REFERENCES

References used to support the information on this website, by section:
  1. Goldenberg MM, et al. Multiple sclerosis review. Pharmacy and Therapeutics 2012;37(3):175–184.
  2. Gilmour H, et al. Multiple sclerosis: Prevalence and impact. Statistics Canada. Available at: www.statcan.gc.ca. Release date: January 2018.
  3. MS Society of Canada. Symptoms. Available at: https://mssociety.ca/about-ms/symptoms. Accessed May 2020.
  4. Cascella M, et al. Features, evaluation and treatment coronavirus (COVID-19). Available at: https://www.ncbi.nlm.nih.gov/books/NBK554776/. Accessed June 2020.
  5. MS International Federation. The coronavirus and MS – updated global advice. Last updated: 18 June, 2020. Available at: https://www.msif.org/news/2020/02/10/the-coronavirus-and-ms-what-you-need-to-know/. Accessed June 2020.
  6. World Health Organization. WHO coronavirus disease (COVID-19) dashboard. Available at: https://covid19.who.int/. Accessed June 2020.
  7. Johns Hopkins Medicine. What is coronavirus? Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus. Accessed June 2020.
  8. World Health Organization. Coronavirus overview. Available at: https://www.who.int/health-topics/coronavirus#tab=tab_1. Accessed May 2020.
  9. Centers for Disease Control and Prevention. People who are at higher risk for severe illness. Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html. Accessed June 2020.
  10. World Health Organization. Coronavirus symptoms. Available at: https://www.who.int/health-topics/coronavirus#tab=tab_3. Accessed May 2020.
  11. World Health Organization. Q&A on coronaviruses (COVID-19). Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses. Accessed June 2020.
  12. World Health Organization. Coronavirus disease (COVID-19) advice for the public. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Accessed May 2020.
  13. MS Society of Canada. What you need to know about coronavirus. Available at: https://mssociety.ca/resources/what-you-need-to-know-about-coronavirus. Accessed May 2020.
  14. National MS Society. Multiple Sclerosis and coronavirus. Available at:  https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus. Accessed June 2020.
  15. COViMS. COVID-19 Infections in MS & Related Diseases. Available at: https://www.covims.org/. Accessed June 2020.
  16. Macaron G and Ontaneda D. Diagnosis and management of progressive multiple sclerosis. Biomedicines 2019;7:56.
  17. Government of Canada. Coronavirus disease (COVID-19): prevention and risks. Available at: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html. Accessed June 2020.
  18. Government of Canada. How to isolate at home when you may have COVID-19. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/covid-19-how-to-isolate-at-home.html. Accessed June 2020.
  19. National MS Society. Multiple Sclerosis FAQs. https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s. Accessed September 2020.
  20. Harvard Health Publishing. Hugs heartfelt in more ways than one. Available at: https://www.health.harvard.edu/newsletter_article/In_brief_Hugs_heartfelt_in_more_ways_than_one. Accessed July 2020.
  1. Giovannoni G, et al. Brain health: Time matters in multiple sclerosis. Mult Scler Relat Disord 2016;9(Suppl 1):S5–48.
  2. Cree BAC, et al. Silent progression in disease activity-free relapsing multiple sclerosis. Ann Neurol 2019;85:653–66.
  3. National MS Society. Research News. Available at: https://www.nationalmssociety.org/Research/Research-News-Progress. Accessed July 2020.
  4. Azevedo FAC, et al. Equal number of neuronal and nonneuronal cells make the human brain an isometrically scaled-up primate brain. Journal of Comparative Neurology 2009. 513:532–541.
  5. NASA. Universe 101: The Milky Way. Available at: http://map.gsfc.nasa.gov/universe/rel_milkyway.html. Accessed July 2020.
  6. Eroglu C and Barres BA. Regulation of synaptic connectivity by glia. Nature 2010;468:223–231. 
  7. Lodish H, et al. Molecular Biology 4th ed. New York: W. H. Freeman; Section 21.2. Online book available at http://www.ncbi.nlm.nih.gov/books/NBK21668/. Accessed July 2020.
  8. National Health and Nutrition Examination Survey (NHANES) 1999–2002. Centers for Disease Control and Prevention. In: Mean Body Weight, Height, and Body Mass Index United States 1960-2002.
  9. MS International Federation. What is MS? Available at: https://www.msif.org/about-ms/what-is-ms/. Accessed November 2020.
  10. Dunn SE, et al. Sex-based differences in multiple sclerosis (MS): Part II: Rising incidence of multiple sclerosis in women and the vulnerability of men to progression of this disease. Curr Top Behav Neurosci 2015;26:57–86.
  11. Brown JW, et al. Association of initial disease-modifying therapy with later conversion to secondary progressive multiple sclerosis. JAMA 2019;321(2):175–187.
  12. Word Health Organization. 2020. Healthy diet. Available at: https://www.who.int/news-room/fact-sheets/detail/healthy-diet. Accessed March 2020.
