Since 1993, our MS Center has worked to provide state-of-the-art neurological consultation and care for persons with multiple sclerosis in North Texas and the surrounding area. In addition to clinical activities, the MS Center is dedicated to all phases of clinical research for new, potential MS treatments from first-in-man Phase I through Final Phase III studies for FDA review.
 C Fish Greenfield, MD
Medical Director
Dr. Greenfield graduated with a BS degree in chemistry and microbiology as well as his medical degree from the University of Oklahoma. He completed his neurology residency and neurophysiology fellowship training at the University of Texas Southwestern Medical Center at Dallas.
Prior to moving to the Dallas area, he practiced neurology in Houston, Texas. Most recently, he has been on the faculty at the University of Texas Southwestern Medical Center and is currently affiliated with Baylor University Medical Center. He is board certified in neurology with particular interests in the treatment of multiple sclerosis, headaches, strokes and neuromuscular disorders.
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 Gary L. Tunell, MD
Dr. Gary Tunell is a board certified neurologist affiliated with Baylor University Medical Center at Dallas. This University of Missouri graduate completed his internship and residency at the University of Texas Southwestern Medical Center at Dallas and Parkland Hospital, serving as Chief Resident in 1979. Following two years in the U.S. Air Force, he began private practice at Baylor University Medical Center in 1981.
Dr. Tunell is Chief of Neurology at Baylor and a Clinical Professor of Neurology at the University of Texas Southwestern Medical Center at Dallas. He presently serves on several advisory boards in Dallas-Fort Worth and is a past-president of the Texas Neurological Society.
Active in patient care and neurological research, Dr. Tunell is a frequent lecturer and has authored several articles for various publications on neurologic diseases.
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 Waleed H. El-Feky, MD
Dr. El-Feky is a graduate from Ain Shams University School of Medicine in Cairo, Egypt. He completed his internship at Texas Tech University Health Sciences Center in El Paso. He completed his neurology training at the University of Texas Southwestern Medical Center at Dallas, where he served as the Chief Resident of Neurology from 1996 to 1997.
Dr. El-Feky completed his fellowship in Neurophysiology at the University of Texas Health Science Center at San Antonio. He completed a second fellowship in Neurointensive Care at the Cleveland Clinic in Cleveland, Ohio in 1999. He is board certified in neurology, neurophysiology, and sleep medicine. He currently holds positions at Baylor University Medical Center at Dallas and at the University of Texas Southwestern Medical Center at Dallas.
Dr. El-Feky practices general neurology. His areas of interests are stroke treatment and prevention, critical care neurology, multiple sclerosis, and peripheral neuromuscular disease. He is currently participating in multiple clinical drug trials for neurological diseases.
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 Shirley O'Leary, NP-C
Shirley O’Leary is a licensed and AANP board certified Adult Nurse Practitioner. She attended Texas Woman’s university where she earned her Bachelor’s and Master’s Degree in Nursing as well as completing her Adult Nurse Practitioner studies. For the last 17 years, she collaborated and specialized in Multiple Sclerosis research and patient care with Dr. J. Theodore Phillips, an internationally and nationally recognized expert in Multiple Sclerosis. In addition to her responsibilities for patient care at the Multiple Sclerosis Center at Texas Neurology, she has served as clinical research coordinator and had a pivotal investigative role for numerous MS Research studies at the Center. She also serves on multiple advisory boards including the clinical advisory committee for the National MS Society. She has been a regular speaker on MS at the International Conference on Treatment of Multiple Sclerosis, and The Consortium of MS Centers. She also speaks frequently to professional and patient groups nationally on symptom management in MS; infusion therapies; and quality of life issues. She has served as a faculty member of the Interactive Network for Continuing Education: “Emerging Treatment Options: Advancing Strategies for MS”, and mentored the prestigious John Dystel Nursing Fellowship Award in MS winner. Some of her published works include: “Practical Guidelines for Administering Natalizumab: A Nursing Perspective,” “Disease-Modifying Therapies in Multiple Sclerosis: Strategiesfor Optimizing Management,” and “Optimizing Quality of Life in Multiple Sclerosis Patients.”
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 Sheilah Harned, LCSW
Sheilah Harned, LCSW, is a Licensed Clinical Social Worker with a Masters degree in Social Work. She received a Bachelors degree in Psychology and Rhetoric and Communication Studies at the University of Virginia. She received her Masters degree in Social Work at the University of Texas at Austin. Sheilah has had over 20 years of experience in medical social work coordinating care for patients at Baylor University Medical Center and Texas Neurology.
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 Lori White RN, MS, CRNI
Lori White RN, MS, CRNI, is the Director of Clinical Operations at Texas Neurology. She received a Bachelor of Science in Nursing from the University of Texas at Arlington and a Master of Science from Texas Women's University. She also holds certification in Infusion Therapy. Additionally, Lori is a long-standing member of Sigma Theta Tau International Nurse's Honor Society. Lori's experience has been in acute medical/surgical and infusion nursing. |
What is Multiple Sclerosis?
Multiple Sclerosis (MS) is a chronic, inflammatory and neurodegenerative human disease which results from the autoimmune destruction of myelin and associated collateral tissue damage within the human central nervous system.
