May 27, 2026
Decisions about managing multiple sclerosis (MS) have grown more complex. Multiple new medications are now available, and the wider field of autoimmune neurology is evolving fast. Jonathan L. Carter, M.D., a neurologist at Mayo Clinic in Phoenix/Scottsdale, Arizona, answers frequently asked questions about referring patients for subspecialized MS care.
As a quaternary center, Mayo Clinic has a distinguished history in the diagnosis and treatment of neuroautoimmune diseases. Each year, Mayo Clinic specialists treat more than 4,300 adults and children with MS. Specialized MS care is available across the enterprise. MS specialists also are available to offer second opinions on diagnosis and treatment.
When should a patient with MS be referred to a major center?
Referring physicians should consider referral for patients who are having breakthrough disease activity — either clinical attacks or changes in MRI scans — on their current therapy. Aggressive treatment with disease-modifying therapies as early as possible can help lower the relapse rate and slow the formation of new lesions.
But many of these immune-modulating therapies carry serious health risks. That's especially true for older patients, who might be more susceptible to infections and other side effects from their therapies. Mayo Clinic has neurologists who focus on MS care and have experience with these new medications.
Mayo Clinic also participates in clinical trials of new therapies, which might be an option for some patients.
How can a major center help with diagnosis?
MS can be misdiagnosed, often because other diseases can mimic MS on MRI scans. At Mayo Clinic, we use 7T MRI to identify novel MS biomarkers. 7T MRI findings within white matter lesions can suggest MS versus changes due to vascular disease, aging or migraine.
Sophisticated laboratory testing is also an asset. Mayo Clinic's neuroimmunology laboratory has developed assays that can differentiate MS from other neuroautoimmune conditions, such as neuromyelitis optica and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
How might referral help address patients' symptoms?
While focusing on immune therapies, it's easy to forget the symptomatic therapies that can help patients manage issues such as spasticity, fatigue, and bowel and bladder functions. All these issues have important impacts on quality of life for patients with MS.
Mayo Clinic's multidisciplinary MS care team includes physical medicine and rehabilitation specialists, urologists, psychiatrists and neuro-ophthalmologists. The MS care team works closely with our MS neurologists to manage patients' symptoms.
How else can multidisciplinary care benefit patients?
Interacting with specialists in various disciplines offers insights into patient care. Our multidisciplinary MS team meets regularly to discuss specific patients' needs. Having all these specialists in one center is also efficient for patients because appointments are coordinated across specialties.
Our integrated medical records allow us to access one another's notes and consult across departments and with specialists on other Mayo Clinic campuses. We often can shorten a patient's diagnostic odyssey from a period of months to maybe a week.
Why is timely referral important?
For some autoimmune conditions such as neuromyelitis optica, attacks can lead to permanent disability. It's important to make an accurate diagnosis and start treatment quickly. This field is changing rapidly, with new autoimmune neurology antibodies being discovered every month. Treatment isn't cut and dried, so referral to a major center with experience in these conditions can be helpful.
Patients generally have better recovery after MS attacks but often don't return to their previous baselines. Delaying treatment can impact patients with MS as well.
For more information
Refer a patient to Mayo Clinic.