Understanding MS
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 long-term condition.
Symptoms
There is no standard set of MS symptoms that everyone experiences, but common symptoms include:
- Numbness, tingling or other abnormal sensations
- Difficulty walking
- Weakness, fatigue or dizziness
- Loss of vision or double vision
- Difficulty urinating or a sense of urgency to urinate
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, he or she will take a thorough medical history and perform a neurological examination using tests for nervous system function. It’s important that the doctor ask the right questions, conduct a complete neurological examination, and comprehensively evaluate 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).
The MRI Exam
The MRI examination produces very clear pictures, or images, of the human body without the use of X-rays. As long as safety guidelines are followed, MRI poses no risk to the patient. The guidelines state that MRI is not advisable in people with specific conditions, such as pregnancy or particular implanted devices, including a heart pacemaker or cerebral aneurysm clip. You should receive information on safety precautions, but, if you have any concerns, be sure that you discuss them with your doctor prior to the examination.
With MS, the precise images produced by MRI provides the neurologist clear evidence of scar tissue in deep parts of the brain or spinal cord. However, even abnormal spots on a brain MRI are not always definitive, because similar spots are seen in the brains of older people and people with migraine headaches or high blood pressure.
To accurately interpret the MRI scan, the neurologist must factor in all available information about the patient. Sometimes, an intravenous dye called gadolinium is used to see new areas of MS on the MRI. If the doctor orders gadolinium as part of your test, an intravenous (IV) line will be inserted. If you have severe kidney disease, you should not have gadolinium because it can cause a severe skin condition in patients with poor kidney function.
Though not always necessary, additional tests are sometimes performed to confirm an MS diagnosis. These tests may include:
Spinal Tap
An experienced MS team will be able to determine whether you need this test of cerebrospinal fluid. A finding of abnormalities in the fluid can be helpful in establishing a diagnosis, but, once again, spinal taps are not foolproof, and they are not necessary in all cases.
Blood Tests
Your doctor may order blood tests to help rule out conditions that imitate MS, BUT, at present, MS cannot be detected through blood tests.
Optical Coherence Tomography
Your doctor may order an eye scan which uses light to take specialized and detailed measurements of the retina. This is a painless test that helps determine if the optic nerve and its connections within the retina are affected as part of your condition.
Types
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. The majority of patients start with this type of test.
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. People often think of MS as a rapidly disabling disorder, but that is not true in most cases. Although MS often is disabling, without treatment it typically takes 10 to 15 years. Starting effective disease therapy early is thought to prevent or lessen the risk of long-term disability.
Disease-Modifying Agents
Over fifteen medications, often called disease-modifying agents, have been approved by the Food and Drug Administration (FDA) for the use in MS. Generally, all of these medications aim to reduce the frequency of relapses, the activity seen on MRI scans, and disease progression. Each medication has its own side effects and risks, and how patients respond to each one varies greatly. These include:
Injectable medications
- Interferon beta-1a (Avonex®)
- Interferon beta-1b (Betaseron®)
- Glatiramer acetate (Copaxone®)
- Interferon beta-1b (Extavia®)
- Glatiramer acetate -generic equivalent of Copaxone (Glatiramer Acetate Injection)
- Glatiramer acetate -generic equivalent of Copaxone (Glatopa®)
- Ofatumumab (Kesimpta®)
- Peginterferon beta-1a (Plegridy®)
- Interferon beta-1a (Rebif®)
Oral medications
- Teriflunomide (Aubagio®)
- Monomethyl fumarate (Bafiertam™)
- dimethyl fumarate - generic equivalent of Tecfidera ( Dimethyl Fumarate)
- Fingolimod (Gilenya®)
- Cladribine (Mavenclad®)
- Siponimod (Mayzent®)
- Dimethyl fumarate (Tecfidera®)
- Diroximel fumarate (Vumerity®)
- Ozanimod (Zeposia®)
Infused medications
- Alemtuzumab (Lemtrada®)
- Ocrelizumab (Ocrevus®)
- Natalizumab (Tysabri®)
There are also emerging generic or biosimilar medications which hold promise to achieve great outcomes while lowering the cost of MS care.
Wellness
People with MS 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. Mellen Center research shows that smoking seems to hasten the progression of MS. We strongly urge smokers to quit. Also, people with MS have more problems tolerating excess alcohol or drugs than do people with no health issues and MS 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. Like everyone else, people with MS need regular checkups, immunizations and routine screening tests such as Pap smears, mammograms and prostate exams. Due to a greater likelihood of osteoporosis, MS patients should also get bone density scans.
- Follow a healthy diet. No one knows if diet has an effect on MS, 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 just makes 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 minimizing their impact on your life, is an important component of MS care. Some of the most common symptoms of MS can include fatigue, depression, spasticity, weakness, sensory disturbance, balance problems, 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 approaches, medications to minimize the symptoms, psychological support, and alternative medicine approaches.
