Are you suffering from Multiple Sclerosis?
Overview: Multiple Sclerosis
Features of MS symptoms
- Lhermitte’s sign:When a person flexes the neck, there is an electric-shock-like sensation traveling down the back. This is not unique to MS, but it is often found upon questioning.
- Internuclear ophthalmoplegia (INO): An INO occurs when an MS lesion affects the medial longitudinal fasiculus, a structure that helps coordinate eye movements between the two eyes. This makes it difficult to move one eye fully in towards the nose and the other eye will have nystagmus, or jerking movements. This results in double vision when both eyes are open. When this occurs in a younger patient, MS is high considered.
- Optic neuritis: Optic neuritis is progressive vision loss, usually first affecting color vision, in one eye. It may be painful. This is due to demyelination of the optic nerve. While ON can occur by itself or in other conditions, it is quite common in MS. It is the first symptom of MS in up to 15-20% cases of MS and up to 50% of people with MS will have ON at some time.
- Partial myelitis: Myelitis refers to an inflammatory condition in the spinal cord. In contrast with other causes of transverse myelitis where the entire cross-section of the cord is affected, MS tends to only affect a portion of the level of the spinal cord. This may result in numbness in the feet/legs, spasticity, bladder dysfunction, or erectile dysfunction.
Difficulty or slow walking becomes common in MS. There are medications which have been shown to improve walking speed, such as Ampyra
Cognitive dysfunction: MS may lead to difficulties with multitasking and short-term memory over time.
Fatigue is common in patients who have MS. Notably, the degree of fatigue is often reported to be out of proportion to the person’s activities. Stimulating medications are occasionally used to help combat fatigue.
Consult Our Multiple Sclerosis Specilists
|Doctor Name||Dr. Sana Syed, MD|
|Primary Specialty||Neuroimmunology/multiple Sclerosis and Dementia|
|Subspecialty||Neuroimmunology and Dementia|
Initial Consultation: $139
Follow-up Patient Fee: $79
- Cerebrospinal fluid can be obtained when the diagnostic criteria are not fully met by clinical history or imaging. In this case, oligoclonal bands or elevated IgG testing can show active inflammation in the nervous system, which can support the diagnosis of MS.
Visual Evoked Potentials (VEP)
- In the setting of atrial fibrillation, stronger anticoagulants are used to significantly reduce the risk of stroke. This includes options such as warfarin, apixaban, rivaroxaban, or dabigatran.
- In the setting of a patent foramen ovale, the person should be evaluated for a closure procedure.
- If infective endocarditis is present, IV antibiotics are used, with a rare need for surgery.
Ocular Coherence Tomography (OCT)
- OCT utilizes advanced ultrasound technology to evaluate the optic nerve in the back of the eye to check for thinning or damage that could suggest MS. This can also be followed over time to see if a person’s MS is worsening or is stable.
Tests to rule out mimics of MS
- The Neurologist may suggest blood tests to rule out other conditions that can mimic MS. Including conditions such as Lyme disease and lupus, this list is extensive and tailored to the individual.
Subtypes of MS
RR is the classic pattern whereby a person has relapses – or “attacks” – of symptoms due to MS, and then the symptoms slowly improve.
Book an appointment with us
Acute MS flare / relapse treatments
Steroids are the most common treatment for acute MS relapses. The steroids have been shown to speed up the recovery – or remission – process. Often a high-dose IV steroid called methylprednisolone is used for 3 to 5 days, although occasionally oral prednisone may be used. IV steroids are occasionally given at the hospital, but often these can be arranged in an outpatient infusion center or to be given in the person’s home.
Plasma Exchange (PLEX)
In rare cases where MS symptoms worsen despite high dose steroids, PLEX may be considered. This involves removing a person’s plasma from the blood and replacing it with other plasma. This requires a surgically placed special catheter and often requires hospitalization.