How is multiple sclerosis diagnosed. What are the treatment options for MS. Who should I consult for MS treatment. When should I start MS treatment. What are the available therapies for different types of MS. How to manage MS symptoms effectively. What to do if MS treatments are not working.

Understanding Multiple Sclerosis: Diagnosis and Initial Steps

Multiple sclerosis (MS) is a complex neurological condition that requires prompt diagnosis and treatment. The journey begins with recognizing symptoms and seeking professional help. But how exactly is MS diagnosed?

Diagnosing MS typically involves a combination of methods:

• Neurological examination
• Magnetic Resonance Imaging (MRI) scans
• Lumbar puncture (spinal tap)
• Blood tests to rule out other conditions
• Evoked potential tests

Once diagnosed, it’s crucial to initiate a conversation about treatment options. According to guidelines, your neurologist should discuss treatment possibilities and provide information at the time of diagnosis. Within six weeks, you should receive a follow-up appointment to explore your treatment choices in detail.

Navigating the MS Healthcare System: Who to Consult

Seeking the right medical professional is paramount in managing MS effectively. Who should you turn to for MS treatment advice?

The ideal person to consult is an MS specialist, typically a neurologist with extensive experience treating MS patients. An MS nurse can also provide general information about treatments. However, only an MS specialist can offer personalized advice and prescribe medications for your specific case.

If you don’t already have an MS specialist, request a referral from your general practitioner (GP). Remember, you have the right to ask for an appointment with a specialist at any time, not just during scheduled check-ups.

Key Healthcare Professionals in MS Management

• Neurologist specializing in MS
• MS nurse
• General Practitioner (GP)
• Physical therapist
• Occupational therapist
• Psychologist or counselor

Timing is Everything: When to Initiate MS Treatment Discussions

Timing plays a crucial role in MS management. When is the right time to discuss treatment options?

Official guidelines recommend that everyone with MS should be offered an annual appointment with a specialist to discuss their care, regardless of their MS type or current treatment status. This yearly review serves as an opportunity to evaluate your condition and explore potential treatment adjustments.

If you haven’t seen a specialist for an extended period, you have the right to request an appointment. Should your annual review not occur as scheduled, don’t hesitate to reach out to your GP, MS nurse, or neurologist to arrange one.

It’s important to note that it’s never too late to consider treatment options. Whether you’ve been recently diagnosed or have been living with MS for years, discussing treatment possibilities can potentially improve your quality of life and slow disease progression.

Treatment Options for Relapsing MS: Disease-Modifying Therapies

For individuals with relapsing MS, a range of treatment options exists. What are the available therapies for relapsing MS?

Disease-modifying therapies (DMTs) form the cornerstone of relapsing MS treatment. Over a dozen DMTs are now available that can slow down disease progression and reduce the frequency of relapses. These medications vary in their efficacy and side effect profiles, ranging from milder options with fewer side effects to more potent drugs with potentially more serious adverse reactions.

While DMTs can’t cure MS, they can significantly impact disease course by:

• Reducing the frequency of relapses
• Decreasing the severity of relapses
• Slowing down disability progression
• Reducing the development of new lesions on MRI

In addition to DMTs, various drugs and therapies can help manage specific MS symptoms. Steroids, for instance, can expedite recovery from relapses. It’s crucial to discuss these options with your MS specialist, nurse, or GP to develop a comprehensive treatment plan tailored to your needs.

When Treatments Falter: Exploring Alternative Options for Relapsing MS

Despite the availability of numerous DMTs, some individuals may find their current treatment ineffective. What should you do if your MS medications don’t seem to be working?

If you feel your current DMT isn’t adequately controlling your relapses, it’s essential to communicate this to your neurologist or MS nurse. They can review your treatment plan and consider alternative options, which may include switching to a different DMT or exploring more aggressive treatment approaches.

One such option is Hematopoietic Stem Cell Transplantation (HSCT), a promising therapy for some individuals with highly active relapsing MS. However, it’s important to note that in the UK, HSCT is typically only considered if two DMTs have proven ineffective.

