Multiple Sclerosis

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There is currently no cure for multiple sclerosis, but there are now many treatments that can help to manage symptoms, prevent some complications, control disease progression, and slow disability progression. As the disease varies widely in its manifestation and progression, each case needs to be evaluated individually to determine the best course of treatment. There are three main categories of treatment: treatments for the management of acute attacks, treatments that modify the disease itself, and treatments for the management of symptoms.

Some people with MS experience acute attacks followed by long periods of partial or even full recovery. Others steadily progress in disability. There is no cure for multiple sclerosis, but there are many treatments, and people can live long, productive lives with the disease. While some people become severely disabled by the disease, up to half of people with MS are still able to walk unassisted 15 years after they have been diagnosed.

  • Caregiver team
  • Acute attacks
  • Disease-modifying treatments
  • Treating symptoms
  • Monitoring disease progression
  • Caregiver Team

    Because multiple sclerosis is chronic and degenerative, it should, where necessary, be managed by a team of caregivers. This team may include:

    • Neurologists
    • Nurses
    • Psychologists
    • Neuropsychologists
    • Social workers
    • Occupational therapists
    • Physical therapists
    • Vocational rehabilitation specialists
    • Registered dietitians
    • Speech-language pathologists
    • For more information about these team members:

      • Neurologists and nurses
      • Psychologists, neuropsychologists, and social workers
      • Occupational therapists, physical therapists, and others
      • Neurologists and Nurses

        A neurologist is a medical specialist trained to evaluate problems of the nervous system, including the symptoms of MS. Neurologists have an in-depth understanding of the central nervous system and how it is affected by multiple sclerosis. Ideally, it is helpful if the neurologist is affiliated with an MS center, research facility, or teaching hospital. Neurologists diagnose MS; make recommendations for treatment, testing, and symptom management; and are available to answer your medical questions, sign forms, fill prescriptions, and provide help with disability-related issues.

        A consulting neurologist makes recommendations to your local doctor or neurologist for treatment, testing, and symptom management.

        Nurses possess a broad range of experience in advanced practice nursing, research, and treatment procedures. Advanced practice nurses (APNs) are clinical nurse specialists, nurse practitioners, and registered nurses with additional education (certification or master's degree) and expertise in a specialty area or clinical practice. Working independently and in collaboration with a doctor, advanced practice nurses are able to provide a wide variety of services. Physician assistants are clinicians with advanced training who are also able to work independently and in collaboration with a doctor to provide a large number of services.

        Advanced practice nurses and physician assistants who treat people with MS provide many health services, including:

        • Patient and family education about MS and related problems
        • Ongoing assessment and management of MS symptoms
        • Counseling on general health maintenance and wellness
        • Information about medicines and monitoring side effects
        • Education in the management of bowel, bladder, or other personal care issues
        • Administration and monitoring of medicines according to treatment and research protocols
        • Coordination of outpatient care with home care services
        • Consultation to health team members as well as outside providers
        • Speaking at community programs about MS and related topics
        • Psychologists, Neuropsychologists, and Social Workers

          Psychologists are available to help people with MS cope with the cognitive, emotional, and interpersonal aspects of the disease. They offer:

          • Psychological evaluation of emotional and interpersonal problems
          • Individual psychological counseling sessions to reduce emotional distress and improve stress management skills
          • Group psychological counseling to develop strategies for coping with the illness and the resulting life changes
          • Neuropsychological testing to determine if MS is affecting cognitive functions such as attention or memory
          • Neuropsychologists specialize in memory, problem-solving, and other cognitive difficulties. They can evaluate and diagnose cognitive and memory problems in people with MS so they can seek the appropriate treatment. Neuropsychologists might offer cognitive rehabilitation exercises to improve memory, attention, information processing, and reasoning. All of these functions might become slowed because of the process of demyelination in the brain.

