Multiple sclerosis – Diagnosis and treatment – Mayo Clinic

Diagnosis

Neurological exam

Neurological exam checking knee reflexes

Neurological exam

A complete neurological examination and checkup history are needed to diagnose MS .

Multiple sclerosis FAQs

neurologist Oliver Tobin, M.B., B.Ch., B.A.O., Ph.D., answers the most frequently asked questions about multiple sclerosis .

so people who are overweight have a higher prospect of developing MS and people who have MS who are fleshy tend to have more active disease and a faster onset of progress. The independent diet has been shown to be neuroprotective is the Mediterranean diet. This diet is high in fish, vegetables, and nuts, and moo in loss meat .
sol this question comes up a bunch because patients who have multiple sclerosis can sometimes get a transient worsen of their symptoms in heat or if they exercise strenuously. The authoritative thing to note is that hotness does not cause an MS attack or MS get worse. And so it ‘s not dangerous. You ‘re not doing any permanent damage if this occurs. exert is strongly recommend and is protective to the mind and spinal cord .
Scientists do not so far know which stalk cells are beneficial in MS, what route to give them or what dose to give them or what frequency. so at the moment, stem cell treatments are not recommend outside of the context of a clinical test .
Neuromyelitis optica spectrum disorder or NMOSD and MOG-associated disorderliness can give features similar to multiple sclerosis. These are more common in people of asian or african-american ethnicity. And your doctor may recommend blood tests to exclude these disorders .
well, the first drug approved by the FDA for treatment of multiple sclerosis was in 1993. Since then, over 20 drugs have become available for discussion of MS. And the potency of these drugs has increased over fourth dimension to the bespeak where we can about wholly suppress the inflammatory component of the disease. This would not be possible if patients like you did not enroll in inquiry studies. There are many different types of research studies, not just drug trials, but besides experimental studies, as all of these enhance our understand of the disease, hopefully to lead to evening better cures for multiple sclerosis .
well, the most important thing about having a diagnosis of multiple sclerosis is that you are at the center of your aesculapian team. A comprehensive MS kernel is the best set for management of multiple sclerosis, and this typically includes physicians with expertness in multiple sclerosis, neurologists, but besides urologists, physiatrists or physical medicate and rehabilitation providers, psychologists, and many other providers who have specialty interest in multiple sclerosis. Engaging this team around you and your finical needs will improve your outcomes over clock time .
There are no specific tests for MS. rather, a diagnosis of multiple sclerosis much relies on ruling out other conditions that might produce exchangeable signs and symptoms, known as a differential diagnosis .
Your repair is likely to start with a thorough medical history and examination .

Lumbar puncture (spinal tap)

Lumbar puncture (spinal tap)

Lumbar puncture (spinal tap)

During a lumbar puncture ( spinal tap ) routine, you typically lie on your side with your knees drawn up to your chest of drawers. then a needle is inserted into your spinal anesthesia canal — in your lower back — to collect cerebrospinal fluid for testing .

MRI multiple sclerosis lesions

Multiple sclerosis lesions on the brain

MRI multiple sclerosis lesions

Brain MRI scan showing white lesions associated with multiple sclerosis .
Your sophisticate may then recommend :

  • Blood tests, to help rule out other diseases with symptoms similar to MS. Tests to check for specific biomarkers associated with MS are currently under development and may also aid in diagnosing the disease.
  • Spinal tap (lumbar puncture), in which a small sample of cerebrospinal fluid is removed from your spinal canal for laboratory analysis. This sample can show abnormalities in antibodies that are associated with MS. A spinal tap can also help rule out infections and other conditions with symptoms similar to MS.
  • MRI, which can reveal areas of MS (lesions) on your brain and spinal cord. You may receive an intravenous injection of a contrast material to highlight lesions that indicate your disease is in an active phase.
  • Evoked potential tests, which record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli. In these tests, you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.

In most people with relapsing-remitting MS, the diagnosis is fairly aboveboard and based on a radiation pattern of symptoms coherent with the disease and confirmed by brain visualize scans, such as MRI .
Diagnosing MS can be more difficult in people with strange symptoms or progressive disease. In these cases, foster testing with spinal anesthesia fluid psychoanalysis, evoked potentials and extra imagination may be needed .
Brain MRI
Brain MRI is often used to help diagnose multiple sclerosis .

Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your multiple sclerosis-related health concerns Start here

Treatment

There is no remedy for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progress of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessity .
Multiple sclerosis research laboratory
multiple sclerosis research testing ground at Mayo Clinic

Treatments for MS attacks

  • Corticosteroids, such as oral prednisone and intravenous methylprednisolone, are prescribed to reduce nerve inflammation. Side effects may include insomnia, increased blood pressure, increased blood glucose levels, mood swings and fluid retention.
  • Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body. Plasma exchange may be used if your symptoms are new, severe and haven’t responded to steroids.