Steps to Take When Treatments Are Ineffective

1. Document your symptoms and relapses
2. Discuss your concerns with your MS specialist
3. Consider switching to a different DMT
4. Explore clinical trials for new treatments
5. Inquire about HSCT if eligible

Progressive MS: Treatment Landscape and Emerging Options

The treatment landscape for progressive MS differs from that of relapsing MS. What treatment options are available for individuals with progressive MS?

For most people with progressive MS, traditional DMTs have shown limited efficacy. However, exceptions exist for those with ‘active’ progressive MS, characterized by ongoing relapses or visible inflammation on MRI scans.

If you have secondary progressive MS classified as ‘active’, two DMTs may be beneficial:

• Extavia (a beta interferon)
• Siponimod (Mayzent)

For primary progressive MS, a relatively new DMT called ocrelizumab (Ocrevus) has shown promise in early stages, particularly when inflammation is visible on MRI scans. Eligibility for this treatment typically requires an Expanded Disability Status Scale (EDSS) score between 3.0 and 6.5.

While DMT options may be limited for progressive MS, numerous treatments, therapies, lifestyle modifications, and assistive devices can help manage symptoms and address disability associated with progressive MS. It’s crucial to discuss these options with your healthcare team to develop a comprehensive management plan.

Advocating for Your Care: Navigating Disagreements with Healthcare Providers

Disagreements with healthcare providers can occur during the treatment journey. How should you handle situations where you’re not satisfied with your specialist’s recommendations?

If you find yourself at odds with your specialist’s advice or struggle to understand the information provided, consider the following steps:

1. Open communication: First, express your concerns directly to your neurologist. Discuss your reservations about the proposed treatment plan or request clarification on any information you find confusing.
2. Seek a second opinion: You have the right to request a second opinion from another MS specialist. This can be arranged through your current neurologist, GP, or the hospital where you receive care.
3. Research and self-education: While medical advice should come from professionals, educating yourself about MS and available treatments can help you engage in more informed discussions with your healthcare team.
4. Patient advocacy groups: Consider reaching out to MS patient advocacy organizations for support and guidance in navigating complex healthcare decisions.
5. Document your concerns: Keep a record of your symptoms, questions, and concerns to discuss during appointments.

Remember, effective MS management often requires a collaborative approach between you and your healthcare team. Don’t hesitate to voice your concerns or seek additional opinions to ensure you receive the most appropriate care for your individual needs.

Holistic Approach to MS Management: Beyond Medications

While medications play a crucial role in MS treatment, a holistic approach can significantly improve quality of life. What non-pharmacological strategies can complement MS treatment?

Managing MS effectively often involves a multifaceted approach that extends beyond medication. Consider incorporating the following strategies into your MS management plan:

• Physical therapy: Tailored exercise programs can help maintain mobility, strength, and balance.
• Occupational therapy: Learn adaptive techniques and use assistive devices to maintain independence in daily activities.
• Cognitive rehabilitation: Address cognitive challenges through specialized exercises and strategies.
• Stress management: Techniques such as mindfulness meditation, yoga, or counseling can help manage stress, which can exacerbate MS symptoms.
• Nutrition: While no specific diet has been proven to cure MS, a balanced, healthy diet can support overall well-being.
• Sleep hygiene: Prioritize good sleep habits to manage fatigue, a common MS symptom.
• Social support: Engage with support groups or counseling to address the emotional aspects of living with MS.

Integrating these non-pharmacological approaches with your medical treatment can lead to better overall management of MS and improved quality of life. Discuss these options with your healthcare team to develop a comprehensive care plan tailored to your specific needs and preferences.

Benefits of a Holistic Approach to MS Management

1. Improved symptom control
2. Enhanced physical function and mobility
3. Better emotional and mental well-being
4. Increased independence in daily activities
5. Reduced reliance on medications for symptom management

By adopting a holistic approach, individuals with MS can take a more active role in their care and potentially achieve better outcomes in managing their condition.

Getting treatment for MS | MS Society

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You have the right to ask about getting treatment for your MS. This is true no matter what kind of MS you have – or how long you’ve had it.

