That depends on the course. Relapsing-remitting multiple sclerosis produces attacks with recovery between them, and disability accumulates slowly if at all in the early years. Progressive forms worsen steadily without distinct relapses. Disease-modifying therapy has changed both pictures, most clearly the relapsing one.
That depends on the course. Relapsing-remitting multiple sclerosis produces attacks with recovery between them, and disability accumulates slowly if at all in the early years. Progressive forms worsen steadily without distinct relapses. Disease-modifying therapy has changed both pictures, most clearly the relapsing one.
Most people are diagnosed with relapsing-remitting disease, in which new symptoms develop over days, persist for weeks, then improve either completely or partially. A relapse is defined as new or worsening neurological symptoms lasting more than a day in the absence of infection or fever. Some people later enter a secondary progressive phase, where disability accumulates gradually with fewer or no relapses. A smaller group have primary progressive disease from the outset. The course is not fixed at diagnosis, and the distinction matters because treatment differs.
These treatments reduce the frequency of relapses and the appearance of new lesions, and they slow the accumulation of disability. The effect is clearest in relapsing disease, and starting earlier is associated with better long-term outcomes, which is the main argument against a wait-and-see approach after a first event that meets diagnostic criteria. Options range from oral agents to injected and infused therapies, chosen against disease activity, other conditions and monitoring requirements. Infused therapies are not administered at these offices; they are arranged with a service equipped to give and monitor them.
This distinction changes what happens next, and it is easy to get wrong. Heat, whether from weather, exercise or a hot bath, temporarily worsens existing symptoms and resolves on cooling; that is not a relapse. Infection does the same, and a urinary tract infection is a common and easily missed trigger of what looks like deterioration. Fatigue and poor sleep amplify everything. A genuine relapse brings new or clearly worsened symptoms lasting more than a day without those explanations, so infection is checked for first.
Review focuses on relapse history, symptoms between relapses, walking, bladder function, fatigue, mood and cognition, since the parts that affect daily life are not always the parts a scan shows. MRI surveillance is arranged at an imaging centre and the report reviewed with you here; this practice operates no imaging suite. Evoked potential testing is performed in the office and can demonstrate delayed conduction in pathways that are clinically silent. Vitamin D status and stopping smoking are addressed, both being associated with outcome.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: multiple sclerosis; National Institute of Neurological Disorders and Stroke; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.