Treatments to modify progression

For primary-progressive MS, ocrelizumab ( Ocrevus ) is the alone FDA-approved disease-modifying therapy ( DMT ). Those who receive this treatment are slightly less probably to progress than those who are untreated .
For relapsing-remitting MS, several disease-modifying therapies are available .
much of the immune reply associated with MS occurs in the early stages of the disease. aggressive discussion with these medications angstrom early as potential can lower the get worse rate, slow the formation of new lesions, and potentially reduce risk of brain atrophy and disability accumulation .
many of the disease-modifying therapies used to treat MS carry significant health risks. Selecting the right field therapy for you will depend on careful consideration of many factors, including duration and severity of disease, potency of previous MS treatments, other health issues, cost, and child-bearing condition .
treatment options for relapsing-remitting MS include injectable and oral medications .
injectable treatments include :

  • Interferon beta medications. These drugs are among the most normally positive medications to treat MS. They are injected under the clamber or into brawn and can reduce the frequency and asperity of relapses .
    side effects of interferons may include flu-like symptoms and injection-site reactions .
    You ‘ll need lineage tests to monitor your liver enzyme because liver damage is a possible side effect of interferon consumption. People taking interferons may develop neutralizing antibodies that can reduce drug potency .
  • Glatiramer acetate (Copaxone, Glatopa). This medication may help block your immune system’s attack on myelin and must be injected beneath the skin. Side effects may include skin irritation at the injection site.

oral treatments include :

  • Fingolimod (Gilenya). This once-daily oral medicine reduces backsliding rate .
    You ‘ll need to have your heart rate and blood blackmail monitored for six hours after the beginning dose because your heartbeat may be slowed. other side effects include rare good infections, headaches, high blood imperativeness and blur vision .
  • Dimethyl fumarate (Tecfidera). This twice-daily oral medication can reduce relapses. Side effects may include flushing, diarrhea, nausea and lowered white blood cell count. This drug requires blood test monitoring on a regular basis.
  • Diroximel fumarate (Vumerity). This twice-daily capsule is similar to dimethyl fumarate but typically causes fewer side effects. It’s approved for the treatment of relapsing forms of MS.
  • Teriflunomide (Aubagio). This once-daily oral medication can reduce relapse rate. Teriflunomide can cause liver damage, hair loss and other side effects. This drug is associated with birth defects when taken by both men and women. Therefore, use contraception when taking this medication and for up to two years afterward. Couples who wish to become pregnant should talk to their doctor about ways to speed elimination of the drug from the body. This drug requires blood test monitoring in a regular basis.
  • Siponimod (Mayzent). Research shows that this once-daily oral medication can reduce relapse rate and help slow progression of MS. It’s also approved for secondary-progressive MS. Possible side effects include viral infections, liver problems and low white blood cell count. Other possible side effects include changes in heart rate, headaches and vision problems. Siponimod is harmful to a developing fetus, so women who may become pregnant should use contraception when taking this medication and for 10 days after stopping the medication. Some might need to have the heart rate and blood pressure monitored for six hours after the first dose. This drug requires blood test monitoring on a regular basis
  • Cladribine (Mavenclad). This medication is generally prescribed as second line treatment for those with relapsing-remitting MS. It was also approved for secondary-progressive MS. It is given in two treatment courses, spread over a two-week period, over the course of two years. Side effects include upper respiratory infections, headaches, tumors, serious infections and reduced levels of white blood cells. People who have active chronic infections or cancer should not take this drug, nor should women who are pregnant or breast-feeding. Men and women should use contraception when taking this medication and for the following six months. You may need monitoring with blood tests while taking cladribine.

infusion treatments include :

  • Ocrelizumab (Ocrevus). This humanized monoclonal antibody antibody medicine is the only DMT approved by the FDA to treat both the relapse-remitting and primary-progressive forms of MS. Clinical trials showed that it reduced backsliding rate in relapsing disease and slowed worsen of disability in both forms of the disease .
    Ocrelizumab is given via an intravenous infusion by a medical professional. Infusion-related side effects may include discomfort at the injection site, first gear lineage atmospheric pressure, a fever and nausea, among others. Some people may not be able to take ocrelizumab, including those with a hepatitis B infection. Ocrelizumab may besides increase the hazard of infections and some types of cancer, particularly front cancer .
  • Natalizumab (Tysabri). This medicine is designed to block the motion of potentially damage immune cells from your bloodstream to your brain and spinal anesthesia cord. It may be considered a first line treatment for some people with severe MS or as a irregular agate line treatment in others .
    This medication increases the risk of a potentially good viral infection of the brain called progressive multifocal leukoencephalopathy ( PML ) in people who are positive for antibodies to the causative agent of PML JC virus. People who do n’t have the antibodies have extremely depleted gamble of PML .
  • Alemtuzumab (Campath, Lemtrada). This drug helps reduce relapses of MS by targeting a protein on the come on of immune cells and depleting white lineage cells. This effect can limit electric potential nerve wrong caused by the white lineage cells. But it besides increases the risk of infections and autoimmune disorders, including a high risk of thyroid autoimmune diseases and rare immune mediated kidney disease .
    treatment with alemtuzumab involves five consecutive days of drug infusions followed by another three days of infusions a class late. Infusion reactions are common with alemtuzumab .
    The drug is entirely available from file providers, and people treated with the drug must be registered in a especial drug safety monitor program. Alemtuzumab is normally recommended for those with aggressive MS or as moment pipeline discussion for patients who failed another MS medicine .

