treating multiple sclerosis


treating multiple sclerosis

Our mission at The Elliot Lewis Center is to deliver comprehensive care to all of our patients. That means we not only help you find the best treatments for your multiple sclerosis – we work with you to anticipate and address every aspect of how MS will affect your life. The treatment process always starts with establishing long-term, personal relationships with our patients, families, and loved ones. At ELC, your doctor and everyone on the team will do everything we can to ensure that you feel supported throughout your treatment journey.

Understanding your symptoms is just the first step. We consider many other areas such as your mood, relationships, workplace issues, and family planning concerns, to name a few. Then we work with you to design the very best treatment plan for you, one that is personalized to meet your specific needs. Ongoing care doesn’t just happen at appointments. That’s why we are always available to answer all your questions and address your needs, any time you need us.

We know that how you look on the outside may not reflect how you feel on the inside. Despite “looking well,” many of your symptoms may be hidden and not apparent to the outside world, even your immediate family. We understand how frustrating this can be and have the insight and expertise to address your “invisible” symptoms, such as fatigue, cognitive impairment, and pain.

Just as multiple sclerosis can impact every aspect of your life, we know that it also impacts the lives of your friends and family. This is a disease that affects the whole family. You’re in this journey together with them. Because of that, we encourage you to bring family, friends, or caregivers to your appointments, especially the initial appointments.

Comprehensive Treatment of You and Your MS

There are three aspects of multiple sclerosis treatment:

  • Treatment of your symptoms

  • Treatment of acute relapses (often called flares or exacerbations)

  • Treatment to prevent relapses and slow the progression of MS (disease modifying treatments or “DMTs”).

We favor treatment with a disease modifying therapy for most, but not all, patients with multiple sclerosis, particularly those with relapsing forms of MS. It is extremely important to halt the forward progress of MS, to prevent every relapse and new MRI lesion as best we can. Although DMTs do not

directly treat your symptoms, symptoms are more likely to improve over time in treated patients. Choosing a treatment can be complicated because there is no single medication that is appropriate for every person. We understand that everyone with MS is a unique individual, and we will work with you to find the best treatments to suit your specific needs.

In addition to DMTs, there are many medications that can be used to manage the chronic symptoms of MS, like muscle stiffness, pain, bladder issues, depression, and fatigue. These medications do not affect the course of MS but can reduce your symptoms and significantly improve your quality of your life.

Changing your lifestyle can also have an enormous impact on your symptoms and on the course of your MS. As part of your treatment plan, we will talk with you about diet and exercise, stress reduction, mood, and smoking cessation, when appropriate.

If you have new neurologic symptoms or a new medical diagnosis, we want to hear about it in real time and not at your next visit, which may be weeks or months away. This is an essential part of your care. Your doctor will let you know how best to directly contact him or her outside of office hours. This may be a different approach than you have encountered in the past, but quick and direct physician access is a cornerstone of our care model. We promise to provide a quick response and will see you urgently when necessary.

Choosing a Disease Modifying Treatment (DMT)

Over the past 20 years, treatment of relapsing multiple sclerosis has been revolutionized by the development of many highly effective and safe therapies. In addition, we now have medications that have opened the door to the treatment of progressive forms of MS. Choosing a medication can be a daunting task. There are currently over twenty available medication options for treating relapsing MS as well as several options for progressive forms of MS. More treatments are coming, potentially with some exciting new options for the treatment of progressive forms of MS.

Currently available FDA approved options include:

  • Ocrevus (ocrelizumab)

  • Kesimpta (ofatumumab)

  • Tysabri (natalizumab)

  • Lemtrada (alemtuzumab)

  • Mavenclad (cladribine)

  • Tecfidera (dimethyl fumarate)

  • Vumerity (diroximel fumarate)

  • Bafiertam (monomethyl fumarate)

  • Aubagio (teriflunomide)

  • Gilenya (fingolimod)

  • Mayzent (Siponimod)

  • Ponvory (ponesimod)

  • Zeposia (ozanimod)

  • Plegridy (peginterferon beta-1a)

  • Avonex (interferon beta-1a)

  • Rebif (interferon beta-1a)

  • Betaseron (interferon beta-1b)

  • Extavia (interferon beta-1b)

  • Copaxone (glatiramer acetate)

So how do you choose the best option for you and your MS?

It is crucial that you feel comfortable with your treatment strategy. However, we do not expect you to be an expert and to navigate these choices on your own.  We will review the pros and cons of all the options with you, including all of the risks and benefits, and together we will find a medicine that is best suited to your lifestyle and your MS.

Once you decide on a treatment, whether it is a pill, an injection, or an infusion, our team starts working immediately to make the process go smoothly. We will quickly obtain benefit information, authorizations, referrals and appeals, ensuring your medication is accessible, and with minimal hassle to you. The care team also provides resources for financial assistance, when appropriate, to ensure that your medication will be affordable.

Management of Your Symptoms

Symptom management is just as important as choosing the right DMT. Appropriate management of your symptoms can quickly help you to feel better and improve your quality of life. During your visit, we will review a complete list of your symptoms and decide with you if, how, and when to consider treatment. Then we will work with you to design a treatment plan, understanding your personalized plan may need to be re-evaluated and updated frequently. We will partner with you every step of the way, so you have the reassurance of support and expertise when you need it, better equipping you to successfully accomplish your treatment goals

There are many treatment options available to address your symptoms. These include:

  • Medications

  • Counseling provided by our in-house social worker or a mental health professional of your choice

  • Rehabilitation services including physical therapy/occupational therapy/speech therapy

  • Recommendations for assistive devices and/or braces

  • BOTOX (limb or bladder) for individuals with spasticity or certain urinary issues

  • Home safety evaluations performed by a physical therapist, who is an expert in MS and home services

  • Driving evaluations with options for a left foot accelerator or hand controls, when appropriate

  • Intravenous steroids at our on-site infusion center for acute MS flares

Management of MS Flares

Because the currently available DMTs are so effective at reducing the risk of a relapse, multiple sclerosis flares (also called relapses or exacerbations) are much less common than they used to be. However, when flares do occur, they may require treatment with intravenous steroids. It’s important you let your doctor know right away if you have new symptoms. If needed, we can give you steroid treatments on-site at The Elliot Lewis Center, most often within 24 hours of your symptoms, if not on the same day.