Disease-modifying therapies are the drugs that reduce how often multiple sclerosis relapses and how many new lesions appear on MRI. They work on the immune process driving the disease, not on symptoms, and they do not repair damage that has already happened. That distinction explains most of the confusion about whether a therapy is working.
Disease-modifying therapies are the drugs that reduce how often multiple sclerosis relapses and how many new lesions appear on MRI. They work on the immune process driving the disease, not on symptoms, and they do not repair damage that has already happened. That distinction explains most of the confusion about whether a therapy is working.
Injectable therapies came first: interferon beta preparations and glatiramer acetate, both with long safety records and modest effect sizes. Oral therapies include the fumarates, the S1P receptor modulators such as fingolimod and siponimod, teriflunomide and cladribine. Infused or higher-efficacy therapies include natalizumab, ocrelizumab and alemtuzumab, with ofatumumab given by subcutaneous injection at home. Effect size and monitoring burden generally rise together, which is the central trade-off in choosing one.
This practice operates no infusion suite. Where an infused therapy is the right choice, it is administered at an infusion centre or hospital outpatient unit, and the neurologist here selects the therapy, orders and reviews the monitoring, reads the surveillance MRI reports and manages everything around the infusion. Patients sometimes assume that not infusing on site means not offering the therapy. It does not.
Each therapy carries its own schedule. Blood counts and liver function are common to most. JC virus antibody testing governs natalizumab risk. Some S1P modulators require first-dose cardiac observation and eye checks. Surveillance MRI looks for new lesions in someone who feels perfectly well, because silent activity is a reason to change therapy. MRI is arranged at an imaging centre and the report is reviewed with you here.
The evidence for these therapies is strongest in relapsing forms. In progressive disease without relapses the benefit is smaller and fewer options are approved, and the emphasis shifts toward function, spasticity, bladder symptoms, fatigue and walking. Being told a therapy is not indicated is not being told nothing can be done, though it frequently lands that way.
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.