Some treatments help with the symptoms of MS, while others control MS itself. With these treatments you can get fewer and less serious relapses, and disability progression may slow down.

First questions about MS treatments

Who do I ask about treating my MS?

It’s best you speak to an MS specialist, like a neurologist who has many patients with MS. An MS nurse can also talk about treatments in general. Only an MS specialist can give you advice on treating your MS and prescribe drugs for you.

To see your specialist you don’t have to wait for your next appointment to come round. You can ask to see them before then. Ask your GP or MS nurse to book one for you.

If you don’t already have an MS specialist, ask your GP to refer you to one.

> Find out who’s who in the health care system

When should I ask about treatment?

Official guidelines say everyone with MS should be offered an appointment with a specialist at least once a year to talk about their care. This is true no matter what kind of MS you have and whether you’re already on treatment or not. This is a chance to talk about how your MS might be treated.

If you haven’t seen a specialist for quite a long time you have the right to ask for an appointment. And if your yearly review doesn’t happen, you should ask your GP, MS nurse or neurologist about getting one scheduled. It’s never too late to think about treatment.

If you’ve just been told you have MS, guidelines say your neurologist should have spoken to you about treatment and given you information on it when you were diagnosed. Within six weeks of this you should get a follow-up appointment where you can talk about your treatment choices.

I have relapsing MS.

What are my options?

If you have relapses with your MS, over a dozen drugs can now slow down this sort of MS and reduce relapses. They’re called disease modifying therapies (DMTs). Talk to your specialist about them if they haven’t already mentioned them.

DMTs won’t cure MS but they can slow it down and mean you get fewer relapses. They range from less hard hitting drugs with fewer side effects to stronger ones with more serious side effects.

There’s a wide range of drugs and other therapies that can help with specific MS symptoms. And steroids can help you get over a relapse sooner. Talk to your specialist, MS nurse or GP about these.

I’ve got relapsing MS and I don’t think drugs are working

There are a number of very effective DMTs for relapsing MS.

If you don’t feel the drug you’re taking is controlling your relapses well enough, talk over other possible MS relapse treatments with your neurologist or MS nurse. This might include the stem cell therapy HSCT. In the UK HSCT is only an option if two DMTs haven’t worked for you.

My MS is progressive. Is there a treatment for me?

For most people with progressive MS DMTs don’t work. The exception is if your MS is progressive but is classed as ‘active’. This means you still get relapses, or doctors see inflammation on your MRI scans. If you have secondary progressive MS and it’s ‘active’ then two DMTs might help you – Extavia (which is one of the beta interferons) or siponimod (Mayzent).

A new DMT called ocrelizumab (Ocrevus) can work against primary progressive MS early on and if inflammation can be seen on your MRI scans. You also need to have a score on the Expanded Disability Status Scale (EDSS) between 3.0 and 6.5. A score of 6.5 means you need two walking aids – such as canes or crutches – to walk 20 metres without having a rest. This drug has been recommended for use on the NHS for this kind of MS since 2019 in England, Wales and Northern Ireland, and in Scotland since the start of 2020.

If your MS is progressive then HSCT isn’t likely to help you unless you have early primary progressive MS and inflammation is seen on your MRI scans.

But there are lots of treatments, therapies, lifestyle changes and devices that help with the symptoms or disability caused by progressive MS. Ask your GP, MS nurse or neurologist for help.

Our researchers are working to find treatments for progressive MS.

What to do when

I’m not happy with what my specialist says

Maybe you don’t agree with what your specialist says about treating your MS. Or perhaps you don’t understand the information they’ve given you.

It’s worth first talking to your neurologist about your concerns or if you’d like to consider a different course of treatment.

You can ask for a second opinion from another MS specialist. Discuss this with your neurologist, your GP or with the hospital or clinic where you were seen.

However, this could mean having to travel to a different hospital and your treatment could start later. Talk this through with your specialist to see what a delay might mean for you.

