What to know about MS

It can be mild or severe, nearly undetectable, or affect your ability to see, write, speak, and walk. It is Multiple Sclerosis. With March being Multiple Sclerosis Awareness Month, here’s what you need to be aware of when it comes to recognizing symptoms and finding treatment.

Multiple Sclerosis Awareness

Multiple sclerosis, known as MS, is a chronic disease that attacks the body’s central nervous system. It is likely an autoimmune disorder that’s almost completely unpredictable and affects everyone differently. 

With MS, the fatty tissue that surrounds and protects nerve fibers is destroyed in many areas. This loss then forms scar tissue called sclerosis. When the nerves are damaged in this way, they can’t conduct electrical impulses to and from the brain.

There are many possible causes of MS:

• Autoimmune disorders
• Infectious agents, such as viruses
• Environmental factors
• Genetic factors

What should you look for when it comes to MS

While the symptoms of MS are often unpredictable, some seem to be the most common: 

• Blurred or double vision
• Red-green color distortion
• Pain and loss of vision because of swelling of the optic nerve (optic neuritis)
• Trouble walking

Other individuals may also experience abnormal pains like numbness, 

prickling, or pins and needles (known as paresthesia). Please keep in mind that multiple sclerosis may only be one possible reason for these types of symptoms, and a proper diagnosis is needed to begin treatment. 

Find answers at UCR Health

If you are experiencing symptoms, or are concerned you might have MS, talk to your doctor right away. While there is no cure (yet) for MS, there are things that can be done to help change the course of the disease, treat flare-ups, manage symptoms, and improve your function and mobility.

Treatments will likely be based on age, overall current health, as well as past health, how sick you feel, how well you can handle certain medicines, and more. Treatments will likely include medicines, canes or walkers (to assist with mobility), and rehabilitation activities. 

As with any disease, it’s important to see your doctor so you can begin managing your MS as soon as possible.

To speak with a UCR Health physician, please visit https://www.ucrhealth.org/make-an-appointment/ or give us a call at 1-844-827-8000.

About UCR Health

UCR Health is comprised of a team of physicians, specialists, and healthcare professionals dedicated to improving people’s health. With five medical offices located throughout the Inland Empire and Coachella Valley, UCR Health is growing to meet the healthcare needs of the region, bringing innovative, culturally sensitive medical care to the community. Established alongside the School of Medicine at the University of California, Riverside, UCR Health’s patient-centered primary care and specialty services deliver university-based healthcare excellence and innovation to all communities.

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To watch Dr. Rosenberg's latest webinar on the "Management of Multiple Sclerosis Symptoms," please visit our Youtube page.

To make an appointment, please visit https://www.ucrhealth.org/make-an-appointment/

The post July 2022 Physician Highlight – Jay Rosenberg, MD appeared first on UCR Health.

Common Symptoms of Multiple Sclerosis:

• Fatigue
• Numbness or Tingling
• Loss of balance and Dizziness
• Stiffness or Spasms
• Tremor
• Pain
• Bladder Problems
• Bowel Trouble
• Vision Problems
• Problems with Memory and Thinking

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Many propose evidence for one possible mechanism of transition from relapsing remitting disease to progression and degeneration involves the immune system. This system is made up of two main parts: the innate (general) immune system and the adaptive (specialized) immune system. The innate system is the body’s first line of defense against germs entering the body. It responds in the same way to all germs and foreign substances. It consists of cells that are neutrophils, antigen presenting, phagocytes, natural killer cells, dendritic cells, cytokines, complement, and microglia. The adaptive system consists of T and B cells, as well as antibodies. The difference is that the adaptive cells have memory of previous contact with noxious agents. 

In SPMS/PPMS, certain aspects of immunity have been identified and potentially linked to development of progression. In the meninges there are collections of nodules of inflammatory cells that are felt to be active. Cells present in the edges of existing plaques multiply and the plaque expands. The innate immune system is active with proliferation of microglia as identified in specialized neuroimaging studies. These observations are intriguing and support ongoing immunological activity associated with degeneration. 

