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Multiple Sclerosis for the
Non-Neurologist
Mary Ann Picone, MD
Medical DirectorMultiple Sclerosis Comprehensive Care Center at Holy Name
Medical Center
Teaneck, New Jersey
Adjunct Clinical Associate ProfessorTouro College of Osteopathic MedicineNew
York, New York
Rock G. Positano, DPM, MSc, MPH, DSc
(hon)
Professor and Director of the Non-Surgical Foot and Ankle Service
Joe DiMaggio Sports Medicine Foot and Ankle Center
Sports Medicine Service
Hospital For Special Surgery
Weill Cornell Medical College and New York–Presbyterian Hospital
Department of Medicine, Division of Endocrinology, Diabetes and Metabolism
Department of Cardiothoracic Surgery
Department of Obstetrics and Gynecology
Memorial Sloan Kettering Cancer Center (MSKCC)
Orthopedic Service/Foot and Ankle Division/Department of Surgery
New York College of Podiatric Medicine/Foot Center of New York
Departments of Academic Orthopedic Science/Medicine/Orthopedics
New York, New York
Dexter Sun, MD, PhD
Clinical Professor of Neurology
Weill Cornell Medical College
New York, New York


Copyright
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Artist/Illustrator: Jen Clements
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Prepress Vendor: TNQ Technologies
Copyright © 2020 Wolters Kluwer.
All rights reserved. This book is protected by copyright. No part of this book may
be reproduced or transmitted in any form or by any means, including as
photocopies or scanned-in or other electronic copies, or utilized by any information
storage and retrieval system without written permission from the copyright owner,
except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S.
government employees are not covered by the above-mentioned copyright. To
request permission, please contact Wolters Kluwer at Two Commerce Square, 2001
Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via
our website at shop.lww.com (products and services).
9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Names: Picone, Mary Ann, editor. | Positano, Rock G., editor. | Sun, Dexter, editor.
Title: Multiple sclerosis for the non-neurologist / [edited by] Mary Ann Picone,
Rock G. Positano, Dexter Sun.
Description: Philadelphia : Wolters Kluwer, [2020] | Includes bibliographical
references and index.
Identifiers: LCCN 2019013826 | ISBN 9781975102517 (pbk.)
Subjects: | MESH: Multiple Sclerosis
Classification: LCC RC377 | NLM WL 360 | DDC 616.8/34–dc23LC record
available at https://lccn.loc.gov/2019013826
This work is provided “as is,” and the publisher disclaims any and all warranties,
express or implied, including any warranties as to accuracy, comprehensiveness, or

currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare
professionals’ examination of each patient and consideration of, among other
things, age, weight, gender, current or prior medical conditions, medication history,
laboratory data and other factors unique to the patient. The publisher does not
provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of
this work including all medical judgments and for any resulting diagnosis and
treatments.
Given continuous, rapid advances in medical science and health information,
independent professional verification of medical diagnoses, indications, appropriate
pharmaceutical selections and dosages, and treatment options should be made and
healthcare professionals should consult a variety of sources. When prescribing
medication, healthcare professionals are advised to consult the product information
sheet (the manufacturer’s package insert) accompanying each drug to verify, among
other things, conditions of use, warnings and side effects and identify any changes
in dosage schedule or contraindications, particularly if the medication to be
administered is new, infrequently used or has a narrow therapeutic range. To the
maximum extent permitted under applicable law, no responsibility is assumed by
the publisher for any injury and/or damage to persons or property, as a matter of
products liability, negligence law or otherwise, or from any reference to or use by
any person of this work.
shop.lww.com
https://t.me/medicina_free

Dedication
This book is dedicated to our MS patients and their families
whose courage and spirit have been a constant source of
inspiration.
https://t.me/medicina_free

