Vijayshree Yadav M.D.
Dr. Yadav is a board-certified neurologist and the clinical medical director of the OHSU MS Center. Her research interests include integrative medicine options for multiple sclerosis including dietary and lifestyle changes, as well as supplements such as lipoic acid.
Mimics makes multiple sclerosis diagnosis tricky
Verifying an accurate diagnosis of multiple sclerosis (MS) is fundamental, because there are many conditions that can mimic MS.
Additionally, possible symptoms may relapse or be nonspecific. Though much better diagnosed now than in previous years, there are still frequent misdiagnoses of MS. While some cases are clearly identifiable, others can be less definitive. Excluding other causes and accurately diagnosing MS is critical for patient outcomes because permanent neurologic damage can occur even in the early stages without appropriate treatment.
MRI a powerful tool in diagnosis
Though there is no single test that is diagnostic of MS, MRI technology is at the forefront. MRI can show the dissemination of white matter lesions in the brain, which can be the result of MS attacking the myelin. However, every white spot on an MRI does not dictate an MS diagnosis, as white spots can be caused by normal aging, uncontrolled long-standing hypertension, chronic migraines, small vessel ischemic disease due to other vascular diseases, and many other conditions. The quality of the MRI and the expertise of the neuroradiologist reading the imaging can be essential to an accurate diagnosis. At OHSU, patients benefit from the most advanced imaging technology available, coupled with fellowship-trained imaging specialists board-certified by the American Board of Radiology.
Comprehensive imaging at OHSU
At OHSU, patients benefit from the most advanced imaging technology available. All OHSU MRI scanners include state-of-the-art echo-planar imaging, MR spectroscopy, Susceptibility Weighted Imaging (SWI), Diffusion Tensor Imaging with Fiber tracking, Functional MRI, and MRI Perfusion including ASL and DSC methods. OHSU maintains 9 MRI magnets including:
MS requires collaborative and customized care
Now with more than 15 therapies approved by the Food and Drug Administration (a new one added just in March), finding the right approach for the patient’s disease type, symptoms and co-diseases can be complex. Also, these medications require close monitoring and many carry the risk of other complications, including infection.
MS patients also have a spectrum of symptoms from the disease and its effects, from mobility and bladder incontinence to pain and depression. At a comprehensive care center, the health factors and implications for lifestyle can be managed by a multidisciplinary team. In addition to disease modifying therapies, the OHSU Multiple Sclerosis Center emphasizes overall wellness of patients through complementary and integrative therapies, such as dietary and supplement education, physical therapy and mind/body modalities.
Lipoic acid clinical trial Building on research conducted at OHSU by Dennis Bourdette, M.D., F.A.A.N. into the effectiveness of lipoic acid (LA) in reducing inflammation, Yadav completed a study evaluating the effect of LA on damage to the optic nerve in people with MS after optic neuritis. Her colleague, Rebecca Spain, M.D., M.S.P.H., completed a pilot study that evaluated the neuroprotective benefits of LA in 50 people with secondary progressive MS (SPMS). She found that LA may provide significant protection on brain atrophy over the two-year study period. A larger trial is being planned to confirm these exciting results.
In March, the Food and Drug Administration approved the first-ever medication for primary progressive MS, one of the less common types of MS that had no treatment options. The therapy, ocrelizumab (brand name Ocrevus), is given as an intravenous infusion every six months. This drug is unique in its ability to alter the immune system by blocking specifically the B cells, a therapeutic breakthrough. The FDA also cleared the drug for the more common relapsing form of MS.
Technology and expertise for MS at OHSU
At the OHSU MS Center, we provide comprehensive diagnosis and management for MS patients. We have the expertise to help with treatment plans and techniques, but we also rely on open communication with our primary care partners. Additionally, we collaborate extensively with other top MS centers across the United States. We are continuously involved in clinical trials related to MS, keeping our clinicians and MS care providers always a step ahead in finding the best management options for our patients.
In 2014, new classifications of MS t ypes were developed by the International Advisory Committee on Clinical Trials of MS, replacing the previous four classifications established in 1996. The new classification reflects the disease activity based on advances in understanding of the disease process and MRI technology.
• Clinically isolate syndrome (CIS)
• Relapsing-remitting MS (RRMS)
• Progressive MS (PPMS and SPMS)
Lipoic acid clinical trial
Building on research conducted at OHSU by Dennis Bourdette, M.D., F.A.A.N. into the effectiveness of lipoic acid (LA) in reducing inflammation, Yadav completed a study evaluating the effect of LA on damage to the optic nerve in people with MS after optic neuritis. Her colleague, Rebecca Spain, M.D., M.S.P.H., completed a pilot study that evaluated the neuroprotective benefits of LA in 50 people with secondary progressive MS (SPMS). She found that LA may provide significant protection on brain atrophy over the two-year study period. A larger trial is being planned to confirm these exciting results.
When to consult or refer
• To confirm a diagnosis for suspected MS patients.
• To assess MS patients with a comprehensive, multidisciplinary approach for optimal management.
• To treat complex MS cases that require advanced care.
Our experts are available for consultation and as a resource in the diagnosis and management of MS patients as well as other autoimmune conditions of the central nervous system. For a consultation, please call the OHSU Physician Consult & Referral Service at 503-494-4567. To refer a patient, please fax to 503-346-6854.
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