Here is My Question:
I've been diagnosed with RRMS for 9 yrs. I go to a MS Center at a major hospital. My "Neuro exams" at first were thorough. Now I am checked for sensation, reflexes, eye tracking, & finger/nose touch only. They know I have balance problems so they don't ask anymore to see me try the balance tests. I'd like to know what other clinics/MDs do. I know exams vary for each patient, but I feel like my MD isn't quite the "MS Center" he thinks he is.
It depends. Once MS has been diagnosed, the neurological exam primarily serves as a way to confirm a new relapse or inflammatory event, but more commonly to monitor for progressive changes consistent with a primary progressive or secondary progressive course. Clinical metrics that are more common to follow are based on the standard clinical scoring scale called the EDSS (expanded disability status scale) which requires a thorough neurological exam including the items you mentioned. Also, the MSFC (multiple sclerosis functional composite) introduces other measurements such as the 25’ timed walk, 9-hole peg test time, and a cognitive test such as the PASAT (paced auditory serial addition test) or SDMT (symbol digit modalities test). In general, I like to follow (over time) best corrected vision, a leg test (25’ walk test), arm test (9-hole peg test), and cognitive test (symbol digit modalities test). However, I’ve found that these measures are best obtained annually since progression in MS is typically seen over longer time periods rather than over the short term.
If you have concerns over the monitoring of your MS, I’d suggest asking your physician about how he follows this and set up a plan to measure relevant testing over time. You can request the measurements for yourself so you can keep track of this also.
Hope this helps.
A. Scott Niesen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
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