            Social workers provide personal support to people with MS and their families by offering:

            • Short- and long-term counseling regarding adjustment to disability and major life transitions
            • Assistance in accessing community resources and local and national agencies that offer both information and support for people with MS and their families
            • Financial resource information such as Social Security disability, supplemental security income, Medicaid, Waiver 4, and PASSPORT financial assistance programs
            • Information about quality-of-life issues including living wills and durable power of attorney for healthcare
            • Occupational Therapists, Physical Therapists, and Others

              Occupational therapists analyze how MS affects the way people perform their daily tasks, help them learn new ways to do familiar activities, and provide guidance on proper seating as needed. Occupational therapists assist individuals in maximizing their level of functional independence. They offer:

              • Individualized treatment through appropriate exercise and adaptive equipment, following an accurate assessment of each patient's current level of functional performance
              • Ongoing evaluation and appropriate treatment strategies to optimize the range of motion and muscle strength of patients' upper extremities (arms and hands) to help them successfully complete activities of daily living such as dressing, eating, toileting, and bathing
              • Physical therapists are available to design strategies to improve muscle strength, flexibility, coordination, balance, endurance, walking ability, and mobility. They specialize in:

                • Improving function and providing instruction on managing physical disabilities
                • Recommending appropriate exercises to maintain flexibility and conditioning, while preventing and reducing pain
                • Providing instruction regarding the use of assistive devices, braces, or other mobility aids to maximize independence
                • Read more about physical therapy in the managing section

                  Vocational rehabilitation specialists can help you achieve a satisfying work life. For people with MS, finding work that matches their skills, interests, and abilities can be especially challenging.

                  Vocational rehabilitation specialists assist individuals with:

                  • Recognizing their skills and abilities
                  • Exploring new careers
                  • Locating jobs
                  • Preparing for interviews
                  • Developing safe work sites
                  • Coping with work-related issues
                  • Learning the many resources available for making career choices
                  • Assessing an individual's needs is the first step in vocational rehabilitation. Information from the assessment helps the patient and the counselor make the best use of vocational services. During the initial interview, a counselor reviews the person's educational, work, and medical histories and assesses any factors that might affect his or her ability to work. A vocational evaluation also measures the person's general abilities, and specific needs and interests. After the consultation, the individual might be referred to other services or community resources.

                    Read more about vocational rehabilitation in the managing section.

                    Registered dietitians provide nutritional counseling through diet management to promote good nutrition while preventing malnutrition. They are available to:

                    • Develop individual care plans for each patient to promote good nutritional status
                    • If necessary, provide calorie and protein supplements to increase daily caloric and nutrient consumption
                    • Adapt the consistency of foods and liquids if swallowing becomes difficult
                    • Speech-language pathologists can help people with MS maintain as many verbal communication skills as possible. They also teach techniques that conserve energy, including nonverbal communication.

                      The speech-language pathologists are available to:

                      • Evaluate and treat speech disorders and communication problems
                      • Assess swallowing problems to provide assistance with eating and drinking
                      • Recommend appropriate communication technologies to provide treatment that will aid in the success of daily activities
                      • Acute Attacks

                        The development of new symptoms or the worsening of old ones over several days or weeks may indicate an attack, or exacerbation, of multiple sclerosis. An attack is usually accompanied by inflammation or demyelination in the central nervous system, in either new sites or old ones. Treatment (and sometimes hospitalization) may be recommended, depending on the severity and degree of disruption to daily function. The swelling and inflammation of demyelination may be reduced by high doses of a steroid called methylprednisolone.

                        Intravenous Methylprednisolone (Solu-Medrol)

                        The medication methylprednisolone (Solu-Medrol) is used for treatment of multiple sclerosis. Methylprednisolone is a potent anti-inflammatory steroid that may improve your symptoms.

                        On the day of the treatment:

                        • Plan to be at the clinic for about one and a half hours on the day(s) of your treatment. You may receive blood tests before the treatment to monitor your complete blood count and your sodium and potassium levels.
                        • A nurse will check your blood pressure and pulse before and after the treatment.
                        • The medication is given by intravenous drip for 30 to 45 minutes or injected directly into a vein.
                        • After the treatment, you can return to your normal daily activities, including driving.
                        • Following the intravenous treatments, you will be asked to take an oral form of a steroid called prednisone. Your nurse will give you a written schedule of when and how often to take the medication.
                        • You may also be given a prescription for a medication to reduce stomach irritation.
                        • Some possible side effects are below. It's important to remember that not everyone experiences these side effects.

                          • Stomach irritation such as indigestion and heartburn
                          • Increased energy, which may result in difficulty sleeping
                          • Rapid heartbeat
                          • Flushing of the face, neck, or chest
                          • Feeling warm or cool
                          • Fluid retention (Avoid table salt and salty foods)
                          • Mood changes
                          • Metallic taste in the mouth
                          • Insurance coverage for this treatment varies greatly, depending on individual insurance plans. Intravenous methylprednisolone (Solu-Medrol) is usually covered. You may want to check with your insurance company before receiving treatment.

