Years diagnosed with MS?
Your course of MS?
What diagnostic tests were used in diagnosing MS? (Please check all that
apply)
MRI
Lumbar
Puncture
Evoked Potential Test
CAT Scan
Visually
Evoked Potential Test
Brainstem Auditory Evoked Response Test
SomatoSensory
Evoked Potential Test
What symptoms do you experience? (Please check all that apply)
Fatigue
Depression
Cognitive
Paraesthesia (numbness,
tingling, buzzing, vibration sensations)
Pain
Double Vision
Unsteadiness & Dizziness
Weakness
Shaking & Loss of Coordination
Bladder Problems
Bowel Problems
L'Hermitte's (electric shocks and buzzing
when moving head)
Nystagmus (jerky eye movements)
Spasticity
Muscle Atrophy
Dysarthia (slurred speech and speech related
problems)
Clonus
Footdrop
Trigeminal Neuralgia (facial pain)
Do you use any disease modifying therapies and/or chemotherapy?
What therapy do you use? (Please check all that apply)
Avonex
Betaseron
Copaxone
Rebif
Novantrone
Methotrexate
Cytoxan
Mitoxantrone
Do you utilize medications to help ease daily symptoms?
What medications do you use? (check all that apply)
Catapres
Ditropan
Tofanil
Elavil
Prozac
Effexor XR
Zoloft
Celexa
Wellbutrin
Xanex
Paxil
Provigil
Ritilin
Cylert
Tegretol
Flexeril
Neurontin
Robaxin
Dilantin
Baclofen
Dantrium
Valium
Diamox
Gravol
Isoniazid
Meclizine
Zofran
Ambien
BuSpar
Cipro
Have you ever used IV Solumedrol (steroid) for treatment of an
exacerbation flare up?
How many times have you used Solumedrol?
Do you find your family and friends supportive in coping with your
illness?
Do you attend support group meetings?
What information is most important to you when learning about MS?
What aspects concerning MS would you like to learn more about?