The issue of inevitability, centers around aging. It Is argued that we reach a certain age and regardless of what is done, this transition from RRMS to Progression occurs. This theory is tied to the concept of “brain plasticity” and “brain reserve.” Brain Plasticity is the ability of the nervous system to change its structure and functioning throughout a person’s life as a reaction to the environment. Brain Reserve increases the tolerance of the brain to physiological or pathological changes. This reserve is initially acquired genetically, but there are environmental factors such as education and participation levels in social and physical activities that potentially can increase reserve. There are interindividual differences in brain reserve that provide a greater or lesser tolerance in terms of protection produced by the effects of ageing or disease. 

MS produces a constant involvement of demyelination but at various rates of occurrence. Aging plus demyelination are ongoing and definitely at some point produces a major impact on brain reserve. It is argued that aging maybe the key factor in development of progression through this mechanism. The use of “DMTs” appears to decrease this process but doesn’t eliminate it. 

Stephen C Krieger MD put forth an explanatory model of one theory for the mechanism of progression in MS. A recent Scientific American article authored by Brett Stetke, June 2015, summarized the Krieger approach:  He stated:

….Imagine a pool with mountains rising up from the bottom. The mountains represent scars in the central nervous system; the water surface is the threshold at which symptoms appear. Lesions below the water line do not cause symptoms whereas those jutting out of the water do.

The water surface can also be seen as the body's neurologic reserve capacity. Our brains are astoundingly resilient: If one part of the brain is injured, neighboring neurons can step in and take over. But according to Krieger, as we age and as MS progresses, not only does the scarring worsen (that is, the mountains grow higher), the brain also loses its ability to compensate for injured tissue—meaning water starts draining out of the pool and more lesions appear and resulting symptoms become apparent.

Krieger calls his view of MS the topographical model (referring to the mountains jutting out of the water). He believes his concept unites the MS categories and demonstrates the relationship between relapsing and progressive disease. Relapsing-remitting patients have mountains that temporarily rise above the waterline but then sink again. In those with the other two forms of MS—the more consistently progressive forms—the mountains emerge above the surface but never recede and the symptoms never go away.

Thus, with aging, the level of the pool drops. Stress and illness can also affect the level. The lower the level the more symptomatic and potentially progressive the patient

Early research into strategies of intervention emphasized treatment and prevention of relapsing-remitting disease. It turned out that efficacy could be easily demonstrated through  imaging with MRI. This surrogate marker for relapses could be easily counted, measured, and quantified. Measuring of disability was challenging but possible. However, often the time frame chosen for disability was too short. These three outcome measures (MRI, relapses and disability) could potentially establish objective efficacy and safety of various DMTs in a relatively short period of time. Progressive disease turns out to be a totally different ball game. Potentially, outcomes measures are far more subjective and challenging to demonstrate. The biomarkers are limited. The process occurs over prolonged time (multiple years to decades rather than months to years). It is reassuring to note that the research emphasis of the MS Society and the NIH has shifted from relapsing disease to progressive disease. Varying mechanism of actions for progression are being identified and potential targets assessed. 

One of these new strategies being developed presently and in clinical trials consists of the discovery of the Bruton’s Kinase Inhibitors (BTKs). BTKs were initially discovered to be active against certain hematological malignancies. BTK is an enzyme that increases B cell antigen receptors downstream.  This results in increasing of substances that transmit the signals that allow immune cells to respond to foreign antigens by targeting the cells and presenting them for destruction. This consists of highly selective B cells. This strategy differs considerably from the ongoing complete depletion of all B cells through the anti-CD20 mechanism (Ocrevist, Rituxan, Kesimpta). BTK inhibitors are being advanced by several different pharma companies. These products are in various stages of development to establish their safety and clinical efficacy. Initial studies have been encouraging but we must wait for the final data that will analyze their safety and effectiveness.