                            Disease-Modifying Treatments

                            There are currently six FDA-approved medications for the treatment of multiple sclerosis: Avonex (interferon beta-1a), Rebif (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), Novantrone (mitoxantrone), and Tysabri (natalizumab). While there is no cure for MS, these drugs have been shown to modify the course of the disease, reduce the frequency and severity of attacks, and reduce brain lesion development. Because these medications may protect nerves from early irreversible damage and have a significant impact on later disability, MS specialists typically recommend that patients begin a course of drugs immediately after a definite diagnosis. Even at the very early stages of MS—for instance, after a clinically isolated episode of inflammation in the brain, optic nerve, or spinal cord—drugs may be an option.

                            All of these drugs work by altering or suppressing the body's immune system.

                            This section contains more information on:

                            • Interferon-beta
                            • Copaxone
                            • Self-injections
                            • Chemotherapy drugs
                            • Tysabri (natalizumab)
                            • Interferon-beta

                              Interferon-beta is used to treat the relapsing-remitting form of multiple sclerosis, in which symptoms come and go. It decreases the number of episodes of symptoms and slows the development of disability. It has not been shown to help the chronic progressive form of MS. Our bodies make several varieties of the protein interferon naturally, as part of the immune system.

                              Interferon-beta is available as interferon beta-1a (brand names Rebif, Avonex) and interferon beta-1b (Betaseron). These medications are injected by either the patient or a family member or friend. Rebif and Betaseron are injected subcutaneously, into the layer of fat between the skin and muscle, every two to three days. Avonex is injected once a week into the large muscles of the thigh or upper arm. You will be given specific instructions and training. Be sure you understand these instructions and are comfortable with them before beginning to inject yourself.

                              The injection should always be given at the same time of day. You may have flulike symptoms after injection of interferon-beta, so it's good to do the injection at bedtime. Taking acetaminophen or ibuprofen may help relieve these symptoms. You and your caregiver will get specific instructions and training in how to inject interferon-beta; do not inject until you are sure you know how to do it.

                              Before starting interferon-beta, you should tell your doctor if you have depression, thyroid problems, blood problems, seizures, heart problems, or liver disease. The most common side effects are injection-site reactions and flu symptoms. You may also experience constipation, dizziness, or unusual tiredness or weakness.

                              Copaxone

                              Glatiramer acetate (Copaxone) is a synthetic drug that reduces the frequency and severity of flares, also called relapses or attacks, in the relapsing-remitting form of multiple sclerosis. Like interferon-beta, Copaxone is an immunomodulating drug.

                              Copaxone is given once a day as a subcutaneous injection, which means it goes into the layer of fat beneath the skin. You will be given specific instructions and training on how to inject Copaxone. Be sure you understand these instructions and are comfortable with them before beginning to inject yourself.

                              Some people have a reaction immediately within minutes after injecting Copaxone. For several minutes, they may be flushed or have a tight feeling in the chest, palpitations, anxiety, and shortness of breath. These symptoms usually go away on their own within a few minutes.

                              Mild itching and redness are common, but call your doctor if you have severe itching, a blotchy skin reaction (hives), or severe pain at the injection site. Other possible side effects include tremor, unusual tiredness or weakness, vaginal yeast infections, and weight gain.

                              About Self-Injections

                              Both interferon-beta (brand names Rebif, Avonex, and Betaseron) and glatiramer acetate (Copaxone) are often given by self-injection, although many people prefer to have a family member or friend give the injection.

                              Many people are anxious about injecting themselves or having someone else inject them. If you have trouble with anxiety, talk to your doctor about counseling. Speaking with a therapist who specializes in cognitive-behavioral therapy may help you understand your feelings about injections and overcome them. Your doctor may even be able to direct to you a therapist who is experienced in injection counseling.

                              Injection-site reactions include swelling, redness, pain, and itchiness at the injection site. Poor technique is a common cause, so if you are having trouble with injection-site reactions, you may want to ask your doctor for more training in self-injection. Injection-site reactions are more of a problem with subcutaneous injections.

                              Some tips to avoid injection-site reactions include:

                              • Don't inject the medication right after taking it out of the refrigerator; give it time to warm up.
                              • Do not use the same injection site twice in a row. You can write down the injection sites as you use them to help you keep track.
                              • Ask your doctor about a topical anesthetic to apply before injecting your medicine. Alternatively, applying ice to the site before and after injecting may help.
                              • Auto-injectors may be easier to use than normal syringes.
                              • Ask your doctor if you can use a narrower needle.
                              • Chemotherapy Drugs

                                Some chemotherapy drugs are used in multiple sclerosis because they suppress the immune system. That means they may slow the attack of the immune system on your nerves. Although Novantrone (mitoxantrone) is the only chemotherapy drug approved by the Food and Drug Administration for use in multiple sclerosis, doctors may also try other chemotherapy drugs, such as Imuran (azathioprine), Cytoxan (cyclophosphamide), and Leustatin (cladribine).

