Multiple Sclerosis Care

If you have multiple sclerosis (MS), you need long-term, specialized care in a comprehensive MS center to maintain your independence and quality of life.

As a National Multiple Sclerosis Society-affiliated center for comprehensive care, UC San Diego Health provides MS specialty services and coordinated rehabilitation therapy services that address the full spectrum of MS-related problems.

Our program includes the expertise of health care professionals from neurology, urology, pain medicine, psychiatry, nursing, physical therapy, occupational therapy, and speech-language pathology. Our team of specialists aims to promote independence, comfort, health and wellness.

There is no cure yet for multiple sclerosis. Treatments for MS focus on managing symptoms, reducing the frequency, severity and duration of attacks, and attempting to slow disease progression.

Although multiple sclerosis can cause severe disability, the average life span of people with MS is reduced by only a few years. 

Types of MS

Specific treatment for multiple sclerosis is determined by several factors, including where you are in the disease course, your medical history and care preferences.

MS is typically defined by the following courses:

Relapsing-remitting MS (RRMS): the most common disease course characterized by clearly defined attacks of damaging neurologic function. These attacks (also called exacerbations or flare-ups) are followed by periods of limited or full recovery (known as remissions) without continuous worsening between attacks.

Relapsing-remitting disease is viewed as active or stable based on recent relapses or MRI-measured disease activity.

Progressive forms of MS

  • Secondary-progressive (SPMS): follows years of a relapsing-remitting course or can occur after a single relapse; this is further classified by the degree of inflammation and rate of continuous worsening.
  • Primary-progressive MS (PPMS): characterized by continuous worsening of neurologic function from the onset of the disease. It is further classified by the presence or absence of inflammation.

Medical Therapies for MS

Our specialists assess your individual condition to identify whether you are likely to benefit from a selected therapy.

Medical therapies we offer include:

  • Injectable therapies: These treatments include beta interferons (interferon beta- 1a and interferon beta- 1b) and glatiramer acetate, which are immune-modulating medications designed to reduce the frequency and severity of relapses.
  • Oral therapies: Available as second line treatment and in some cases first line treatment for relapsing forms of MS. These medications include Fingolimod, Dimethyl Fumarate and Teriflunomide.
  • Monoclonal antibody treatment: A monoclonal antibody is a laboratory-produced molecule created to specifically bind to target cells or proteins. Monoclonal antibodies such as Natalizumab block potentially damaging immune cells from entering the brain and spinal cord. Rituximab reduces a specific type of lymphocyte called a CD20 B-cell that contributes to the damage of the myelin sheath. Alemtuzumab depletes all lymphocytes and tends to produce greater immune suppression.
  • Chemotherapy: Intended for especially severe forms of relapsing-remitting and secondary-progressive MS, chemotherapy drugs such as cyclophosphamide work by suppressing the immune system and reducing the number of immune cells causing inflammation.

Because each medical therapy may cause side effects, the risks and benefits of each treatment must be thoroughly considered. Chemotherapy drugs are often only considered in certain patients because of the potential short and long-term risks associated with treatment.

As a chronic, progressive disease, multiple sclerosis eventually leads to increasing disability in most people. Currently, no known therapies have shown benefit for people who have progressive MS with no evidence of ongoing inflammatory activity.

Researchers are actively working to find effective treatments for this type of progressive MS.

Rehabilitation Services

Rehabilitation is an integral part of comprehensive multiple sclerosis care, aiding in the management of the diverse set of problems many patients encounter. Our neurological rehabilitation program provides education, exercises, assistive devices and tools designed to improve and maintain function at all stages of the disease.

Common MS rehabilitation programs include:

 Physical therapy: eases problems related to walking and mobility. Exercises are designed to improve issues related to balance (including dizziness), posture, energy, and strength. Physical therapy may also include training in the use of mobility aids, such as canes and wheelchairs.

  • Occupational therapy: focuses on enabling independence and safety in self-care activities (dressing, bathing), productive activities (work, home management), and leisure activities. Occupational therapists also evaluate your mobility to determine the most appropriate mobility device for your situation.
  • Cognitive rehabilitation: provides techniques for improving memory, learning, and thinking.
  • Cognitive behavioral therapy (CBT): helps you identify distressing thoughts, change your thinking and initiate behavioral change. CBT is used for depression, anxiety and adjustment difficulties.
  • Speech-language pathology: addresses problems related to speech and swallowing. Speech-language pathologists evaluate your speech patterns and facial muscular control to help you regain and maintain speech abilities.

Exercise and Strength Training

People with multiple sclerosis are at a greater risk for deconditioning or the loss of muscle tone and fitness due to prolonged physical inactivity. One of the best ways to maintain your health while managing multiple sclerosis is through a regular exercise and weight lifting program.

Studies have demonstrated that aerobic exercise helps people with MS achieve improved overall health and better perform activities of daily living.

Thirty minutes of aerobic activity four to five days per week (two to three days per week when recovering from a relapse) can help ease symptoms.

Benefits associated with exercise include:

  • Better cardiovascular fitness
  • Improved strength and balance
  • Improved bone density and reduction in fracture risk
  • Reduced muscle stiffness and involuntary muscle spasms
  • Elevated mood
  • Improved cognitive function
  • Less fatigue
  • Better bladder and bowel function

It's important to consult with your doctor before beginning any type of exercise program. Your exercise program should fit your capabilities and limitations to prevent the risk of strain on an already compromised muscular system.

Our neurologists and physical therapists can work with you to develop a personal exercise program that meets your needs.

Common types of exercise for people with MS include:

  • Walking
  • Jogging
  • Riding a street or exercise bicycle
  • Swimming and water aerobics
  • Tai chi
  • Yoga