The post When Does the Transition from Relapsing Remitting Disease (RRMS) to Progressive Disease (Secondary Progression (SPMS) or Primary Progression (PPMS) Occur and Is It Inevitable? appeared first on UCR Health.

It was announced that anyone whose immune system is immunocompromised is eligible for a booster. Further, it was announced that after 8 months everyone will be available for a booster.  In the next several weeks the CDC will further clarify this issue and hopefully by the end of the summer will explain the status of vaccinations for children age 2-12. 

I cannot wait until that particular issue is resolved.  Children appear to be getting sick at a higher rate than anticipated.  The mask controversy related to their use in schools is in my opinion absurd.  Science shows that the use of masks does cut down on infection.  Anyone with young kids who attended school last year (mostly private) could observe, like us, that the young children did not get sick as in previous years. 

My 4-year-old and 6-year-old grandchildren wear masks as second nature; they have never questioned it.  I think that the return of masks for indoor dining, gatherings, and school only makes public health sense.  The issue appears to be whether public health mandates for the greater good outweighs perceived infringement upon individual rights. 

If you have MS, have or have not been vaccinated, and contract COVID-19, remember that the presence of the fever and infection can allow your previous symptoms to emerge very symptomatically (Pseudo-relapse). 

My recent experience was with a patient who had onset MS. Their symptoms were fever and a headache sending this patient straight to the ER. Because they had only a tiny bit of shortness of breath, they were going to be sent home.  What was brought to the attention of the ER attending was that the presence of fever results in decompensation of the symptoms of his MS and made functioning at home dangerous and very challenging.  Not only could he not manage at home, but his fever and headache were continuous and complicated his interpretation of symptomatology.  In the normal patient, one might not be admitted but in the MS patient, I think admission with those symptoms is mandatory. This patient had not been vaccinated. 

The overall message is to get vaccinated and if eligible for a booster get it.  The CDC will approve the booster for those over the age 65 eight months after their initial vaccine.  For me, this will be on Sept 30. 2021.  I can’t wait!

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I met Judy during my senior year of medical school and after graduation, we attached our two cars together and started our adventure across the country to Los Angeles.  We detoured to Denver, Colorado to join friends to be spontaneously married on June 18, 1968.  We had briefly discussed each other’s various infirmities. Mine was one of a hereditary bone condition that had required numerous surgeries which she had already researched.  I knew very little of her medical history; however, during my time off of work, I became aware of a drop foot and difficulty with vision out of one eye.   She raised an issue of possible Multiple Sclerosis (MS).  Being quite naive at the time, we had no idea of the implications and meaning of the words “Multiple Sclerosis”.  We honeymooned the rest of the way arriving in Los Angeles in late June, and we settled in South Pasadena.  

On July 1, I began my internship at the Los Angeles County USC Medical Center. The Vietnam War had escalated and as a physician, my 4-F status was changed to 1-A.  LAC-USC Medical Center’s house staff was immense.  One half of the staff had already served in Vietnam and the other half listened to their war stories.  As a result, I decided I wanted no part of Vietnam.  I had planned, and I was admitted into several psychiatric residencies but without a military deferment, I could not proceed.  In I969, the army had drafted too many physicians. As a result, they offered one-year deferments which I enthusiastically accepted, but psychiatric residencies wanted 3-year continuity and refused to admit me. Rotating on neurology at the time, a residency position became available.  I believed a year of neurology would be helpful in a psychiatry residency, and I filled the spot.  Several months into the neurology program, I was granted a 3-year deferment in psychiatry.   I found neurology fascinating, and I signed on the dotted line to complete the three-year residency. 

