Table Of ContentNavigating Life with
Multiple Sclerosis
Lisa M. Shulman, MD
Editor-in-Chief, Neurology Now™ Books Series
Fellow of the American Academy of Neurology
Professor of Neurology
The Eugenia Brin Professor in Parkinson’s Disease and Movement Disorders
The Rosalyn Newman Distinguished Scholar in Parkinson’s Disease
Director, University of Maryland PD & Movement Disorders Center
University of Maryland School of Medicine
Baltimore, MD
Other Titles in the Neurology Now™ Books Series
Navigating Life with Parkinson’s Disease
Sortirios A. Parashos, MD, PhD; Rose Wichmann, PT; and Todd Melby
Navigating Life with a Brain Tumor
Lynne P. Taylor, MD, FAAN; Alyx B. Porter Umphrey, MD; and Diane Richard
Navigating the Complexities of Stroke
Louis R. Caplan, MD, FAAN
Navigating Life with
Multiple Sclerosis
Kathleen Costello, MS,
ANP-BC, MSCN
Associate Vice-President, National Multiple Sclerosis Society
Nurse Practitioner, The Johns Hopkins Multiple Sclerosis Center
Baltimore, MD
Ben W. Thrower, MD
Medical Director
Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center
Atlanta, GA
Barbara S. Giesser, MD
Clinical Director, UCLA Multiple Sclerosis Program
David Geffen UCLA School of Medicine
Los Angeles, CA
1
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Library of Congress Cataloging-in-Publication Data
Costello, Kathleen, author.
Navigating life with multiple sclerosis / Kathleen Costello, Ben W. Thrower,
Barbara S. Giesser.
p. ; cm. — (Neurology now books series)
ISBN 978–0–19–938173–9
I. Thrower, Ben W., author. II. Giesser, Barbara S., author. III. Title.
IV. Series: Neurology now books.
[DNLM: 1. Multiple Sclerosis—diagnosis—Popular Works. 2. Multiple
Sclerosis—therapy—Popular Works. WL 360]
RC377
616.8′34—dc23
2014036627
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CONTENTS
About the AAN’s Neurology Now™ Books Series | ix
Lisa M. Shulman, MD
Preface: Navigating Life with MS | xiii
1. What Is Multiple Sclerosis? | 1
So What Is Multiple Sclerosis, Anyway? | 2
What Are the Types and Stages of Multiple Sclerosis? | 6
What Type of Multiple Sclerosis Do I Have? | 11
Summary | 13
2. How Multiple Sclerosis Affects the Nerves | 15
How the Nervous System is Organized | 15
The Immune System and Multiple Sclerosis | 19
How Does the Immune System Cause Nerve Damage? | 21
Summary | 24
v
vi CONTeNTS
3. How Multiple Sclerosis Is Diagnosed | 25
Clinically Isolated Syndrome | 26
The Initial Diagnosis of Multiple Sclerosis | 30
Putting the Picture Together | 37
Summary | 39
4. Managing Multiple Sclerosis Symptoms | 40
How Multiple Sclerosis Affects Mobility | 41
How Multiple Sclerosis Affects Sensation | 54
Issues with Vision and Other Senses | 59
How Multiple Sclerosis Can Affect Memory and Other Cognitive
Functions | 60
Genitourinary Problems | 66
Summary | 71
5. Treating and Managing Multiple Sclerosis: Relapses and
Disease-Modifying Therapies | 72
Relapses | 72
Disease-Modifying Therapies | 80
Beta Interferons | 84
Glatiramer Acetate | 86
Reproductive Issues | 93
Summary | 96
6. Lifestyle Management | 97
Finding Relief from Multiple Sclerosis–Related Fatigue | 97
Other Contributors to Fatigue and Sleep Disorders | 105
How Multiple Sclerosis Affects Mood | 107
exercise and Multiple Sclerosis | 113
Physical Therapy | 116
How to Work for Wellness with Multiple Sclerosis | 117
Summary | 128
Contents vii
7. Reproductive Issues in Multiple Sclerosis | 129
MS and Pregnancy | 129
Disease-Modifying Therapies | 130
Summary | 134
8. The Future of Multiple Sclerosis Management | 135
How Is Research Conducted? | 135
Summary | 142
9. Planning for Your Future: Managing Your
Personal Affairs | 143
Your emergency Notebook | 145
Informal and Formal Arrangements | 147
Durable Power of Attorney | 152
Trusts | 154
Healthcare Directives | 160
Guardianship and Conservatorship | 166
Your Will | 167
GLOSSARY | 169
ABOUT THe AMe RICAN ACADeMY OF NeUROLOGY AND
AMeRICAN BRAIN FOUNDATION | 175
INDeX | 177
ABOUT THE AAN’S NEUROLOGY NOW™
BOOKS SERIES
Here is a question for you:
If you know more about your neurologic condition, will you do better
than if you know less?
Well, not simply optimism but hard data show that individuals
who are more knowledgeable about their medical conditions do have
better outcomes. So learning about your neurologic condition plays
an important role in doing the very best you can. The main purpose
of both the Neurology Now™ Books series and Neurology Now maga-
zine from American Academy of Neurology (AAN) and American
Brain Foundation (ABF) is to focus on the needs of people with neu-
rologic disorders. Our goal is to view neurologic issues through the
eyes of people with neurologic problems, in order to understand and
respond to their practical day-to-day needs.
So, you are probably saying, “Of course, knowledge is a good thing,
but how can it change the course of my disease?” Well, health care is
really a two-way street. After you have had a stroke, you need to find
a knowledgeable and trusted neurologist; however, no physician
can overcome the obstacle of working with inaccurate or incom-
plete information. Your physician is working to navigate the clues
you provide in your own words combined with the clues from their
neurologic examination, in order to arrive at an accurate diagnosis
ix