  13. Kappos L, et al. Relapse-associated worsening and progression independent of relapse activity in patients with relapsing multiple sclerosis in the phase III OPERA I and OPERA II studies. Poster presented at: the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS); 10–12 October 2018; Berlin, Germany. Poster P547.
  14. Trojano M, et al. The transition from relapsing-remitting MS to irreversible disability: clinical evaluation. Neurol Sci 2003;24(Suppl. 5):S268–S270.
  15. National MS Society. Secondary progressive multiple sclerosis. Available at:  https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Secondary-progressive-MS. Accessed May 2020.
  16. Tedeholm H, et al. Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs. Mult Scler 2013;19(6):765–774.
  17. MS Society of Canada. Primary Progressive MS. Available at: https://mssociety.ca/managing-ms/living-with-ms/progressive-ms. Accessed August 2020.
  18. Kutzelnigg A, et al. Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain 2005;128(11):2705–2712.
  19. National MS Society. Medications. Available at: https://stage.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-The-MS-Disease-Modifying-Medications.pdf. Accessed September 2020.
  20. MS Society of Canada. Symptoms. Available at: https://mssociety.ca/about-ms/symptoms. Accessed August 2020.
  21. Lizarraga AA, et al. Multiple sclerosis in 2019: predicting progression. Lancet Neurol 2020;19(1):12–14.
  22. Wiendl W and Meuth SG. Pharmacological approaches to delaying disability progression in patients with multiple sclerosis. Drugs 2015;75:947–77.
  23. Cinar BP and Yorgun YG. What we learned from the history of multiple sclerosis measurement: expanded disability status scale. Noro Psikiyatr Ars 2018;55(Suppl 1):S69–75.
  24. Stankiewicz JM, et al. An argument for broad use of high efficacy treatments in early multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2020;7:e636.
  25. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics 2013;10:97–105.
  26. Brownlee WJ, et al. Diagnosis of multiple sclerosis: progress and challenges. Lancet 2017;389:1336–46.
  27. Schulz D, et al. Cognition in the early stages of multiple sclerosis. J Neurol 2006;253:1002–10.
  28. White CP, et al. Invisible and visible symptoms of multiple sclerosis: Which are more predictive of health distress? J Neurosci Nurs 2008;40:85–95.
  29. Kasser SL, et al. Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships. Disabil Health J 2017;10:207–13.
  30. Gelfand JM. Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. Handb Clin Neurol 2014;122:269–90.
  31. Murphy KL, et al. Multiple sclerosis: Perspectives in treatment and pathogenesis, Chapter 4. 2017.
  32. Braley TJ and Chervin RD. Fatigue in multiple sclerosis: Mechanisms, evaluation, and treatment. Sleep 2010;33:1061–7.
  33. Beiske AG, et al. Pain and sensory complaints in multiple sclerosis. Eur J Neurol 2004;11:479–82.
  34. Davis SL, et al. Thermoregulatory dysfunction in multiple sclerosis. Handb Clin Neurol 2018;157:701–14.
  35. National MS Society. Dizziness and vertigo. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Dizziness-and-Vertigo. Accessed July 2020.
  36. de Silva RN, et al. Diagnosis and management of progressive ataxia in adults. Pract Neurol 2019;19:196–207.
  37. Hugos CL and Cameron MH. Assessment and measurement of spasticity in MS: State of the evidence. Curr Neurol Neurosci Rep 2019;19:79.
  38. Balci PB. Spasticity measurement. Arch Neuropsychiatry 2018;55:(Suppl 1):S49−53.
  39. Oreja-Guevara C, et al. Cognitive dysfunctions and assessments in multiple sclerosis. Frontier Neurol 2019;10:(581)1–9.
  40. Feenaughty L, et al. Speech and pause characteristics in multiple sclerosis: A preliminary stuy of speakers with high and low neuropsychological test performance. Clin Linguist Phon 2013;27:134–51.
  41. Merson RM and Rolnick MI. Speech-language pathology and dysphagia in multiple sclerosis. Phys Med Rehabil Clin N Am 1998;9:631–41.
  42. De Pauw A, et al. Dysphagia in multiple sclerosis. Clin Neurol Neurosurg 2002;104:345–51.
  43. National MS Society. Pain & Itching. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain. Accessed July 2020.
  44. Koch M, et al. Tremor in multiple sclerosis. J Neurol 2007;254:133–45.
  45. Schmidt EZ, et al. Sexuality in multiple sclerosis. J Neural Transm 2005;112;1201–11.
  46. Fletcher SG, et al. Sexual dysfunction in patients with multiple sclerosis: a multidisciplinary approach to evaluation and management. Nat Clin Pract Urol 2009;6:96–107.
