Patient Safety at Ohio State
During this time of public health concern, some appointments for multiple sclerosis care may take place via telehealth wherever possible and appropriate. You can also request a telehealth or video visit by contacting your provider. For all in-person visits, you can feel confident that our locations are safe. We've taken significant measures to minimize the risk of the spread of COVID-19 and ensure that our patients are protected. Learn more by visiting our patient safety page.
Here at the MS Center at The Ohio State University Wexner Medical Center we know that MS symptoms and complications can strike without notice, throwing your life into chaos.
At the Multiple Sclerosis Center at The Ohio State University Wexner Medical Center, we have expert MS specialists that can customized a care plan to address all of your needs.
If you are experiencing medication side effects, you’re feeling tired or if you need advice about pregnancy or breastfeeding or disease complications, our MS experts will create a personalized plan that reflects the best treatments and research available. Request an appointment or learn more today.
What is MS?
Multiple sclerosis, often called MS, is a disease that attacks the central nervous system (CNS), which includes the optic nerves (the nerves that transmit visual information from the retina to the brain), brain and spinal cord. People with MS can experience a wide range of symptoms, including weakness, numbness, visual loss, double vision, imbalance and difficulties with memory and multitasking.
Nerve fibers are normally surrounded by a protective covering called the myelin sheath. In people with MS, the immune system inappropriately attacks and injures the myelin sheath and the nerve fiber that it’s wrapped around. As a result, communications between the central nervous system and the rest of the body are interrupted, resulting in a variety of symptoms. In the most common form of MS, the immune system strikes the CNS episodically, causing areas or patches of damage, called “lesions,” in the optic nerves, brain and spinal cord. The symptoms a patient experiences during a given episode, or relapse, depend on the location of the lesion. For example, a lesion in the optic nerve causes visual loss, while a lesion in the middle of the spinal cord causes numbness and/or weakness below the waist. Over time, some people with MS develop gradually worsening weakness, imbalance, numbness or cognitive decline, called progressive MS. A subset of individuals experience progressive MS without relapses beforehand. MS is different for each person. Some people may go through life with only minor problems, while others may become disabled. There’s no cure for MS, but there are now drugs, called disease modifying therapies (DMT), that can decrease the risk of relapses and future nervous system damage. Our goal is to help patients reach a state of “no evidence of disease activity” (NEDA), meaning complete stability in neurological function and MRI scans, when possible.
MS generally falls into 1 of 4 categories:
Clinically isolated syndrome (CIS) - A first episode of neurological symptoms and deficits caused by a typical MS lesion, that may evolve into definite MS in the future if additional inflammatory activity occurs. MRI scans and/or spinal fluid tests can indicate if someone with CIS has a high chance of developing definitive MS. CIS is most frequently caused by inflammation in the optic nerve (causing visual loss in one eye), spinal cord (causing numbness and/ or weakness in one or more limbs, often with bladder control difficulties), or brainstem (causing symptoms such as double vision, vertigo, and gait imbalance). In most cases, doctors will prescribe medicine for people who have CIS with risk factors for future relapses. These medicines, when taken early and even before the diagnosis of MS, may keep the disease from getting worse or extend one’s time without definitive MS.
Relapsing-remitting (RRMS) – MS characterized by recurrent, self-limited episodes of new neurological symptoms, or acute worsening of existing symptoms, followed by full or partial recovery. These episodes, which are often referred to as relapses, typically last weeks to months. By definition, they have to last one day or longer, and they’re caused by the formation of new MS lesions or the expansion of existing lesions within the CNS. Patients are generally stable during the periods between relapses, which are called remissions. However, some symptoms associated with MS, such as fatigue and muscle spasms, can persist during remissions, Most people who develop MS have a relapsing-remitting course initially. RRMS occurs 2 – 3 times more often in women than men, and usually is diagnosed in young adulthood (20s to 30s).
Secondary progressive (SPMS) – This is a phase of MS that follows the relapsing-remitting course in some individuals. It’s marked by steadily and gradually worsening neurological disability, usually in the form of weakness and/or numbness in one or more limbs, gait imbalance, and/or memory difficulties. The secondary progressive phase typically starts after 15 – 20 years of relapsing remitting disease. Not everyone with RRMS develops SPMS. Progressive MS is considered to be active when relapses, or new inflammatory lesions detected on MRI scans, are superimposed on the gradual neurological decline. Active disease is more likely to be responsive to disease-modifying therapy.