During that first year of residency, Judy was employed by Los Angeles Children Hospital as one of the first pediatric dialysis nurses. She had several episodes of numbness and tingling moving up from the feet to the waist.  I was concerned about the stress of working nights, but she was not.  We decided to seek neurological consultation and made an appointment with one of my favorite professors.   She met with us, took a history, and performed an examination promptly informing us that the diagnosis was multiple sclerosis.  This was immediately followed by her major advice, “you should have no children.”  Having reviewed the literature on pregnancy and MS, I had consumed several articles that reported no adverse effects of pregnancy and in fact, stated that there may be a benefit.   Subsequently, I learned my professor was influenced by a painful experience of an “n of one” (a single patient) who deteriorated and became severely incapacitated in the middle of her pregnancy.   For the next twenty minutes, the professor described in vivid detail her own children.  Until much later in my career, it didn't impact upon me how this behavior demonstrated a true lack of empathy.    

We went on to have two normal and uneventful pregnancies.   A daughter was born and immediately afterwards an IUD was placed for contraception.  Ten and a half months later, my son was born.  Only afterwards, did we discover that at the time of IUD insertion, it had penetrated through the uterine wall and settled in the left pelvic gutter.   After the children were born, Judy never returned to work.  Caring for two “Irish Twins” was a challenging task and required 181 diapers per week (pampers were not as readily available at the time). 

At the end of residency training, the Army decided they didn’t want to assume my medical care the rest of my life and I was discharged.  I joined the neurology department of Kaiser Permanente in San Diego as the first, full time neurologist.  In the early years not only did my practice encompass all adult neurology but also pediatric neurology.  I was made Chief of Neurology in 1973 and began to build a department that ultimately consisted of one pediatric neurologist and 9 adult neurologists. 

As the sole neurologist in the group, I was busy working day and night.   I engaged and fathered my children to the best of my abilities.  In our household, Judy practiced the “no talk rule” when it came to Multiple Sclerosis.  As denial was her major coping defense mechanism, I passively concurred.   She did not discuss nor complain to any of us about her MS-related symptoms.  She would occasionally have numbness and tingling that would come and go.  She rationalized that there was no treatment and scarred by her initial interaction with the professor; she sought no medical care.  She remained amazingly healthy and active, and we were a family no different than any other.  We learned to ski together, which she did without any difficulty. What became evident to me over the next 14 years was a gradual progression of impaired walking.  This culminated when she watched the video of a family milestone celebration and suddenly commented, “Oh my God is that the way I walk”. 

In the 1970s and 1980s, no disease-modifying therapies existed. Dr. Rose, a professor at UCLA and one of the major thought leaders of the time, published one of the first randomized control trials for relapsing and remitting MS with intravenous ACTH versus placebo at the time of relapse.  This required short-term hospitalization.   The results reported that exacerbations resolved quicker with ACTH compared to placebo; however, treatment with ACTH did not change the course of the disease.    

In May of 1977, she found a lump in her right breast. Initially, it was like a small pebble that could hardly be felt.  A month later it was obvious and the head of the Department of Surgery at the time commented, “it was nothing, but we should remove it.”  Immediately following the biopsy, he informed us that the frozen section confirmed adenocarcinoma of the breast. He must have thought we were in denial for he repeated over and over again, “this is cancer, cancer”. A right modified radical mastectomy and axillary node dissection followed. There was no follow-up therapy other than making sure that the incision had healed. As the Chief of Surgery, he did not believe in a comprehensive breast program that utilized the support of other additional health care providers. Reconstruction was not discussed, and she was satisfied to use a prosthesis. 

Over the next five years, her MS symptoms of unsteadiness, tingling, and numbness would come and go, but at no time did she complain, nor did this interfere with her level of function. We still practiced the no-talk rule. At the five-year mark, a supraclavicular node indicated tumor reoccurrence with a biopsy confirming the identical original tumor.  She underwent radiation therapy to the right neck and the internal mammillary chain. We then sought an opinion from the head of oncology at UCSD. As he was a pioneer in the use of adjuvant chemotherapy, we launched into a 6-month course. At the 3-month mark, the chemotherapy regime resulted in complete destruction of all her white blood cells to zero. A 10-day hospitalization with IV antibiotics prevented infection and the count returned to normal.  