Contributors List
Joshua M. Adkinson MD Assistant Professor of Surgery, Chief of Hand Surgery,
Division of Plastic Surgery, Department of Surgery, Indiana University School of
Medicine, Indianapolis, Indiana
George Alexiades MD Associate Professor of Clinical Otolaryngology,
Department of Otolaryngology, Weill Cornell Medical College, New York, New
York
Philip J. Aliotta MD, MSHA, CHCQM, FACS Chairman, Department of
Urology, Catholic Health System of Western New York, Chief of Urology, Sisters
of Charity Hospital and, St. Joseph Campus, Buffalo, New York,
Mohini Aras MD Assistant Professor, Department of Medicine, Weill Cornell
Medical College, New York, New York
Louis J. Aronne MD, FACP, DABOM Stanford I. Weill Professor of Metabolic
Research, Department of Medicine, Weill Cornell Medical College, Attending
Physician, Department of Medicine, New York–Presbyterian Hospital, New York,
New York
Andrea Arzt LSCW Director of Healthcare Provider Engagement, National
Multiple Sclerosis Society, New York, New York
Meghan Beier PhD Assistant Professor, Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
Regina Berkovich MD, PhD Assistant Professor of Clinical Neurology,
Department of Neurology, University of Southern California, Los Angeles,
California
Francois Bethoux MD Professor, Department of Medicine, Cleveland Clinic
Lerner College of Medicine, Director of Rehabilitation Services, Mellen Center for
Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, Ohio
Jagriti “Jackie” Bhattarai PhD National MS Society Postdoctoral Fellow,
Department of Physical Medicine and Rehabilitation , Johns Hopkins University
School of Medicine, Baltimore, Maryland
Michelle G. Carlson MD Professor, Department of Clinical Orthopedic Surgery,
Weill Cornell Medical College, Attending Orthopedic Surgeon, Department of
Orthopedic Surgery, Hospital for Special Surgery, New York, New York
Tanuja Chitnis MD Associate Professor, Department of Neurology, Harvard
Medical School, Director, Partners Pediatric Multiple Sclerosis Center, Department
of Child Neurology, Massachusetts General Hospital, Boston, Massachusetts
Michael A. Ciaramella BA Medical Student, Rutgers-Robert Wood Johnson
Medical School, Piscataway, New Jersey
https://t.me/medicina_free

Joseph T. Cooke MD Associate Professor of Clinical Medicine, Department of
Medicine, Weill Cornell Medical College, Chairman, Department of Medicine,
New York–Presbyterian Queens, New York, New York
Danielle E. Currier DMD Clinical Instructor in Surgery, Department of Oral &
Maxillofacial Surgery, Weill Cornell Medical College, New York, New York
Christopher Der MD Assistant Clinical Professor, Department of Anesthesiology,
Harbor – UCLA Medical Center, Torrance, California
Joshua S. Dines MD Associate Professor, Department of Orthopedic Surgery,
Weill Cornell Medical College, Associate Attending Physician, Department of
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York,
New York
Alisha N. Dua MRES Medical Student, Department of Otolaryngology, Weill
Cornell Medical College, New York, New York
Mostafa El Khashab MD, FACS, IFAANS Attending Neurological Surgeon,
Attending Pediatric Neurological Surgeon, Department of Neurological Surgery,
Advanced Neurosurgeons Associates, Rutherford, New Jersey
Brandon J. Erickson MD Chief, Shoulder & Elbow Surgery, , Phelps Hospital,
Department of Orthopedic Surgery, Rothman Orthopedic Institute, New York, New
York
Dorothy A. Fink MD Assistant Professor of Medicine, Department of Medicine,
Weill Cornell Medical College, Assistant Attending Physician, Department of
Medicine, Hospital of Special Surgery, New York, New York
Frederick W. Foley PhD Professor of Psychology, Department of Ferkauf
Graduate School of Psychlogy, Yeshiva University, Bronx, New York Director of
Clinical Psychology, Multiple Sclerosis Comprehensive Care Center, Holy Name
Medical Center, Teaneck, New Jersey
Molly Forlines BA Research Assistant, Non-Surgical Foot and Ankle Service,
Hospital for Special Surgery, New York, New York
Steven Galetta MD, FAAN Professor and Chair, Department of Neurology, New
York University School Of Medicine, New York, New York
Doria M. Gold MD Resident, Department of Neurology, New York University
School of Medicine, New York, New York
Tracy B. Grossman MD, MSc Fellow , Maternal Fetal Medicine, Department of
Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
Ronald Guberman DPM, DABPS Podiatry Residency Program Director,
Department of Surgery, Wyckoff Heights Medical Center, Brooklyn, New York
June Halper MSH, APN-C, MSCN, FAAN Chief Executive Officer, Consortium
of Multiple Sclerosis Centers, Hackensack, New Jersey
Lauren Hooper BA Director of Education, Healthcare Relations, and Grants
Management, Multiple Sclerosis Association of America, Cherry Hill, New Jersey
Anna-Marie Hosking BS Medical Student IV, University of California, Irvine
School of Medicine, Irvine, California
Misa Hyakutake MD Resident/Future Fellow, Department of
Medicine/Department of Geriatrics and Palliative Medicine, Icahn School of
Medicine at Mount Sinai, New York, New York
https://t.me/medicina_free