> Find out more about getting a second opinion on the NHS choices website

I’ve got a long wait to see my neurologist

It can be difficult to get an appointment with a neurologist and long waiting times are sometimes an issue.

Neurologists are meant to follow NICE recommendations and offer everyone with MS a comprehensive review of all aspects of their care at least once a year.

While you’re waiting to see your neurologist, we recommend speaking to your MS Nurse about your treatment options so you’re prepared when you see them.

If you’ve been waiting a long time for an appointment with a neurologist and are concerned about the impact on your MS, please get in touch with at [email protected]. Sharing your experiences helps us make the case locally for MS services and campaign for better access to treatments.

If you’ve been waiting a long time for an appointment with a neurologist and would like some information and support on what services are available to you, please contact our Helpline on 0808 800 8000 or at [email protected].

I’ve been denied an NHS treatment for my MS

When you have a diagnosis of relapsing MS, your neurologist should guide you through which treatments you’re eligible for and help you make a decision.

If you feel you’re not being prescribed a DMT you’re eligible for, this could be due to a number of different reasons. If you have a clinician who’s reluctant to prescribe you a treatment, that doesn’t mean you’re not eligible for any. It’s important to be aware of your treatment options before you see your specialist.

If you’re unclear about why you’re not being offered your preferred treatment option, we may be able to help. Contact your local Regional External Relations Officer who may be able to raise the issue with decision-makers locally.

I’ve been denied a NHS treatment that’s not currently approved for MS

Some treatments that could help you have either been rejected by your national level commissioner or haven’t been reviewed for treating MS on the NHS yet.

Whether you’ll have any success accessing these treatments will depend on how expensive they are for your local NHS to fund and whether national commissioners have explicitly recommended they shouldn’t be used.

For exceptional circumstances it is possible to receive NHS funding through applying for an individual funding request.

I want to explore Individual Funding Requests or Individual Patient Treatment Requests

To access treatments that haven’t been approved for MS on the NHS you may want to try to get an Individual Funding Request (IFR) or Individual Patient Treatment Request (IPTR) in Scotland. These are to request funding for people who are considered to have exceptional clinical circumstances. They have to be submitted by a healthcare professional.

These requests are submitted to your local commissioner. The treatments are not routinely available and it’s unlikely funding will be granted for a non-approved treatment where there are lots of people who’d like to access it for the same reason.

Your neurologist will be able to advise you on the likely success of submitting a request.

I want to get HSCT for my MS

HSCT is now being funded by the NHS for people with relapsing MS who have continued to have relapses despite taking two other DMTs. However, it’s not yet widely available.

NICE will review HSCT for the NHS in England and Wales once they have enough clinical trial evidence. This appraisal will decide whether it should be made more widely available.

> Find out more about HSCT

Find out about your rights in different parts of the UK

England and Wales

The National Institute of Health and Care Excellence (NICE) are responsible for approving DMTs for England and Wales. Once NICE approves a treatment, the NHS across England and Wales has three months to implement that guidance. Once that has happened patients are legally entitled to be prescribed the treatment (so long as they meet the eligibility criteria ).

Northern Ireland

The Department of Health, Social Service and Public safety has formal links with NICE. Once NICE approves a treatment it’s reviewed locally for applicability to Northern Ireland. Where appropriate it’s then endorsed for implementation in Health and Social Care (HSC). This process should be completed within 8 weeks.

Scotland

The Scottish Medicines Consortium (SMC) is responsible for approving DMTs in Scotland. When the SMC approves a DMT, the NHS boards in Scotland take it into account when they decide which medicines are available in their area. But they don’t have to follow the SMC decision.

Making an official complaint

Making a complaint in England and Wales

If a NICE approved treatment that you’re eligible to take is unavailable in your area, you can make an official complaint.

Officers from the Patient Advice and Liaisons Service (PALS) are available in all hospitals. They offer confidential advice, support and information on health-related matters to patients, their families and carer.

Making a complaint in Northern Ireland

If you have a complaint about your level of treatment you can contact the Patient and Client Council who support NHS patients with complaints in Northern Ireland.

