Neurology

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (the brain, spinal cord, and optic nerves). There are more than 450,000 people in the United States with MS, making it among the most common neurological illnesses in North America. Although MS can appear at any age, it most commonly begins between the ages of 20 and 40, and affects women twice as often as men.

The Multiple Sclerosis Clinic at the University of Pennsylvania was established in 1963 under Dr. Donald Silberberg and is the first clinic in the United States devoted to the care and treatment of patients with MS. In addition to providing unparalleled care to patients with MS, the MS Division has a rich history of research excellence and has been responsible for training some of the world leaders in the field of multiple sclerosis and other demyelinating disorders. The MS Division at the University of Pennsylvania is one of the few in the world with expertise and training fellowships in both pediatric and adult MS care and research. This collaboration with the MS physicians at the Children's Hospital of Philadelphia permits continuity of care with MS experts along the full age spectrum.

In 2014, the National MS Society designated the Penn MS Center as a National MS Comprehensive Care Center. This achievement recognizes the ability of the Penn MS Clinic to provide comprehensive, state-of-the-art care to patients with MS. As a multispecialty program, our team of physicians, nurses, nurse practitioners and social workers collaborate with experts across multiple disciplines to provide diagnosis, care and management of MS and associated disorders. The diverse team of health professionals includes specialists from the Departments of Physical Medicine and Rehabilitation, Neuropsychology, Psychiatry, Urology, Neurosurgery and Radiology. The Penn MS Center also works with the local chapters of the National MS Society and Multiple Sclerosis Association of America to assure the highest level of care for our patients.

Penn physicians at Multiple Sclerosis Center provide evaluation, diagnosis and treatment for patients with multiple sclerosis (MS) and associated disorders, including, optic neuritis (inflammation of the optic nerves), transverse myelitis (inflammation of the spinal cord), neuromyelitis optica, acute disseminated encephalomyelitis, and other autoimmune of the central nervous system.

The Penn MS Clinic is located at the Hospital of the University of Pennsylvania. Members of the MS Division also staff clinics at Pennsylvania Hospital and Penn Presbyterian Medical Center.

Symptoms of MS

As virtually any region of the central nervous system may be affected by MS, the symptoms of MS are quite varied. Approximately 50% of patients with MS first present with an isolated neurological problem and an almost equal number have more than one symptom heralding their illness. Symptoms of multiple sclerosis may be mild or severe and can occur in varying degrees of intensity. Relapses or the exacerbation of symptoms can last for days or weeks and then resolve. Over time, the symptoms of multiple sclerosis can also become chronic and longstanding. Among the most common symptoms of MS are:

  • Fatigue
  • Visual loss
  • Double vision
  • Vertigo
  • Trigeminal neuralgia (facial pain)
  • Facial weakness
  • Numbness and tingling
  • Weakness of one or more extremities
  • Gait abnormalities and imbalance
  • Cognitive difficulties
  • Bowel and bladder problems
  • Sexual dysfunction

Diagnosing MS

Symptoms of MS may mimic many other neurologic disorders. A diagnosis of MS starts with a thorough history and neurologic examination. Other diagnoses that may mimic MS must be excluded. Objective evidence of demyelination, damage to the myelin sheath, the covering that protects nerve fibers, is obtained by examination and supplementary studies.

Laboratory, imaging, and electrophysiological studies that may be performed to diagnose and appropriately manage MS include the following:

  • Blood tests
  • Electrical conduction studies (evoked potentials)
  • Lumbar puncture (spinal tap)
  • MRI of the brain and spinal cord
  • Optical coherence tomography (OCT)
  • Visual field testing
  • Other studies, such as, neuropsychological testing, bladder ultrasound, urodynamic studies, etc. may be warranted depending on the nature of the problems.

Our Approach to Treating MS

Our MS center includes experienced, highly trained physicians who are experts in the diagnosis and management of MS. Symptom management, treatment, patient education, health maintenance and improving the general well-being for patients with MS are undertaken in collaboration with dedicated nurses, nurse practitioners, and social workers. Every patient has a unique treatment plan that may include the following:

  • Disease modifying therapy (these therapies may be injected into skin or muscle or intravenously administered)
  • Symptomatic medications
  • Nutritional counseling
  • Physical and occupational therapy
  • Social work
  • Speech and swallowing evaluation and treatment

The Penn MS center offers patient services including:

  • Access to an onsite outpatient infusion clinic for intravenous medication administration.
  • Collaboration with the Children's Hospital of Philadelphia (CHOP)
  • Support groups for patient education and continued therapy
  • Training and support for symptom management, self-injection of immunomodulatory therapies, and counseling.

To date, there is no cure for multiple sclerosis. However, over the past two decades, MS has become a highly manageable disease with therapies that cannot only accelerate the recovery from new symptoms due to a relapse, but also therapies that decrease the frequency of disease relapses and activity.

Research and Clinical Trials for MS

Research conducted by members of the Penn MS Program includes efforts to understand the pathobiology of MS with advanced imaging techniques and immunologic studies. Studies are also being conducted on the effects of MS on visual pathways. Clinical trials include studies of novel disease modifying therapies, the role of hormonal therapies, the effect of vitamin D on disease expression and the influence of disease modifying drugs on viral expression.