Treatments for MS signs and symptoms

Physical therapy session
physical therapy for multiple sclerosis
forcible therapy can build muscleman lastingness and ease some of the symptoms of MS .

  • Physical therapy. A physical or occupational therapist can teach you stretching and strengthening exercises and show you how to use devices to make it easier to perform daily tasks .
    physical therapy along with the use of a mobility care when necessary can besides help manage leg weakness and early gait problems much associated with MS .
  • Muscle relaxants. You may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal, Gablofen), tizanidine (Zanaflex) and cyclobenzaprine may help. Onabotulinumtoxin A treatment is another option in those with spasticity.
  • Medications to reduce fatigue. Amantadine (Gocovri, Osmolex), modafinil (Provigil) and methylphenidate (Ritalin) may be helpful in reducing MS-related fatigue. Some drugs used to treat depression, including selective serotonin reuptake inhibitors, may be recommended.
  • Medication to increase walking speed. Dalfampridine (Ampyra) may help to slightly increase walking speed in some people. People with a history of seizures or kidney dysfunction should not take this medication.
  • Other medications. Medications also may be prescribed for depression, pain, sexual dysfunction, insomnia, and bladder or bowel control problems that are associated with MS.

Clinical trials

explore Mayo Clinic studies testing new treatments, interventions and tests as a intend to prevent, detect, regale or manage this condition .

Lifestyle and home remedies

To help relieve the signs and symptoms of MS, test to :

  • Get plenty of rest. Look at your sleep habits to make sure you’re getting the best possible sleep. To make sure you’re getting enough sleep, you may need to be evaluated — and possibly treated — for sleep disorders such as obstructive sleep apnea.
  • Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination. Swimming or other water exercises are good options if you’re bothered by heat. Other types of mild to moderate exercise recommended for people with MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi.
  • Cool down. MS symptoms often worsen when the body temperature rises in some people with MS. Avoiding exposure to heat and using devices such as cooling scarves or vests can be helpful.
  • Eat a balanced diet. Since there’s little evidence to support a particular diet, experts recommend a generally healthy diet. Some research suggests that vitamin D may have potential benefit for people with MS.
  • Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help.

Alternative medicine

many people with MS use a variety show of option or complementary color treatments or both to help manage their symptoms, such as fatigue and brawn trouble .
Activities such as practice, meditation, yoga, massage, eating a healthier diet, acupuncture and liberalization techniques may help boost overall genial and physical wellbeing, but there are few studies to back up their use in managing symptoms of MS .
According to guidelines from the american english Academy of Neurology, research strongly indicates that oral cannabis extract ( OCE ) may improve symptoms of muscle spasticity and trouble. There is a miss of evidence that cannabis in any other form is effective in managing other MS symptoms .
daily inhalation of vitamin D3 of 2,000-5,000 international units day by day is recommended in those with MS. The connection between vitamin D and MS is supported by the association with exposure to sunlight and the hazard of MS .

Coping and support

Living with any chronic illness can be unmanageable. To manage the stress of living with MS, consider these suggestions :

  • Maintain normal daily activities as best you can.
  • Stay connected to friends and family.
  • Continue to pursue hobbies that you enjoy and are able to do.
  • Contact a support group, for yourself or for family members.
  • Discuss your feelings and concerns about living with MS with your doctor or a counselor.

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the brain and skittish system ( neurologist ) .

What you can do

  • Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
  • Make a list of all your medications, vitamins and supplements.
  • Bring any clinical notes, scans, laboratory test results or other information from your primary care provider to your neurologist.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Write down questions to ask your doctor.
  • Ask a relative or friend to accompany you, to help you remember what the doctor says.

What to expect from your doctor

Your repair is probable to ask you a number of questions. Being cook to answer them may reserve clock to go over points you want to spend more clock on. You may be asked :

  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Does anyone in your family have multiple sclerosis?

Questions to ask your doctor

  • What’s the most likely cause of my symptoms?
  • What kinds of tests do I need? Do they require any special preparation?
  • Is my condition likely temporary or chronic?
  • Will my condition progress?
  • What treatments are available?
  • I have these other health conditions. How can I best manage them together?

In addition to the questions that you ‘ve prepared to ask your doctor of the church, do n’t hesitate to ask early questions during your appointment .

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