> Find contact details for each health trust’s complaints department

Making a complaint in Scotland

If you have a complaint about your level of treatment you can contact the Patient Advice and Support Service (PASS) who provide free, confidential advice and support for NHS patients in Scotland.

Take political action

If you’re repeatedly denied a treatment you feel you’re eligible to take, you can contact your MP, SMP or Assembly Member to help you challenge the decision. Find out who your representatives are here.

Contact our MS Helpline on 0808 800 8000 for support and information about taking this step.

Talking about treatments – questions to ask my MS specialist

MRI and MS: 7 things you need to know

MRI plays a vital role in how we diagnose and monitor MS. In fact, over 90% of people have their MS diagnosis confirmed by MRI.

1. What is MRI?

Magnetic resonance imaging, or MRI for short, uses strong magnetic fields to see inside the body. It’s particularly useful in MS as it allows us to measure what’s happening in the brain and spinal cord.

2. Why are MRI scans important for an MS diagnosis?

In MS your immune system attacks the myelin coating surrounding nerves. MRI scans can pick up these areas of damage, called lesions, in different parts of your central nervous system.

MRI has shaped how we monitor and treat MS too. It’s used to build a picture of how someone’s MS is changing over time. This can help to decide if a treatment is working.

Research has highlighted the benefits of regular MRI scans to monitor MS and inform treatment decisions. But, there’s lots of factors to consider when deciding how often to have a scan. It’s best to discuss this with healthcare professionals

3. What’s it like to have an MRI scan?

During an MRI scan you’ll be asked to lie flat on a bed that’s then moved inside the scanner. The scan usually lasts for 15 to 90 minutes, depending on how many images are being taken.

Although the procedure is painless, the machine itself can be very noisy. You’ll also be asked to keep as still as possible during the scan, so it’s important to get comfortable before it starts. 

Read MS blogger Nicola’s tips on having an MRI scan.

4. Are there different types of MRI scans?

There are a number of different images that can be taken during a single MRI session.

A common type of MRI for MS is a T2-weighted scan, which detects all areas of myelin damage in the brain and spinal cord. Doctors may also use a type of scan called FLAIR, which makes it easier to spot the lesions.

Doctors will also use a contrast agent called gadolinium with a T1-weighted scan to focus on newer, active lesions. Gadolinium only highlights active damage because it can’t enter the brain unless there’s inflammation.

5. Can an MRI explain my symptoms?

What we can see on an MRI scan can explain the symptoms you might be experiencing. But it doesn’t always.

This is because many lesions may be in areas of the brain that don’t produce symptoms. And some areas of damage that could be causing symptoms might be too small to see on the scan.

6. How does MRI work?

MRI measures how much water there is in the body. Because different parts of the brain have different amounts of water, we can use MRI to distinguish them and build up pictures of the central nervous system.

The protective myelin coating is a fatty substance, so it repels water. This means we can measure how much myelin is present because it looks different to nerves and other cells in the brain on a scan.

7. What’s the future of MRI research?

Researchers sometimes rely on MRI scans in clinical trials to see the effect of a particular treatment. MRI scans can give us a window into the brain to see whether new treatments look promising much earlier on, before symptoms of progression even appear.

New, more powerful scanners will help us to detect even more subtle changes in the brain and spinal cord in MS. Improvements in MRI technology also mean we can run shorter trials to test the potential of new MS drugs, speeding up the whole development process.

Assign tests to students using Microsoft Teams

Microsoft Teams for Education More…Less

The Assignments feature in Microsoft Teams allows you to send quizzes created in Forms to students. It allows students to take tests right in Teams, and you to assign grades.

Assign a test to students in Teams

org/ItemList”>

1. Go to the desired class team and select Jobs .

2. Select “Create > quiz”.

3. Select “+ Create Test ” to create a test or select an existing one. Use the search bar if you don’t see the quiz you’re looking for right now.

Note: Selecting “+Create test ” will open a new web browser window on the device. Create a quiz in Forms and then switch back to Teams. The new test will now be available for students to select and assign.

