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Multiple Sclerosis Center at NNA
[Multiple Sclerosis Center at NNA - printable Brochure]

The Multiple Sclerosis Center is part of the Neurology and Neuroscience Associates, Inc. (NNA). The MS Center at NNA offers state-of-the-art resources to provide advanced, comprehensive care for patients with MS. The MS center is supported by advanced medical technologies and an extensive program of clinical research and education. The MS Center is a specialized program for the diagnosis and treatment of MS, managing thousands of patient visits annually during the past 30 years. Our mission is to provide people with MS and their family with compassionate, innovative care, to educate allied health care providers about the disease, to promote the education of our patients and their families, to increase the public awareness of the disease.

About Us

Through a team approach, staff members in our MS center focus on the early diagnoses of the diseases, the comprehensive management addressing physical, emotional, cognitive and rehabilitation needs of our patients and their family members. MS Center physicians include neurologists and psychologists with ample subspecialty experience related to MS pathogenesis and medical management. The MS center participated in many major national and international clinical trials that have made major contributions in the development of disease modifying drugs to control MS disease activity and progression. Please see selected publications from members in our team.

MS Center at NNA includes diagnostics (neuroimaging and electrodiagnostic studies), therapeutics, spasticity management and clinical research. We provide high quality service in imaging the brain and spinal cord with standard, high resolution MRI equipment operated by an expert team. We offer comprehensive electrodiagnostic tests to assist the early detection of MS lesions. All of the FDA approved treatment options and some important drugs that are in advanced stage of national and international clinical trials are available in the MS center at NNA. Our infusion suite delivers all MS-related pharmaceutical therapies. Spasticity management via the use of baclofen pumps and botox injections provides significant symptom relief in patients with MS and MS-related disorders.

The MS Center at NNA provides significant clinical research opportunities available for our patients. These opportunities range from injection device studies to new immunomodulating agents
(Clinical Trials at NNA).

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MS Center Specialists Team

Neurologists

• DeRen Huang, MD, PhD - Medical Director
• Peter A. Cutri, DO
• Roswell B. Dorsett, III, DO
• Zach R. Lewton, MD
• Amir C. Mazhari, MD
• Hugh J. Miller, MD
• José C. Rafecas, MD
• Lawrence M. Saltis, MD
• Roger M. Weiss, MD

Advanced practice clinicians (nurse practitioners):

• Ruthann Ferik, M.S.N., C.R.N.P.
• Kathryn Parker, M.S.N., C.R.N.P.
• Stephanie Hartman, M.S.N., C.R.N.P.
• Maria Biviano, M.S.N., C.R.N.P.
• Jennifer Woods, M.S.N., C.C.N.S.
• Anthony Gilbaldi, M.S.N., C.R.N.P.
• Erin Daly, M.S.N., C.R.N.P.

Neuroradiologists:

• Amir C. Mazhari, MD

Neuropsychologists:

• Laura Pennell Samson, PsyD.
• DeAnna Frye, PhD

Social workers

Occupational therapists

Physical therapists

Speech-language pathologists

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Our Service

The MS Center at NNA provides service in the diagnosis and management of MS and MS-related disorders. The majority of our patients we care for have MS. However, the experts in MS Center at NNA treat patients with other related neuroimmunological disorders such as neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), transverse myelitis (TM), neurosarcoidosis and CNS vasculitis, among others.

• Early diagnosis through comprehensive evaluation by our neurologists and health care team.
• On-site advanced imaging technology with high resolution.
• Evoked potentials performed by our neurodiagnostic lab.
• Convenient infusion suite for injectibles.
• Neuropsychologist on staff for psychological assessments and counseling.
• Expertise in the latest medication and treatment options for each stage of the disease.
• Approved site for clinical research trials.
• Development of treatment plans designed specific to individual needs.
• Patient and family education by our medical staff, patient support groups and learning center.
• Coordination of physical, occupational and speech therapy programs, as well as social services and disability assistance.

Comprehensive care and education for patients and families living with MS.

Infusion Suite

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Diagnosing MS

Multiple sclerosis is a disease that is not easily diagnosed because of the unpredictability and variety of the symptoms. Our physicians and staff understand the complexities of MS and will establish a diagnosis by performing some or all of the following:

• Complete review of the patient's medical history
• Neurological examination
• MRI
• Evoked potentials to confirm whether MS has affected nerve pathways
• Blood tests

Early diagnosis and preventative treatments can significantly alter the progression of the disease and symptoms.

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What is Multiple Sclerosis (MS)?

• MS is a chronic, unpredictable and often disabling disease that attacks the central nervous system.
• MS is thought to be an autoimmune disease whereby the body attacks myelin, the sheathing that insulates the nerve fibers in the brain and spinal cord, and creates scars (sclerosis).
• The damaged myelin and nerve fibers cause nerve impulses to and from the brain to be distorted or interrupted, causing the symptoms.
• MS is most often diagnosed in people between the ages of 20 and 40, more commonly in women.
• MS is not considered a fatal disease. Two thirds of people with MS do not become severely disabled and can walk with assistance.
• There is currently no known cure for MS, but there are a variety of new treatment options to slow the progression of the disease.