                                Because these drugs suppress the immune system, taking them may make you more prone to infection. Avoid contact with people who are sick. Do not get any vaccinations without your doctor's approval.

                                Novantrone is given intravenously every three months. Novantrone can cause serious side effects, especially damage to the heart, even if used only for a short time, so your health should be closely monitored during treatment. Before your treatment begins, you will need blood tests, an electrocardiogram (EKG), and an echocardiogram (ultrasound) heart test to determine the strength of the heart muscle. Call your doctor immediately if you have a rapid or uneven heartbeat or swelling of the arms or ankles. Like many chemotherapy drugs, Novantrone can cause hair loss and many other side effects. If you have any concerns or questions, discuss them with your doctor or nurse.

                                Imuran is generally taken orally, in the form of tablets. Your white blood cell count and your weight will determine the dose that is prescribed. The starting dose is low and is slowly increased. Imuran is generally taken twice a day. While you are taking this medicine, you will need regular blood tests (blood cell counts and liver function tests) to evaluate the medicine's effectiveness and to monitor your response to the medicine. Some mild nausea often occurs when you start taking Imuran. This discomfort is expected and usually will go away as your body gets used to the medicine. If you have extreme nausea with vomiting, notify your doctor.

                                Methotrexate (Folex or Rheumatrex), used for rheumatoid arthritis, is also sometimes given as an MS treatment. There is not enough evidence yet to know for sure whether it is effective.

                                Cytoxan is typically given once each month. Before treatment, you may need blood tests, a urine test (urinalysis), an electrocardiogram (EKG), and a chest X-ray. Cytoxan suppresses your immune system, so you will be prone to infection for two to three weeks after each treatment. Avoid contact with people who are sick.

                                Call your doctor right away if you have any symptoms that cause concern or may be signs of infection:

                                • Fever over 100°F (38°C)
                                • Sweats or chills
                                • Skin rash
                                • Pain, tenderness, redness, or swelling
                                • Wound or cut that won't heal
                                • Red, warm, or draining sore
                                • Persistently sore throat, scratchy throat, or pain when swallowing
                                • Persistent sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones
                                • Persistent, dry, or moist cough that lasts more than two days
                                • White patches in your mouth or on your tongue
                                • Nausea, vomiting, or diarrhea that persists for more than one or two days
                                • Flulike symptoms (chills, aches, headache, and fatigue) or generally feeling "lousy" for more than one week
                                • Trouble urinating: pain or burning, constant urge, or frequent urination
                                • Bloody, cloudy, or foul-smelling urine or black, tarry stools
                                • Tysabri (Natalizumab)

                                  Tysabri was approved for the treatment of multiple sclerosis in November 2004, after accelerated review by the Food and Drug Administration. Just four months later, it was taken off the market after three people taking Tysabri suffered from a rare viral brain infection; two died. In early 2006, the FDA allowed the makers of Tysabri to continue clinical trials in MS patients who had previously received the drug.

                                  Tysabri is now back on the market, with stringent rules to track its delivery and complications. Tysabri can be given only at registered infusion centers. Patients who use Tysabri and their doctors must also be registered.

                                  The FDA limits use of Tysabri to relapsing forms of MS and recommends that Tysabri generally be used only by patients who have not responded to other treatments for multiple sclerosis. Because of the risk of infection, Tysabri should definitely not be taken by patients with compromised immune systems or patients who are taking any immune-suppressing drugs. In fact, the FDA approved Tysabri to be used alone, because not enough is known about its interactions with other drugs.

                                  Tysabri is given intravenously once every four weeks. Before starting therapy, you will have an MRI to get a baseline image of the lesions present in your brain.

                                  During and after treatment, be alert for changing neurological symptoms such as changing eyesight, balance, or personality or other symptoms. If these changes occur, your doctor may suspend Tysabri treatment and do tests for viral infection.

