Multiple Sclerosis & Other Neurological Disorders Clinic
Since January 2022, the Metropolitan Hospital has operated the Multiple Sclerosis & Other Neurological Disorders Clinic, under the direction of Professor Konstantinos Voumvourakis, Neurology–Neuroimmunology, National and Kapodistrian University of Athens (NKUA).
In addition to Multiple Sclerosis, the clinic provides diagnostic and therapeutic management for a wide range of neuroimmunological disorders, including:
- Neuromyelitis Optica (Devic’s disease)
- Autoimmune Meningoencephalitis
- Guillain-Barré Syndrome & other autoimmune peripheral neuropathies
- Myasthenia (Myasthenia Gravis)
- Lambert-Eaton Myasthenic Syndrome
- Autoimmune Dysautonomia
- Myositis
- Necrotizing Myositis
- Inclusion Body Myositis
- Paraneoplastic Neurological Syndromes / Onconeural Antigens
- Autoimmune Encephalitis
- Autoimmune Cerebellar Ataxia
- Autoimmune Epilepsy
- Autoimmune Dementias
- Stiff-Person Syndrome / PERM
- Autoimmune Chorea
- Brainstem Syndromes
- Myelopathy
- Sensorimotor Neuropathy of paraneoplastic origin
- Alzheimer’s Disease
- Creutzfeldt-Jakob Disease
Multiple Sclerosis
Multiple Sclerosis (MS), the most common acquired neurological disease in young adults, is a chronic inflammatory disorder of the central nervous system that affects a wide range of physical, cognitive, and psychological functions. Its exact cause remains unknown, but three main factors are believed to contribute to its pathogenesis:
- Genetic susceptibility: inheritance of numerous susceptibility genes combined with very few protective ones
- Exposure to one or more environmental pathogenic factors
- Development of abnormal immune mechanisms targeting the central nervous system
The disease typically manifests between the ages of 20 and 40, though earlier or later onset is also possible. It is significantly more common among women and individuals of Caucasian descent. Globally, it affects just over 3 million people. In the general population, the lifetime risk is approximately 1 in 1,000. Family history plays a role: siblings or children of affected individuals have a 1–3% risk of developing MS themselves, while twin studies indicate a concordance rate of about 30%.
If left untreated or inadequately managed, MS is the leading cause of disability among young adults during their most productive years.
MS is classified into four main forms, based on its clinical course:
- Relapsing-remitting MS (RRMS): characterized by acute relapses evolving over days or weeks, often followed by full or partial recovery over weeks or months.
- Secondary progressive MS (SPMS): initially relapsing, later progressing steadily after an unpredictable interval.
- Primary progressive MS (PPMS): gradual, continuous worsening from disease onset.
- Progressive-relapsing MS (PRMS): progressive disease course from the beginning, punctuated by occasional relapses.
Two “atypical” forms represent borderline or early stages of the disease:
- Radiologically isolated syndrome (RIS): the disease remains “silent” and subclinical for years, only to be discovered incidentally through imaging or subtle symptoms,
- Clinically isolated syndrome (CIS): the first clinical manifestation of MS, presenting as a single neurological episode or symptom.
According to current international consensus, early recognition of both typical and atypical forms of MS, along with timely and appropriate therapeutic intervention, is essential for effective management of this complex condition.
The Team of the Clinic
Multiple Sclerosis is a multifaceted disease, and therefore its holistic management requires a specialized and multidisciplinary team composed of experienced medical and paramedical staff.
The Clinic at Metropolitan Hospital is staffed by the Director Neurologist, three Consultant Neurologists with expertise in the field, a specialized Neuropsychologist, and is administratively supported by a dedicated secretary with five years of experience in a University Neurology Clinic’s Multiple Sclerosis Unit.
With the goal of providing comprehensive care for this complex condition, the above team collaborates with a Physiatrist, Orthopedic Surgeon, Urologist, Ophthalmologist, Internist, and Psychiatrist specialists experienced in managing the chronic residual problems caused by Multiple Sclerosis and other possible comorbid conditions. The Clinic is further supported by Radiology, Hematology, and Neurophysiology laboratories, and is complemented by Physiotherapists, Psychologists, and Nurses healthcare professionals whose contribution is considered crucial in addressing the persistent and challenging issues faced by patients living with the disease and its complications.
The Clinic’s approach to the disease
The diagram below accurately reflects the Clinic’s patient-centered philosophy and its objectives for every patient it seeks to support.
The Clinic’s method is the regular monitoring of patients. Follow-up takes place through scheduled re-examinations every 3 or 6 months, while in the interim periods, in collaboration with the patients’ treating physicians (private doctors, insurance physicians, or outpatient clinics of other private or public healthcare facilities), the necessary medical services are provided. This ensures a comprehensive and as effective as possible approach to the multifaceted nature of Multiple Sclerosis and the complications arising from potential comorbidities.
How the Clinic operates & How diagnosis is made
Diagnosis of Multiple Sclerosis is based on the latest internationally recognized criteria (e.g., McDonald Criteria, 2005, 2010, 2017).
The process begins with a detailed medical history and a clinical examination of the patient at the clinic. Subsequently, the necessary imaging and laboratory tests are performed. Based on the clinical and paraclinical evaluation, a differential diagnosis is established, leading to a confirmed diagnosis of the disease. In cases where the diagnosis is uncertain, the patient is admitted to the Multiple Sclerosis & Other Neurological Disorders Clinic for further assessment.
Patient treatment is carried out according to International Guidelines (e.g., updated guidelines from the American Academy of Neurology). Depending on the case, therapies may include:
- Injectable subcutaneous or intramuscular therapies, with patient training for self-administration following the initial dose,
- Newer oral therapies,
- Intravenous infusions, administered as needed following admission to the Short-Stay Unit
In parallel, a structured follow-up program is implemented to monitor residual symptoms and potential complications. This includes assessing the patient’s physical, mental, and cognitive abilities and addressing any impairments. Medical rehabilitation is essential to help patients “live with the disease” and to prevent potential complications. Rehabilitation can support learning strategies for daily activities, helping patients maintain a higher level of independence and self-esteem.
The program aims to exercise the body, mind, and spirit, recognizing that a holistic approach has the most positive impact on overall patient health. Furthermore, there is increasing recognition of the importance of a multidimensional and individualized rehabilitation program for improving functional outcomes in Multiple Sclerosis patients and enhancing their quality of life. Significant scientific evidence now supports the notion that patients with Multiple Sclerosis should be actively involved in decision-making to determine the most appropriate rehabilitation approach at each stage of the disease.
Additional Clinic activities for more effective treatment
Due to the chronic nature of Multiple Sclerosis, patients often experience fatigue and may discontinue their treatment or turn to alternative therapies. The immediate goal of the clinic team is to prevent these critical points in treatment and to support patients, helping them maintain adherence through educational and support programs such as support groups, patient seminars, and a dedicated helpline. The ultimate aim is to promote self-management and encourage patients to take responsibility for following their individualized care plan..
For the same reason chronicity care givers of MS patients also frequently experience fatigue. Caregivers play a crucial role in developing and implementing the patient’s care plan. The clinic actively works to prevent caregiver burnout and its consequences by offering programs aimed at relief and empowerment, including specialized seminars and caregiver support groups.