This turned out to be an incredible fortuitous event. What we noticed over the next several months was that her MS improved dramatically, and all symptoms disappeared. Simultaneous to this event, Dr. Howard Weiner from Harvard University published the first article that outlined the use of Cytoxan for the treatment of multiple sclerosis. This was one of the drugs used in her chemotherapy regimen for her breast cancer reoccurrence. For the next 18 months, Judy returned to total normal function and it was as if her multiple sclerosis did not exist.   

However, as reported in the literature, 18 to 20 months after the initiation of chemotherapy, symptoms returned, and she developed a slowly progressive course. In the early 1980s at one of our Academy meetings, I met Randy Schapiro for the first time.  He was practicing in Minneapolis and had a huge MS practice.  It was refreshing to interact with somebody whose philosophy was similar to mine.  He was the first individual who did not just “diagnose and adios” but believed that MS symptoms could be treated effectively. He was charismatic, enthusiastic, and thus began my MS education. 

My neurology practice remained relatively generalized but emphasized neuro-oncology and neuropsychiatry. Then, in 1988, after three years of suffering in relative silence, progressive headaches became so severe and intolerable that Judy finally agreed to see a neurological colleague who ordered her first imaging study; a CT scan. This showed hydrocephalus, an enlargement of her ventricular system, along with a large cystic structure with a small nodule in the cerebellum where the coordination area is located in the back of the brain. Upon my review of the scan, the cystic tumor did not appear to be consistent with the spread of breast cancer to the brain. At noon we saw the neurosurgeon who hospitalized her and operated on the next morning. She had a stormy postoperative course with some lethargy which gradually improved. The tumor was not breast cancer but rather a relatively benign tumor originating in the brain and diagnosed as a ganglioglioma. 

On a one-month post-operative visit, the neurosurgeon could not understand why her walking had not improved as he had anticipated. He did not appreciate the comorbidity of MS. She underwent her first MRI scan and this showed some white matter changes but not as severe as I had anticipated. From this point on, denial disappeared, the no-talk rule was broken, and she became involved in the MS community. She joined a support group which she ultimately chaired as the group leader holding the meeting in our living room. She was placed on the first Patient Advisory Board of the National MS Society and was instrumental in establishing the guidelines for the structure and function of MS support groups. She served with me on the first MS guideline committee for the evaluation and treatment of Fatigue. My practice subsequently expanded in MS ultimately reaching over 300 patients.  

Judy often accompanied me as I traveled extensively for business. She and I often met with patient and professional groups as motivational speakers. We would share our story and our life experience to date. These presentations created an environment for interactivity and dialogue. We both found this a very meaningful and healing experience. In addition, as a family, we traveled together for pleasure across the globe. We became adept at dealing with the airlines, transporting our manual and power mobility devices. We became very skilled and knowledgeable at adapting and creating solutions to different challenges to improve our quality of life. 

In 1993, Betaseron became available as the first FDA-approved treatment for MS. This was met with huge excitement but some skepticism.  We were introduced for the first time to the details of how a “clinical trial” demonstrates efficacy and side effects. This disease-modifying approach was never anticipated to be so successful and has been followed by the licensing of 16 FDA-approved medications. 

The first clinical trial for secondary progressive MS was a multicenter national and international effort.  I was the Principal Investigator for the San Diego Kaiser site where we enrolled over 30 patients.  At the time Judy was 14 years disease-free from cancer. She and I had a conversation over her participation and obtained several professional opinions. Ultimately, we decided to pass.  It was a good thing that we had made that decision because one year later, her cancer returned to her chest. If she had participated, we might have blamed the reoccurrence on Betaseron. 