Anthony M. Iuso OMS-I, BS Medical Student, OMS-I, Touro College of
Osteopathic Medicine, New York, New York Research Assistant, Department of
Clinical Research, Holy Name Medical Center, Teaneck, New Jersey
Joseph L. Jorizzo MD Professor of Clinical Dermatology, Department of
Dermatology, Weill Cornell Medical College, Professor of Dermatology,
Department of Dermatology, New York–Presbyterian Hospital, New York, New
York Professor, Former and Founding Chair, Department of Dermatology, Wake
Forest University School of Medicine, Winston Salem, North Carolina
Randy Karim PT, DPT, NCS, CBIS Clinical Specialist, Director of Neurologic
PT Residency Program, Department of Rehabilitation and Sports Therapy, Mellen
Center for MS Treatment and Research, Cleveland Clinic, Cleveland, Ohio
Herbert I. Karpatkin PT, DSc, NCS, MSCS Assistant Professor, Department of
Physical Therapy, Hunter College, City University of New York, New York, New
York
Dale J. Lange MD Professor of Neurology, Department of Neurology, Weill
Cornell Medical College, Chair and Neurologist In-Chief, Department of
Neurology, Hospital for Special Surgery, New York, New York
Richard I. Lappin MD, PhD Assistant Professor of Clinical Medicine,
Department of Emergency Medicine, Weill Cornell Medical College, Attending
Physician, Department of Emergency Medicine, New York–Presbyterian Hospital,
New York, New York
John A. Lincoln MD, PhD Associate Professor, Department of Neurology,
McGovern Medical School - UT Health, Staff Physician, Department of Neurology,
Memorial Hermann Hospital, Houston, Texas
Waldemar Majdanski DPM, FACFAS Associate Attending Physcian, Department
of PodiatryWyckoff Medical Center, Brooklyn, New York
Kathy C. Matthews MD Fellow, Maternal Fetal Medicine, Department of
Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
Kyle W. Morse MD Resident, Department of Orthopedic Surgery, Hospital for
Special Surgery, New York, New York
Robert W. Motl PhD Professor and Director of Research, Department of Physical
Therapy, University of Alabama at Birmingham, Birmingham, Alabama
Nida Naushad BA Medical Student, Yale School of Medicine, New Haven,
Connecticut
Andrui Nazarian MD, MS, MSHAM Clinical Anthesiologist, Department of
Anthesiology, Olive View – University of California Los Angeles Medical Center,
Sylmar, California
Dorothy E. Northrop MSW, ACSW Social Worker, Multiple Sclerosis
Comprehensive Care Center, Holy Name Medical Center, Teaneck, New Jersey
Annette F. Okai MD Medical Director, Baylor Scott & White Multiple Sclerosis
Treatment Center of Dallas, Dallas, Texas
Constantine J. Pella BS Research Assistant, Holy Name Medical Center, Teaneck,
New Jersey
Tiffany Peng, MD Resident Physician, Department of Otolaryngology, New York–
Presbyterian Hospital of Columbia & Cornell, New York, New York
Carlos A. Pérez MD Fellow, Department of Pediatrics – Division of Child and
Adolescent Neurology, University of Texas Health Science Center at Houston,
https://t.me/medicina_free