Primary progressive (PPMS) – This is a form of MS characterized, from its inception, by steadily worsening neurologic disability, without prior clinical relapses and remissions. It resembles SPMS, except for the absence of a history of episodic neurological symptoms before the gradual decline becomes evident. PPMS is equally common in men and women, and it’s generally diagnosed in mid-life (40s to 50s). As in SPMS, some people with PPMS experience relapses and/or new inflammatory MRI lesions, superimposed on the progressive disease course. In those cases, the disease is considered to be active and is more likely to be slowed down by treatment with disease-modifying therapies.
Sometimes, people without symptoms of an MS attack who undergo an MRI for other reasons, such as headache or head trauma, are incidentally found to have lesions that resemble the lesions seen in MS. These people should be examined by an MS specialist and may need additional tests. If they have never had symptoms suggestive of an MS attack and their exam is normal, they do not have and cannot be diagnosed with MS. A scenario such as this is called radiologic isolated syndrome (RIS). The diagnosis of RIS is made when MRI pictures look very similar to MS, but there haven’t ever been symptoms of an MS attack. People with RIS should be under the care of an MS specialist and generally are monitored with annual MRI scans to detect future areas of inflammation in the brain and spinal cord, which sometimes don’t cause symptoms. In a five-year period, 34% of individuals with RIS will be diagnosed with MS after they develop symptoms of an MS attack.
- Modify your home to keep it safe and easy to get around. For example, to help prevent falls, install grab bars in the bathroom and don’t use throw rugs. Try adjusting your daily schedule so that your routine is less stressful or tiring.
- Be physically active and try to exercise at least five days each week, either on your own or with the help of a physical therapist. Yoga and stretching improve the quality of life for many people with MS.
- Get help with urination problems. At some point, most people with MS have bladder problems. Your doctor may prescribe a medicine to help you. In some cases, you may be referred to a urologist, who specializes in conditions that affect the bladder.
- Avoid getting overheated. Increased body temperature can temporarily make your symptoms worse. Use an air conditioner, keep your home cool, and avoid heated swimming pools and hot tubs. During warm or hot weather, exercise in an air-conditioned area rather than outdoors, and wear a cooling vest or collar when you go outside.
- Eat plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats and low-fat dairy products. A balanced diet for a person who has MS is the same as that recommended for most healthy adults.
When to call a doctor
- You experience a new MS attack.
- You begin having a symptom that you have not had before, or you notice a significant change in symptoms that are already present lasting longer than 24 hours.
The Ohio State University Wexner Medical Center’s Multiple Sclerosis Center provides comprehensive care to patients with MS as well as other autoimmune neurologic conditions. Care is provided by a collaborative team of medical professionals, including fellowship-trained neurologists, ophthalmologists, urologists, neuropsychologists, clinical pharmacists and physical therapists specially trained to care for patients with MS and related disorders. We utilize a team approach to ensure the best patient outcomes. Our clinic locations have radiology services, lab facilities and physical therapy all under one roof for easy patient access. Clinical trials are performed on site at our medical facility.
Our team of health professionals who may be involved in evaluating symptoms of MS and treating the condition include:
Benjamin Segal, MD
MS Program Director, Neurologist
Robert Fallis, MD
MS Specialist, Neurologist
Tirisham Gyang, MD
MS Specialist, Neurologist
Margaret Hansen, RPh
Kristi Epstein, APRN, CNP, CCRN
MS Nurse Practitioner
Kristi has over 20 years of experience as a clinical nurse, including critical care with special certification, infusion therapy, oncology and neurology. She worked in neurology infusion prior to joining the team as a certified nurse practitioner. Special interests within the MS clinic include wellness, reproductive issues and clinical research. She has a BSN with honors from Saint Francis College of Nursing and an MSN with honors from Bradley University. She has been recognized nationally for nursing excellence and has obtained multiple clinical certifications.View my bio