In October 2003, for treatment of metastatic cancer to the skin in the left supraclavicular area, radiation therapy was administered on two separate occasions. Because the right neck had been previously radiated, complete loss of autonomic function followed as an adverse event. Severe orthostatic hypotension made it difficult to go to a standing position because of a large drop in blood pressure. Her gastric emptying slowed considerably, and weight loss followed. At 108 pounds, a percutaneous gastric feeding tube was not approved, and only when her weight reached 85 pounds was it prescribed. As her needs increased, we hired a caregiver. Not realizing that she had extensive metastatic disease, the entire family spent ten days in New Zealand over the holidays. During the visit, she became quite debilitated limiting our travel within the country. 

On our return, we remained in denial.  By the third week in January, she was hospitalized because of a pathological fracture of the radius and general debilitation.  Only then was extensive metastatic disease diagnosed and upon discharge she was placed on hospice.  During her last week, we were all present taking turns at the bedside.  The clergy, who we had sought consultation with 6 months before, were very comforting.  The last hours she refused any pain medication and was totally awake and aware.  About five minutes before her last breath, she asked my daughter and I “What Shall I tell Him?”  We answered, “you tell him you are a wonderful person who has led a very loving life and that he should welcome you with open arms.”  

In 1986, I joined the Practice Committee of the American Academy of Neurology and became the first chair of the Academy’s initial guideline committee. I put together a group of diverse neurologists with a wide variety of expertise. This committee established and legitimized outcomes and evidence-based medicine in neurology. The process changed my life and practice began with my ongoing experiential fellowship and education in Multiple Sclerosis. I am indebted to my patients, colleagues, Pharma, and our educational meetings. I have attended yearly the American Academy of Neurology (AAN), the European Consortium in the Treatment and Research in MS (ECTRIMS), the Consortium of MS Centers (CMSC), and the American Consortium for the treatment and Research in MS (ACTRIMS). It is at these venues where the latest scientific research is presented, controversy is highlighted, and meaningful interchange occurs between thought leaders. The proceedings are published in peer-reviewed literature. Thus, with my patients and a positive relationship with all of Pharma, my educational process and experiential fellowship continue.  

I hope that this blog will be ongoing, educational, and meaningful. I dedicate the blog to Judith Ann Rosenberg. There is an ongoing fund at the American Brain Foundation in her name at the American Academy of Neurology.  

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At UCR Health, our specialists are fellowship trained and skilled in the diagnosis of MS. We work with you and your family to determine the best treatments for managing your disease and improving your day-to-day quality of life.

More than 400,000 Americans are living with MS with symptoms ranging from mild to severe. There are also additional people affected by demyelinating disorders, such as neuromyelitis optica and transverse myelitis. Most people with these disorders learn to manage their disease and lead productive lives with the help of advanced medical care - such as the care provided by UCR Health specialists.

Our medical offices are located in Riverside making it convenient for people living in our local communities of Riverside, Corona, Moreno Valley, and Palm Springs to receive care. Our physicians are affiliated with the University of California, Riverside School of Medicine, assuring you and your family that we will deliver the best care with access to other specialties should you need them. For more information or to schedule an appointment, call us at 844.827.8000.

CONDITIONS WE TREAT

Our neurologists treat the following conditions:

• Adult and pediatric multiple sclerosis
• Neuro-immunological disorders
• Neuromyelitis optica spectrum disorders (NMOSD, Devic’s disease)
• Optic neuritis
• Suspected multiple sclerosis
• Transverse myelitis

TREATMENTS AND SERVICES

Common treatments and services we offer include:

• Bladder scan screening for multiple sclerosis
• Cognitive evaluations and neuropsychological testing
• Consultations for suspected multiple sclerosis
• Disease-modifying therapy and symptom management for multiple sclerosis and related demyelinating conditions such as optic neuritis, transverse myelitis and neuromyelitis optica
• First-dose observation for fingolimod (Gilenya®) for multiple sclerosis
• Health promotion and wellness care, including educational programs
• Intravenous infusion of natalizumab (Tysabri®) and other immune suppressant medications for multiple sclerosis
• Symptom management
• Telemedicine consultations for multiple sclerosis

PHYSICIANS

• David Franklin, PsyD
• Elizabeth Morrison-Banks, MD
• Jay Rosenberg, MD
• Lynsey Lakin, FNP-C

RESEARCH

In addition to providing comprehensive, patient-centered care, our team of experts is at the forefront of MS research, aiming to find new therapies to treat this autoimmune disease.