Houston, Texas
Mary Ann Picone, MD Medical Director Multiple Sclerosis Comprehensive Care,
Center at Holy Name Medical Center, Teaneck, New Jersey, Adjunct Clinical
Associate Professor, Touro College of Osteopathic Medicine, New York, New
York,
Jeffrey G. Portnoy MA PhD Candidate, Ferkauf Graduate School of Psychology,
Yeshiva University, Bronx, New York Neuropsychology Staff, Multiple Sclerosis
Center, Holy Name Medical Center, Teaneck, New Jersey
Rock CJay Positano DPM Co-Director of the Non-Surgical Foot and Ankle
Service, Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for
Special Surgery, New York, New York, Resident Physician, Department of
Podiatry, New York–Presbyterian/Brooklyn Methodist Hospital, Brooklyn, New
York
Rock G. Positano, DPM, MSc, MPH, DSc (hon) Professor and Director of the
Non-Surgical Foot and Ankle Service, Joe DiMaggio Sports Medicine Foot and
Ankle Center, Sports Medicine Service, Hospital For Special Surgery, Weill Cornell
Medical College and New York–Presbyterian Hospital, Department of Medicine,
Division of Endocrinology, Diabetes and Metabolism, Department of
Cardiothoracic SurgeryDepartment of Obstetrics and GynecologyMemorial Sloan
Kettering Cancer Center (MSKCC)Orthopedic Service/Foot and Ankle
Division/Department of SurgeryNew York College of Podiatric Medicine/Foot
Center of New YorkDepartments of Academic Orthopedic
Science/Medicine/OrthopedicsNew York, New York
Qibin Qi PhD Associate Professor, Department of Epidemiology and Population
Health, Albert Einstein College of Medicine, Bronx, New York
Gwendolyn S. Reeve DMD Assistant Professor, Department of Surgery, Weill
Cornell Medical College, Attending Surgeon, Department of Surgery, New York–
Presbyterian Hospital, New York, New York
W. Mark Richardson BA Clinical Research Coordinator, Department of
Neurology, Hospital for Special Surgery, New York, New York
Marsha E. Rubin DDS Assistant Professor, Department of Surgery, Weill Cornell
Medical College, Director of Dentistry/ Chief of Dental Medicine, Department of
Surgery, New York–Presbyterian Hospital, New York, New York
Janet C. Rucker MD Professor, Department of Neurology, New York University
School of Medicine, New York, New York
Katherine H. Saunders MD Assistant Professor of Clinical Medicine,
Comprehensive Weight Control Center, Weill Cornell Medical College, New York,
New York
Stephanie L. Silveira PhD Postdoctoral Fellow, Department of Physical Therapy,
University of Alabama at Birmingham, Birmingham, Alabama
Anthony J. Smith MD Associate Attending of Clinical Medicine, Department of
Medicine, Weill Cornell Medical College, New York, New York Division Chief of
Pulmonary and Critical Care Medicine, Department of Medicine, New York–
Presbyterian Queens, Queens, New York
Catherine Stratton BA MPH Candidate, Chronic Disease Epidemiology, Yale
School of Public Health, New Haven, Connecticut
Quy Tran MD Assistant Clinical Professor, Department of Anesthesiology, David
Geffen School of Medicine at UCLA, Los Angeles, California Attending Physician,
https://t.me/medicina_free
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