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Neurology: Multiple Sclerosis

 The Neuroimmunology division specializes in multiple sclerosis and related diseases. Multiple Sclerosis, or MS, is a devastating as yet incurable autoimmune disease that affects the central nervous system.

People diagnosed with MS can present with one of four clinical courses of the disease. Relapsing-remitting is the most common; patients with this type of disease experience flare-ups of neurologic impairment that either partially or completely reverse. According to the National Multiple Sclerosis Society (NMSS), anyone can develop MS, but the typical candidate is between the ages of 20 and 50, a woman two to three times more often than a man, and of Northern European descent. About 400,000 Americans acknowledge having MS. Worldwide that number may be 2.5 million.

FOR FOLLOW-UP APPOINTMENTS CALL (314) 362-3293 - option 2

FOR NEW PATIENT APPOINTMENTS - Refer to instructions below regarding necessary paperwork.


Front, from left: Rob Naismith MD; Greg Wu MD, PhD
Back, from left:  Cathie Martinez LPN; Megan Orchard PA; 
Anne Cross MD; Becky Jo Parks, MD
(not pictured, Erin Longbrake, MD, PhD)
Four neuroimmunology specialists man the clinic, along with two MS fellows. They consult with clinicians, imaging specialists, and laboratory researchers weekly to ensure that any new insights are translated as quickly as possible into clinical practice.

MS Treatment Team

Anne H. Cross, MD, Director
Erin Longbrake, MD, PhD
Cathie Martinez, LPN
Rob Naismith, MD

Megan Orchard,  PA
Becky Jo Parks, MD
Gregory Wu, MD, PhD


Referrals are accepted from primary care physicians, other neurologists, attending physicians, and patients themselves for treatment and for second opinions. The MS Center is also a tertiary referral center, helping managing out-state patients in conjunction with their local neurologist.

Making a New Patient Appointment

New patients should call (314) 362-3275.

Medical records should be faxed or mailed in advance of scheduling an appointment. The center has one of the fastest appointment times in neurology. Patients are seen within four weeks to six weeks after receipt of records. Depending on the availability of specific clinicians, there may be a longer wait time. By having the records reviewed before the appointment, it can save the patient time and stress associated with being referred to the wrong department.

The John L. Trotter Multiple Sclerosis Center has been caring for patients with MS for three decades. The Center is physically located on the lower level of the McMillan Hospital building at 517 South Euclid Avenue, on the Washington University Medical Center.

To obtain an appointment for a new patient, mail or fax to (314) 362-0338, the following items:

  • A note requesting a consult and/or the reason for referral
  • Patient contact and insurance information
  • Pertinent medical records, office notes, MRI reports, blood work results and lumbar puncture results

Mailing Address:

The John L. Trotter MS Center
660 S. Euclid Ave., Campus Box 8111
St. Louis, MO 63110

New patient fax number: (314) 362-0338

The Center is involved in leading edge research on glial cells, immune cells, and human clinical trials. They provide a comprehensive approach to care, including patient education, training of future specialists, imaging, and research to better understand the disease process. Nurses in the center have more than 25 years experience in neuroimmunology.

Other related diseases also seen at the John L. Trotter MS Center include:

Optic Neuritis

Optic neuritis (ON) is a demyelinating inflammation of the optic nerve. Many cases of ON are associated with multiple sclerosis (MS), but ON can occur in isolation. In cases associated with MS, ON is commonly the first manifestation of the chronic demyelinating process. Long-term follow-up studies have indicated that up to 75% of female patients initially presenting with ON ultimately develop MS. Occasionally, ON can be due to an infectious process involving the orbits or paranasal sinuses or occur in the course of a systemic viral infection.

Transverse Myelitis

Transverse myelitis is a neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. This damage causes nervous system scars that interrupt communications between the nerves in the spinal cord and the rest of the body.

Although some patients recover from transverse myelitis with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Most patients will have only one episode of transverse myelitis; a small percentage may have a recurrence. Transverse myelitis occurs in adults and children, in both genders, and in all races. An estimated 1,400 new cases of transverse myelitis are diagnosed each year in the United States.

Neuromyelitis Optica (Devic’s Disease)

Devic’s Disease, also called Devic’s syndrome and neuromyelitis optica, is a rare, chronic inflammatory demyelizing disease of the central nervous system that resembles multiple sclerosis in several ways. It is characterized by attacks of acute optic neuritis usually in both eyes. It may be combined or followed by severe transverse myelopathy. Recovery from attacks of Devic's disease is typically poorer than remissions seen in relapsing-remitting multiple sclerosis but the relapses are usually less frequent than is typical in MS. Neurologists argue as to whether Devic's syndrome is a completely different disease to MS or whether it a variant of it.

CNS Vasculitis

This is an autoimmune-like, inflammatory disease of unknown cause. The blood vessels in the brain (or, much more rarely, the spinal cord) become so damaged that both the blood vessels and brain cells are destroyed. The result is a wide range of neurological problems, many of them severe. People with CNS Vasculitis face serious disabling symptoms such as head pain, confusion, paralysis, mental changes, fatigue, impaired cognition, sensitivity to overstimulation, and a host of other neurological problems. CNSV is very difficult to diagnose and treat. The signs and symptoms of CNS vasculitis are similar to those encountered in more common forms of neurologic disease such as multiple strokes from hardening of the arteries (atherosclerosis), emboli (dislodged blood clots that travel to the brain from the heart or large blood vessels in the neck), infections or even multiple sclerosis.

CADASIL

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is the most common form of hereditary stroke disorder, and is thought to be caused by mutations of the Notch 3 gene on chromosome 19. The most common clinical manifestations are transient ischemic attacks or strokes, which usually occur between 40 and 50 years of age, It affects the muscle walls in the small arteries that provide blood flow to the brain, allowing the small blood vessels to be defective. The resulting blood vessel damage can lead to migraines, emotional and mental disorders, stroke-like episodes, dementia, and other impairments of normal brain function. Most patients with CADASIL do not have the common risk factors for stroke and heart attack.

 

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Copyright 2014 Washington University School of Medicine