MS affects approximately 2.5 million persons worldwide. In the United States, MS is the most common cause of non-traumatic, long-term neurological disability in young adults, affecting at least 400,000 persons. Although MS is found throughout the world, marked regional variability is well known and likely reflects a combination of multiple interacting genetic and environmental influences. MS is usually first noted in young adults, affecting women two to three times more frequently than men.
Despite the common description of MS as one disease, several subtypes are recognized clinically. The established clinical subtypes include: relapsing-remitting (RRMS), primary progressive (PPMS), secondary progressive (SPMS), and progressive-relapsing (PRMS) forms. Over decades most untreated persons with RRMS will become “secondarily progressive”; i.e. will develop SPMS. At least 85% of the entire MS population is represented within the combined categories of RRMS and its subsequent form, SPMS. Persons with primary progressive MS (PPMS) are those who never have relapses and remissions, and comprise about 10% of all persons with MS. Progressive-relapsing MS (PRMS) is progressive from the onset without remission and is later punctuated with relapses and remissions. This form of MS affects about 5% of persons with MS.
Figure. The Natural History of MS: Clinical and MRI Features (Compiled from numerous sources.)
A common individual course of MS is shown in the figure. As shown, the first clinical evidence of RRMS is usually preceded by subclinical disease activity most sensitively detected by changes in magnetic resonance imaging (MRI) of the brain. Eighty to 90% of new MRI events may not cause clinical symptoms perhaps due to their relatively small size, preferential distribution within the brain white matter, and redundancy of brain circuitry.
A new MRI event is an area of inflammation which is typically detected with a gadolinium (Gd)-enhanced MRI of the brain or spinal cord. After a period of a few weeks, the inflammation subsides, leaving an area of scar tissue (sclerosis) behind. The descriptive diagnostic term “multiple sclerosis” derives from the multiplicity of these scarred (sclerotic) areas accumulated over time.
Clinical relapses can be associated with a variety of symptoms due to MS-related damage in brain and spinal cord. These may include disturbances of sensation, limb weakness, changes in vision or speech, balance or coordination problems, bowel and bladder control problems, excessive fatigue, and cognitive problems. As more inflammatory events occur over time, some of which actually reach clinical prominence (clinical relapses), the overall clinical and MRI extent of disease mounts (as shown in the Figure, white and orange lines, respectively).
At the same time, and now known to begin at even the earliest stages of MS, brain tissue loss also starts to occur, especially in untreated individuals. These changes correlate with long term irreversible physical and cognitive disabilities seen in many persons with MS. After 10 years disease duration, approximately 50% of untreated RRMS individuals will transition to SPMS.
This evolution is currently only recognizable after slow clinical worsening is noted in the absence of clinical relapses. All of these processes together lead to gradual MS worsening such that half of untreated persons with MS require a walking aid after 15-20 years of illness. The goals of early treatment of persons with MS are to help prevent the accumulation of brain and spinal cord damage that results in the disabling features of MS.
What causes MS?
The answer still remains obscure. Many studies suggest that both genetic and environmental influences play important interacting roles in determining risk for developing MS. MS prevalence varies with geographic location such that MS is more common in high northern or southern latitude regions and less common in equatorial regions. This peculiar finding is perhaps due in part to emigration patterns of higher risk groups, but most recently have been suggested to be related to less sun exposure and abnormalities in vitamin D metabolism more prominent at higher latitudes.
Various infectious causes have also been considered over the last 60 years, although none have shown a clear association with the disease. Recently, attention has been re-focused on the Epstein-Barr virus as a possibly important influence early in life, but there is no evidence that MS is infectious. Neither is MS is an inherited illness in any classic sense, but genes do appear to play some role in determining susceptibility to acquiring MS.
Disease Modifying Agents (DMAs) in MS:
In 1993, the first disease-modifying treatment for MS was approved by the US FDA (interferon beta-1b subcutaneous; Betaseron). Since then, five additional disease modifying agents have been approved for use in MS: Avonex (interferon beta-1a intramuscular), Copaxone (glatiramer acetate; copolymer-1; Cop-1), Rebif (interferon beta-1a subcutaneous), Novantrone (mitoxantrone intravenous), and Tysabri (natalizumab intravenous). These agents are called “disease modifying” because each is capable of altering the individual’s MS course for the better. Specifically, the approved DMAs all tend to suppress further worsening of MS, particularly regarding relapses.
As of 2008, approximately 20 new possible DMAs are in Final Phase III testing. These include new agents attacking many different aspects of MS, and these also include oral medications. The future holds true promise for developing new, effective, safe, and more convenient treatments for MS. New and exciting approaches to repair MS-related brain and spinal cord damage are on the near horizon. The future, we feel, is bright and encouraging.
Multiple Sclerosis Web Links:
The National Multiple Sclerosis Society (NMSS): http://www.nationalmssociety.org/
The Consortium of Multiple Sclerosis Centers (CMSC): http://www.mscare.org/cmsc
The Multiple Sclerosis Association of America (MSAA): http://www.msassociation.org/
International Organization of Multiple Sclerosis Nurses (IOMSN): http://www.iomsn.org/
Multiple Sclerosis International Foundation: http://www.msif.org/
