn More

MyChart

Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that connects patients to their medical record. Patients can register for MyChart through their physician’s office or by going online.

Previous: Wellness