Multiple Sclerosis (MS)
Patients must be referred by their primary care doctor for a second opinion or diagnosis/treatment. Patients are advised to bring essential records (neurological assessments, MRI or CDF results, neuroimaging, etc.) to their first visit.
The UW Health neurology program in Madison, Wisconsin provides comprehensive treatment for multiple sclerosis (MS).
Our program is affiliated with the National Multiple Sclerosis Society and has a status of NMSS-Wisconsin Chapter Affiliate. This designation signifies that, because of the demonstrated excellence of our care, the National Multiple Sclerosis Society refers patients to our clinic.
Our team offers new treatments, early intervention and continuity-of-care, always keeping the individual patient's needs foremost in our minds. Our staff also has a strong connection to the latest MS research, which keeps us apprised of the latest breakthroughs to counter the disease.
What is multiple sclerosis?
Multiple sclerosis is a chronic disease that attacks the central nervous system (brain, spinal cord and optic nerve). The course of the disease is unpredictable and can vary with regard to progression, severity and symptoms.
Multiple sclerosis is not fatal. Life expectancy is near normal. In the United States, there are about 400,000 individuals affected by multiple sclerosis.
Multiple sclerosis symptoms can vary and may include:
- Blurred vision
- Sensory changes (numbness and tingling or pain)
- Extreme fatigue
- Walking difficulties
- Poor memory or concentration
- Decreased coordination
- Muscle weakness, muscle spasms or spasticity
- Slurred speech and difficulty with verbal communication
- Problems with bladder and bowel control
- Sexual functioning problems
- Susceptibility to depression
Usually diagnosis of multiple sclerosis is made between the ages of 20 and 50. It is more commonly diagnosed in women than men. Multiple sclerosis is not easy to diagnose because the symptoms can overlap with those of other diseases and symptoms may come and go over several years. There is no specific symptom or diagnostic test that by itself can determine the diagnosis of multiple sclerosis. The diagnosis of MS consists of multiple pieces of a puzzle that the neurologist pieces together.
Multiple Sclerosis Categories
- Relapsing remitting: Characterized by clearly-defined, acute attacks with full or partial recovery and no disease progression between attacks. This is the most common form of MS at the time of diagnosis.
- Primary progressive: Characterized from the beginning by progressive disease, with no plateaus or remissions, or an occasional plateau and very short-lived, minor improvements.
- Secondary-progressive: Characterized by initial relapsing-remitting and then becoming progressive at a variable rate, possibly with an occasional relapse and minor remission.
- Progressive-relapsing: Characterized by disease progression from the beginning but with clear, acute relapses, with or without full recovery from those relapses along the way.
Treatment medications include immunomodulating drugs, given by injection, that have helped patients with relapsing/remitting MS by reducing severity and the number of relapses. These medications may slow down the progression of MS and reduce disease activity.
Immune system suppressors have shown to be effective in slowing MS that is worsening or becoming progressive.
Steroids given intravenously for short periods of time are sometimes used for acute attacks.
There are many medications to relieve symptoms such as pain, fatigue and spasticity. Symptom management is also aided by:
- Physical and occupational therapies
- Adaptive devices
- Diet, exercise and rest
- Attention to environmental factors such as heat
- Treatment of infections such as urinary tract infections
It is always important for the patient to take cues from their body to help manage symptoms, which in turn will give them a feeling of having more control over the disease.
Shared Decision Making Model
The Shared Decision Making Model allows management decisions to be determined by a partnership between the patient and his or her health care providers. All treatments carry risks for potential benefit or adverse (side) effects, and the best treatment for you depends on your individual medical facts and your individual preferences. The Shared Decision Making Model consists of:
- Watchful Waiting Option: For many patients with early or mild multiple sclerosis, delaying or forgoing treatment is a perfectly acceptable management plan, as long as there is periodic reassessment and re-evaluation in clinic.
- Disease Modifying Treatment (DMT) Option: DMTs - drugs considered in early relapsing-remitting MS - are given by injection on a specific, self-administered schedule. They reduce the frequency of attacks or flares by about 30 percent but differ mainly in the schedule of injection and sometimes in side effects.
- Experimental Treatment Option: Several treatments are being tested in clinical trials. Each clinical trial has the permission of the FDA and UW Institutional Review Board to enroll patients. Previous research has shown promise for each of the agents, and it is our hope that eventually these or other clinical trials will lead to treatments which are more effective and safe than current DMTs.