                                  Treating Symptoms

                                  There are many tactics for managing the various symptoms of multiple sclerosis. For example, a doctor might prescribe medications such as baclofen or tizanidine to treat spasticity. In the case of depression, the antidepressants called SSRIs (selective serotonin reuptake inhibitors) are often used; for erectile dysfunction, drugs like Viagra may be prescribed. Pain and tingling sensations may be helped in some cases by anticonvulsant medications. Patients should update their doctors regularly on new and old symptoms and current medications so a course of treatment may be modified accordingly.

                                  This section contains more information on:

                                  • Baclofen and tizanidine
                                  • Botulinum toxin
                                  • Baclofen and Tizanidine

                                    Baclofen (brand name Lioresal) is a medicine commonly used to decrease spasticity related to multiple sclerosis, spinal cord injuries, or other neurological diseases. Spasticity is a motor disorder characterized by tight or stiff muscles that can interfere with voluntary muscle movements. An imbalance of excitatory and inhibitory input in the spinal cord causes hyperactive muscle stretch reflexes. These reflexes result in involuntary spasms and increased muscle tone. Baclofen, a gamma-aminobutyric acid (GABA) agonist, works by restoring the balance of excitatory and inhibitory input to reduce muscle hyperactivity. This allows more normal motor movements.

                                    Baclofen is typically taken orally and is usually effective at decreasing stiffness, muscle cramps, and jerking movements. A common side effect, which can limit its use, is sedation with weakness. Tizanidine (Zanaflex) is another medication that can help with spasticity. It has an advantage over baclofen in that it causes less weakness, although its sedating effects can be more pronounced. Focused use of tizanidine at night can be particularly helpful in patients who have difficulty sleeping.

                                    Spasticity can become so severe that oral medications are not sufficient to help, or cause unacceptable side effects. An alternative is intrathecal baclofen, delivered into the intrathecal space, which contains the cerebrospinal fluid, the fluid surrounding the spinal cord and nerve roots. Oral baclofen goes to the whole body, with only a small portion reaching the spinal fluid, where it is needed to work. An intrathecal delivery system provides the baclofen right to the target site in the spinal cord. The baclofen pump continuously delivers baclofen in small doses directly to the spinal fluid, increasing the therapeutic benefits and causing fewer and less severe side effects compared with the oral medicine.

                                    The baclofen pump system may be helpful to someone who has spasticity and is not responsive to—or tolerant of—oral medicines. The system consists of a catheter (a small, flexible tube) and a pump. The pump—a round, metal disc, about 1 inch thick and 3 inches in diameter—is surgically placed under the skin of the abdomen near the waistline. The pump stores and releases prescribed amounts of medicine through the catheter. The pump is refilled by inserting a needle through the skin into a filling port in the center of the pump. With a programmable pump, a tiny motor moves the medicine from the pump reservoir through the catheter. Using an external programmer, your treatment team can make adjustments in the dose, rate, and timing of the medicine.

                                    Patients must return to their doctor's office for pump refills and medicine adjustments, typically every two to three months. The pump is taken out and replaced at the end of the battery's life span, which is usually five to seven years. The pump's main advantage is that it efficiently reduces spasticity and involuntary spasms, promoting a more active lifestyle, better sleep, and reduced need for oral medicines. Pain and discomfort from spasms and spasticity are often reduced or eliminated, but the pump can be turned off if it shows no benefit. Oral and intrathecal baclofen can have side effects, including dizziness, drowsiness, headaches, nausea, and weakness.

                                    This section contains more information on:

                                    • Initial evaluation for baclofen therapy
                                    • Initial Evaluation for Baclofen Therapy

                                      If you are considering intrathecal baclofen therapy, you will most likely have an initial evaluation by a treatment team that might include a doctor who specializes in rehabilitation (physiatrist), a physical therapist, an occupational therapist, a nurse, and a social worker. If your treatment team recommends the baclofen pump system after your evaluation, you will have a trial of the intraspinal therapy to test the potential effectiveness of the medicine.

                                      During the medicine trial, baclofen is injected into the spinal canal (using a small needle) and you are assessed by the treatment team over two to four hours to determine how well the medicine treats the spasticity. If your muscles don't relax during the first trial, a larger dose might be given on a later date to determine its effectiveness.

                                      Patients who experience positive results with the intrathecal medicine can decide with their doctor and family members if they should have a baclofen pump system implanted during a surgical procedure. Prior to surgery, you will meet with the surgeon and nurse to ask questions about the procedure.

                                      After the implantation procedure, you will stay in the hospital a few days so your recovery can be closely monitored. While you are in the hospital, the dose of baclofen will be adjusted. You will have follow-up visits with your doctor.