Patient Services
Medical Concierge
Complimentary assistance for out-of-state patients and families traveling to Ohio for care is available at Cleveland Clinic in Ohio. Call 800.223.2273, ext. 55580, or email medicalconcierge@ccf.org for assistance.
Global Patient Services
Cleveland Clinic in Ohio provides complimentary assistance for national and international patients and families traveling to Ohio for care. Call 216.444.8184 for more information.
Remote Consults
Request a remote medical second opinion from Cleveland Clinic. MyConsult is particularly valuable for patients who wish to avoid the time and expense of travel. For more information call 800.223.2273, ext 43223.
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.
Appointments & Locations
Make an Appointment in Ohio
To make an appointment with a Mellen Center for Multiple Sclerosis specialist in:
- Cleveland, Ohio - call 216.636.5860 or 866.588.2264.
- Las Vegas, Nevada - call 702.483.6000 or 866.588.2264.
Virtual Visits
Whether you're a new or existing patient, you can get an initial evaluation or follow-up care from a multiple sclerosis 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
- Learn more about the Mellen Center for Multiple Sclerosis in Ohio
- Learn more about the Mellen Program for Multiple Sclerosis in Nevada
MyConsult® Online Second Opinion
MyConsult Online Second Opinion program connects patients to the expertise of top Cleveland Clinic specialists without the time and expense of travel or a face-to-face in-person or virtual visit. Through our secure web platform, patients can submit their detailed health information, medical records and diagnostic test results. The most appropriate Cleveland Clinic expert is assigned to the consultation and will render a detailed second opinion. The report includes commentary about the diagnosis, treatment options or alternatives, and recommendations regarding future therapeutic considerations. Patients are also able to send additional questions to the physician who provides the report. Online medical second opinions are available for more than 1,200 medical diagnoses.
Why Choose Us
Mellen Center for Multiple Sclerosis offers leading-edge resources to provide the most advanced and specialized care, supported by extensive research and education programs. The center is one of the largest and most comprehensive programs for MS care and research worldwide, managing more than 20,000 patient visits every year. Basic and clinical research conducted at Cleveland Clinic sheds new light on MS every year.
Mellen Center physicians are national leaders in basic and clinical research related to MS pathogenesis and medical management, and have made major contributions in the development of drugs to control MS disease activity and progression. They provide consultative services for neurologists and patients worldwide and ongoing care for approximately 8,000 patients annually, including approximately 1,600 new patient/consult visits.
Program highlights at Mellen Center include:
- Clinical research
- Neurorehabilitation
- Imaging
- Therapeutics
- Health psychology services
We have an integrated spasticity management program that treats stiff muscles with medication or through the use of baclofen (Lioresal®) pumps and botulinum toxin (Botox®) injections. The latest pharmaceutical therapies are delivered in a 12-chair infusion center. Standard and investigational imaging is provided through standard and high field-strength MRI equipment staffed by an expert team. The Mellen Center also offers an MS Wellness Consultation Program, on request.
The Mellen Center makes available to patients significant clinical research opportunities, ranging from genetic studies to trials of new treatments.
What’s unique about the Mellen Program for Multiple Sclerosis in Las Vegas?
We’re the only comprehensive MS center in Nevada run by fellowship-trained MS specialists and the only National Multiple Sclerosis Society Partner in Care in Nevada.
Thanks to a robust philanthropy program, at Cleveland Clinic Nevada we’re able to offer an array of supportive services at no cost to patients and their families.
Our social workers are trained to help you make the best decisions for your or a loved one’s care by providing information and tools that can help you reduce stress levels and understand your options. We understand that asking for help is never easy, particularly when it comes to recognizing you need help to care for yourself and those you love, but we encourage you to take the first step.
For Cleveland Clinic Patients and Their Care Partners
The following services are available only by referral from a Lou Ruvo Center for Brain Health neurology team member, who will notify the social work team of your interest in our services.
Case management
Community resource referrals to help identify services available in the community. The following is but a small sample:
- In-home care services
- Transportation resources
- Accessible housing
- Home modifications
- Disability accommodation for travel
- Home safety and monitoring equipment
- Workplace accommodations
- Veterans’ benefits
- SSDI/SSI applications
- Medicaid and Medicare applications
- Advance Care, financial and legal planning
- Assisted living, group home and nursing home referrals
Counseling
- Individual therapy for patients and care partners
- Family therapy
Above and beyond
Established by Gloria and Emilio Estefan to honor her father who died of MS, Fajardo Patient Services Program at the Mellen Program for MS at Lou Ruvo Center for Brain Health offers patients and families the following complimentary services:- Transportation to medical appointments at Cleveland Clinic
- Yoga for MS + concurrent patient and family support groups
- Access to dedicated patient services coordinator who helps patients with non-medical issues
Learn more about the Mellen Program for Multiple Sclerosis in Las Vegas