Our physicians and researchers participate in many studies that include the investigation of chemical compounds to treat the underlying loss of myelin-associated with MS and alter the body’s immune system to reduce disease symptoms and disability. 

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At UCR Health, we understand that multiple sclerosis (MS) affects each patient in unique ways. Our MS care team is dedicated to providing you with an individualized management plan based on your needs – delivering compassionate, advanced medical care to help you manage your symptoms and provide you with greater control over your illness.

The Multiple Sclerosis Program at UCR Health is designated by the National Multiple Sclerosis Society as a Partner in MS Care. Led by Dr. Elizabeth Morrison-Banks, our MS care team has extensive knowledge and experience in MS care:

Elizabeth Morrison-Banks, MD, MSED, Director: Dr. Morrison-Banks is a Health Sciences Clinical Professor of Neurology and a fellowship-trained neuroimmunologist. She is also a clinical researcher and has more than 13 years of experience caring for adults and teens with multiple sclerosis and related conditions.

David Franklin, PsyD, Neuropsychologist: Dr. Franklin is Health Sciences Associate Professor of Psychiatry at the UCR School of Medicine and provides neuropsychological testing for patients of the UCR Multiple Sclerosis Program.

Lynsey Lakin, NP-C, Multiple Sclerosis Fellow: Lynsey is a neurology nurse practitioner who is currently completing a multiple sclerosis fellowship at the UCR Multiple Sclerosis Program. She currently sees patients as an MS fellow with Dr. Morrison-Banks.

In addition to providing comprehensive, patient-centered care, our team of experts is at the forefront of MS research, aiming to find new therapies to treat MS. We also care for patients who have been diagnosed with other demyelinating disorders such as neuromyelitis optica and transverse myelitis.

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Multiple sclerosis (MS) is a disease of the central nervous system, and the most common cause of non-traumatic disability in young adults in the United States. Multiple sclerosis affects more than 400,000 people in the U.S. and more than 2.3 million people worldwide. Within the central nervous system, multiple sclerosis causes the body’s immune system to attack the myelin sheath that insulates the nerve fibers, causing scars (“sclerosis”) that interrupt nerve impulses traveling to and from the brain, optic nerves and spinal cord.

Multiple sclerosis symptoms, diagnosis, and treatment

Symptoms vary from person to person and include muscle weakness, numbness and tingling, and vision loss, among others. Most people with MS are diagnosed between the ages of 15 and 50. At this time, there is no one single test that can diagnose MS. A neurologist who specializes in treating MS can rule out other conditions and make an accurate diagnosis of MS based on your medical history and neurological examination.

While there is no cure, most people living with MS learn to manage their symptoms and lead productive lives with the help of advanced medical care.

Researching new MS treatment options

Although the MS disease course is unpredictable, researchers are making progress in developing effective new treatments, including research on remyelination and neuroprotection in multiple sclerosis. The 2018 Americas Committee for the Treatment and Research in MS (ACTRIMS) annual meeting focused on emerging therapies for treating multiple sclerosis. Researchers presented on several topics, including extended interval dosing for certain patients to reduce the risk of developing progressive multifocal leukoencephalopathy (PML), pioneering work on myelin repair, and how vitamin D protects myelin in people with progressive MS.

Elizabeth Morrison-Banks, MD, MSED is a neurologist at UCR Health and director of the UCR Health Multiple Sclerosis Program.

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