After selecting the required test, it will appear in the task in section “Instructions” . Enter the rest of the job parameters and select Assign .

Students will be able to submit a quiz directly to Teams where you can grade it.

Note: Forms automatically calculate scores for queries with multiple choices . For more information about viewing and returning test results, see Teams in this article.

Evaluate and return feedback to students

1. Select “Assignments” in the desired class team, and then select the test.

   By default, assignments are displayed in order of completion and show how many students submitted each assignment.

2. org/ListItem”>

   On the Return tab, you will see that all students have been assigned a test and their work status is: Not Passed” , “ Reviewed” and “Passed” .

   Select “Enabled ” next to the student’s name to check.

   Tip: You can open multiple tests to review and grade at the same time. On the Check In tab select the Status drop-down list to sort students by assignment status. Select the checkboxes for students who turn in work, and then select the highlighted group to open it.

3. The assignment grade view opens for the student’s test scores. When reviewing, you can:

   Select “Review” next to to move from question to question when viewing a student’s test.

   See automatic replies with multiple choices. Forms will already have calculated scores, but you can change the score to receive partial or additional credit.

   leave feedback for one answer.

   Review the short answers and questions and add points.

   Select at the top of a test to provide comments for the entire test.

   When working with multiple tests that are enabled at the same time, use the drop-down menu on the People tab to navigate between students.

4. To publish a student’s grade and return the grade, select More options > grade .

   Select “Post” to submit your final feedback and scores.

5. Return to the assigned puzzle and update it. Tests that you have completed and returned will be displayed on the “Returned ” tab.

If you need to collect responses from students outside of a test scenario, you can still use assignments to distribute a form or survey completed in Forms.

1. In Microsoft Forms, select the form or survey you want to assign.

2. drop menu “Share” copy the link to the form.

   Note: Verify that the view permissions are set according to your needs in the script. With assigned to students, only members of my organization can respond to privacy requests at your school or district, and anyone with the link can be helpful in submitting forms to families.

3. Open Teams and go to the Assignments tab in the class team. Just as you would create a new assignment for a Jew, select “Create > assignment” .

4. Complete the assignment instructions and select Add Resources .

5. From the Resources menu, select the ” Link” tab, and then paste the “Form” link you copied earlier and enter the display text. Select “Connect”.

6. Fill in any remaining assignment information, and then select “ Assign”.

Additional information

Microsoft Forms for Education

Create a quiz using Microsoft Forms

Create an assignment in Microsoft Teams

Set up branching in a Microsoft Forms form or quiz

View assignment details in Microsoft Teams (for students)

Pass professional testing for free in Moscow

Pass professional testing

Pass professional testing for free at the Employment Center “My Job”.
Why do you need to take a vocational test?

More

• Determine your career path
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• Find out the levels of your soft and hard skills
• Recognize your strengths and areas of potential development

Professionals of the Employment Center will select the necessary tests, help
interpret the results and conduct an individual consultation, where they will tell
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• Find out which career path will bring you success.
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• Learn about your professional and personal competency levels – for example,
  levels of emotional intelligence or digital competencies.

Learn more about developing your career and improving your personal and professional skills
with the help of career guidance tests in the My Job Center!

You can be tested if you:

Employed

Career Guidance Test for Working Adults to Help Form Pathways
career development and alternative ways of professional development.

Are looking for a job

Professional testing for those who wish to find a job will allow you to choose
suitable profession, identify and reflect key competencies in the resume and
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Student or schoolboy

Vocational testing for young people will determine the inclination to the areas of professional
activities, will help you choose the right
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How is vocational testing done

As part of professional testing, specialists:

01.

Select the necessary tests for you to fully answer your request.

02.

Interpret test results and make personalized recommendations.

How to pass a career guidance test for free

• Offline professional testing:

  • visit the Employment Center “My Job” and take the test in a live order
    queues.
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• Online professional testing

Career guidance testing

Determines the profile direction when choosing training; will help you decide on a profession, if you want to change the field of activity.

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Identifies professional development areas, professional inclinations and leading personal competencies

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