Finding the right therapy for you
Many people with MS experience occasional relapses of symptoms. In more advanced cases, secondary progression and overall diminished health may occur. At the Multiple Sclerosis Center, we aim to get you on a therapy that minimizes relapses and prevents further progression in your condition.
Diagnosis
A diagnosis of multiple sclerosis is made using the patient’s clinical history, a careful neurological exam, and tests including magnetic resonance imaging (MRI) of the brain and spinal cord and cerebrospinal fluid (CSF) analysis. Other causes of symptoms the patient is experiencing must be ruled out. The Revised McDonald Criteria from 2017 outlines how to make a diagnosis. Evidence showing that inflammation and demyelination have occurred both at different points in time and in separate locations within the central nervous system is required to make a diagnosis of MS.
Various types of MS
The most common type of MS is relapsing multiple sclerosis (RMS). Relapses are defined as new or worsening neurologic symptoms that last over 24 hours. A new lesion or lesions in the central nervous system typically cause the relapses.
Clinically Isolated Syndrome (CIS) is the first episode of neurological complaints caused by central nervous system demyelination. Patients with CIS do not yet meet criteria for the diagnosis of MS. They may or may not go on to develop MS.
Most patients with relapsing MS eventually transition to secondary progressive multiple sclerosis (SPMS). In this phase of MS, patients typically develop gradually worsening symptoms over time.
The least common type of MS is primary progressive multiple sclerosis (PPMS). Patients with this type of MS don’t have early relapses and have increasing disability over time. Patients tend to be older at time of onset and often have more spinal cord lesions than brain lesions.
After receiving a diagnosis
Patients with MS are encouraged to exercise, keep a well-balanced diet, and to maintain good sleep hygiene after they are diagnosed. Patients need to quit smoking if they currently use tobacco, and not start smoking if they don’t. Patients also need to be compliant with their MS medication once they start. Most individuals diagnosed with MS are able to continue the activities they enjoy. While being diagnosed with MS can be challenging, it typically should not prevent patients from working or having families. Patients should be open with the MS team about their challenges so they can decide on a plan to overcome them together.
Treatments
Following a diagnosis, we seek your input to determine a treatment plan that's right for you. There are over a dozen treatments for relapsing MS, ranging from oral, injectable, and intravenous agents. Choosing a disease modifying therapy is not a “one size fits all” process and depends of a variety of factors, including efficacy, safety, side effects, suspected prognosis and patient preference. At Tufts MC, the MS team and the patient discuss the various treatment options and decide together the best course of treatment. If a change needs to be made after treatment is initiated, there are fortunately many other options available.
Since MS can lead to other health problems, we work closely with other Tufts MC specialties, such as ophthalmology, urology, psychiatry and rehabilitation, to manage your overall well-being. Depending on the progression of your illness, you can expect to visit our clinic twice a year for evaluations.