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Symptoms of MS

The symptoms of MS depend on the area of the brain or spinal cord affected. They are unpredictable, may come and go, appear in any combination, and be mild to severe. These symptoms may include:

• Tingling, numbness or painful sensations
• Slurred speech, cognitive changes
• Blurred or double vision
• Problems with coordination or balance
• Muscle weakness, tremor or paralysis
• Bladder, bowel and sexual dysfunction

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The Course of MS

The course of MS is unpredictable and varies from person to person. Four basic types of MS have been defined and are based on the level of disability and severity of the attacks. Different treatment options and therapies are available depending on the level of the progression of the disease.

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Treatment of MS

• While there is no cure for MS, various treatments are available to help manage symptoms, control disease progression and minimize disability.
• A number of new disease-modifying drugs have been shown to modify the course of the disease, but must be initiated early to be most effective.
• Medications are also available to control exacerbations, or flare ups of the symptoms.
• There are many other therapies to moderate MS symptoms, such as physical, vocational and speech therapy, cognitive rehabilitation and complementary and alternative medicine.
• The medical management of MS involves an ongoing collaboration between the patient and the health care team, with treatment decisions made on an individual basis.

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Glossary of Terms

Central nervous system (CNS): the brain and spinal cord are considered the central nervous system (CNS), as opposed to the peripheral nervous system which consists of the nerves outside of CNS.

Cerebrospinal fluid (CSF): Normal cerebrospinal fluid (CSF) or spinal fluid is a clear, colorless fluid that circulates in around the CNS.

Demyelination: a process where the myelin which covers many nerve fibers is damaged by diseases such as MS.

Evoked potentials: tests that check nerve conduction in the brain, spinal cord and other nerves.

Lesion: a lesion is a localized area of abnormality. In MS it is usually an area in the CNS and a description of a finding seen on MRI or CT scan.

Lumbar puncture: A lumbar puncture (LP) or spinal tap is a test where CSF is taken from the central nervous system, usually by placing a needle in the lower back by a physician. Abnormalities in the cerebrospinal fluid may provide vital information to assist the diagnosis of MS.

Magnetic resonance imaging (MRI): Magnetic resonance imaging is important method to detect MS lesions in the CNS. MRI shows the structural details of the inner tissues of the human body.

Primary progressive MS: people suffering from this form of MS do not have attacks but instead have a slowly worsening disease over time.

Relapsing-remitting MS: patients experience relapses of symptoms and signs (exacerbations) and have complete or partial improvement between attacks (remitting) with or without disease modifying therapies.

Secondary progressive MS: a couple of years after the onset of relapsing-remitting MS, the majority of patients may show a gradually progressive worsening of their function while continue to have MS attacks.

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Clinical Trials in the Clinical Program at NNA

Patients seen by physicians at NNA can participate in cutting-edge, national and international research trials that NNA offers. Our current clinical trials are listed below. For more detailed information, please contact our research coordinator: Margie McCormick, at 330-376-0334 X 156.

[Clinical Research Studies - printable brochure] [PDF Help]

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Selected Publications:

1. Neurodegeneration and Neuroprotective Agents in Multiple Sclerosis. Recent Patents on CNS Crug Discovery. 2008 in press.

2. Advance in Immune Pathogenesis and Treatment in Multiple Sclerosis. CNS Agents in Medicinal Chemistry. 2008 in press.

3. Update on PML: Lessons From the HIV Uninfected and New Insights in Pathogenesis and Treatment. Current HIV/AIDS Report. 2008 Aug;5(3):112-9.

4. Progressive multifocal leukoencephalopathy in rheumatic diseases: evolving clinical and pathologic patterns of disease. Arthritis and Rheumatism. 2007 Jul;56(7):2116-28.

5. Inflammatory progressive multifocal leukoencephalopathy in human immunodeficiency virus-negative patients. Annals of Neurology. 2007 Jul;62(1):34-9.

6. The neuronal chemokine CX3CL1/fractalkine selectively recruits NK cells that modify experimental autoimmune encephalomyelitis within the central nervous system. FASEB Journal. 2006 May;20(7):896-905.

7. An analysis of CTLA-4 and proinflammatory cytokine genes in Wegener's granulomatosis. Arthritis and Rheumatism. 2004 Aug;50(8):2645-50.

8. Control of microglial neurotoxicity by the fractalkine receptor. Nature Neuroscience. 2006 Jul;9(7):917-24..

9. Dinucleotide repeat expansion in the CTLA-4 gene leads to T cell hyper-reactivity via the CD28 pathway in myasthenia gravis. Journal of Neuroimmunology. 2000 Jun 1;105(1):69-77.
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   Contact information

   Telephone: 330.376.1902
   Fax: 330.376.1599

   Office Hours: Monday through Friday
   8:00 a.m. to 5:00 p.m.
   

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