                                      Botulinum Toxin

                                      Botulinum toxin is a muscle-relaxing medication used to decrease spasticity related to multiple sclerosis and other neurological conditions. Botulinum toxin is derived from the bacterium Clostridium botulinum and is in a class of drugs called neurotoxins. Your doctor will decide which type of botulinum toxin (type A/Botox or type B/Myobloc) is more appropriate for you. Many other types of botulinum toxin have been identified but are not used for treatment of MS symptoms.

                                      Please note: The use of botulinum toxin in the treatment of MS-related spasticity has not yet been approved by the Food and Drug Administration, despite the drug's effectiveness. Please talk with your doctor about the potential benefits, risks, and side effects of receiving botulinum toxin to treat your MS-related spasticity.

                                      Botulinum toxin is given as an intramuscular injection. Your physician will determine the muscle(s) in need of treatment. The injections are given during an outpatient appointment. You can expect the appointment to last from one to two hours. A very fine needle is used for the injection. Some patients report minor and temporary discomfort from the injection. The medication does not sting or cause irritation after it has been injected. If the muscles to be injected are small or difficult to reach, it may be necessary to send short electric impulses, or to record electric signals from the muscles, to ensure that the appropriate muscles are receiving the injected medication.

                                      The effects of the medication begin to appear one to two weeks after the injection. The muscles injected should then relax. You may experience relief of stiffness and spasms and improved ability to use the affected part of the body. Physical and occupational therapy after the injections increases the chances of getting an optimal result. The medication is effective from two to six months, depending on the individual. The effect of the injections is temporary. Therefore, injections must be repeated over time to maintain the beneficial effects. Injections are not repeated more often than every three months to minimize the risk of developing antibodies to the botulinum toxin, causing the botulinum toxin to be less effective, because the antibodies bind to the toxin and neutralize it. If this occurs, switching to the other type of toxin (e.g., from type A to type B) may be helpful.

                                      The benefit of botulinum toxin is limited to the injected muscles. Therefore, botulinum toxin may not be a good treatment choice when many muscles are involved or when the spastic muscles are large. Botulinum toxin injections are not always covered by insurance. Check with your insurance provider before receiving treatment to determine how much of the procedure will be covered.

                                      Side effects of botulinum toxin include:

                                      • Brief flulike symptoms (these may develop one day to one week after the injections and usually last only about one day)
                                      • Temporary weakness of the injected muscle and weakness in some nearby muscles
                                      • Please talk to your doctor about the potential side effects of the medication before agreeing to treatment.

                                        After the treatment, please call your doctor:

                                        • If you think that the medication is not working (please wait at least two weeks after the injection)
                                        • If you are experiencing side effects that you think may be related to botulinum toxin
                                        • When the effects of the medication wear off
                                        • Monitoring Disease Progression

                                          Over the past several years, the approach to MS treatment has focused on initiating therapy at an early stage. This is done to try to stop the inflammatory process and the resultant tissue damage to the nervous system. Therapy is also started early to decrease the risk of future disability. Although the currently available therapies are effective and safe, they do not work 100 percent for everyone all the time. Therefore, after you begin therapy, it remains important to monitor your disease to confirm that your treatment is working as intended.

                                          Disease activity is detected in several ways. First, the doctor asks about possible relapses (attacks) and whether you or your family have noted any changes in your overall condition or ability to function. Second, the doctor performs a neurological examination, focusing on aspects or symptoms that you feel might have worsened. For this assessment, quantitative tests, such as timing how fast you can walk, might be utilized. Finally, the doctor uses magnetic resonance imaging to monitor MS because it can identify inflammatory activity that is not apparent on a clinical exam.

                                          During the MRI, the patient receives an injection of gadolinium, which displays spots of active inflammation on the MRI that enhance or ("light up") after the patient receives the injection. The doctor looks for new spots on the recent MRI scan that were not present on the previous MRI scan. The overall number of spots and the presence of atrophy (shrinkage of the brain) are used to determine the overall amount of damage that has occurred.

                                          Continued disease activity means your therapy has not been completely effective in treating your MS. In that case, the options include adding new treatments (for example, one or several courses of IV steroids) or switching to another medicine (for example, from Copaxone to Avonex, or vice versa). To decide the new course of treatment, the doctor considers how long you have been treated with your current therapy, how active your MS has been in the past, how active it appears to be now, and the available treatment options for your personal situation.

                                          Last reviewed on 03/19/2007

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