  47. Sa MJ. Psychological aspects of multiple sclerosis. Clin Neurol Neurosurg 2008;110;868–77.
  48. Löffler LAK, et al. Emotional dysfunctions in neurodegenerative diseases. J Comp Neurol 2016;524:1727–43.
  49. Mahadeva A, et al. Urinary tract infections in multiple sclerosis: under-diagnosed and under-treated? A clinical audit at a large university hospital. Am J Clin Exp Immunol 2014;3:57–67.
  50. Hodge BH. The use of symptom diaries in outpatient care. Fam Pract Manag 2013;20:24–28.
  51. National MS Society. Working with your doctor. Available at: http://www.nationalmssociety.org/getmedia/41d32d7f-6da1-4919-93d5-187dd9d08a33/Volume6. Accessed July 2020.
  52. National MS Society. Cognitive Changes. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Cognitive-Changes. Accessed September 2020.
  53. Ben-Zacharia A, et al. Impact of shared decision making on disease-modifying drug adherence multiple sclerosis. Int J MS Care 2018; 20(6): 287–297.
  54. Wendrich, K et al. Toward digital self-monitoring of multiple sclerosis. Int J MS Care 2019; 21(6): 282–291.
  55. MS Society of Canada. Spasticity, Mobility Problems and Multiple Sclerosis. Available at: https://mssociety.ca/qc/Documentation/spasticity_web.pdf. Accessed August 2020.
  56. Smith PEM. If it’s not epilepsy. J Neurol Neurosurg Psychiatry 2001;70(Suppl II):ii9-ii14.
  57. Epilepsy.com. Clonic seizures. Available at: https://www.epilepsy.com/learn/types-seizures/clonic-seizures. Accessed July 2020.
  58. MS in focus. Spasticity in MS. Issue 12. Available at: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Documents/MS-in-focus-11-Spasticity-English.pdf. Accessed August 2020.
  59. NCBI Bookshelf. Characteristics and management of major symptoms – MS. Available at: https://www.ncbi.nlm.nih.gov/books/NBK222388/. Accessed July 2020.
  60. MS News Today. Need to know: How to manage MS leg spasticity. Available at: https://multiplesclerosisnewstoday.com/2019/01/10/leg-spasticity-manage-ms-need-to-know/. Accessed July 2020.
  61. Healthline. Open swim: Multiple sclerosis water therapy. Available at: https://www.healthline.com/health/multiple-water-therapy. Accessed July 2020.
  62. MedlinePlus. Caring for muscle spasticity or spasms Available at: https://medlineplus.gov/ency/patientinstructions/000063.htm. Accessed July 2020.
  63. Healthline. Everything you need to know about bladder spasms. Available at: https://www.healthline.com/health/bladder-spasms. Accessed July 2020.
  64. MS Society of Canada. Bladder dysfunction in MS. Available at: https://mssociety.ca/en/pdf/bladder-dysfunction.pdf. Accessed August 2020.
  65. Multiple Sclerosis Association of America. Bladder dysfunction. Available at: https://mymsaa.org/ms-information/symptoms/bladder-dysfunction/. Accessed July 2020.
  66. MS in focus. Bladder and bowel. Available at:https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Documents/MS-in-focus-24-Bladder-and-bowel-issues-English.pdf. Accessed August 2020.
  67. Namey M, et al. Elimination dysfunction in multiple sclerosis. Int J MS Care 2012;14(Suppl I):1–26. 
  68. Preziozi G, et al. Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies. Degener Neurol Neuromuscul Dis 2018:79–90.
  69. Jeyarajah S and Purkayastha S. Proctalgia fugax. CMAJ Practice 2013; 2013, 185(5) (appendix).
  70. Hertz R, et al. Multiple sclerosis presenting with facial twitching (myokymia and hemifacial spasms). Case Rep Neurol Med 2017;2017:7180560.
  71. Collazo IM and Tobin WO. Facial myokymia and hemifacial spasm in multiple sclerosis. The Neurologist 2018;23:1–6.
  72. Johns Hopkins. Blepharspasm. Available at: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/vestibular/conditions/blepharospasm.html#:~:text=Conditions%20We%20Treat%3A%20Blepharospasm&text=It%20is%20due%20to%20dystonia,lower%20face%20on%20that%20side. Accessed November 2020.
  73. Induruwa I, et al. Fatigue in multiple sclerosis – a brief review. J Neurol Sci 2012;323:9–15.
  74. NCBI. Characteristics and Management of Major Symptoms. Available at: https://www.ncbi.nlm.nih.gov/books/NBK222388/. Accessed July 2020.
  75. MS Society of Canada. Fatigue info sheet. Available at: https://mssociety.ca/library/document/rJfL1dpR3wsaAEvX284B5ITCnVQxy67S/original.pdf. Accessed August 2020.
  76. MS in focus. Fatigue and MS. Available at: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Documents/MS-in-focus-19-Fatigue-English.pdf. Accessed August 2020.
  77. Gümüş, H. Fatigue can be objectively measured in multiple sclerosis. Arch Neuropsychiatry 2018;55(Suppl 1):S76−79.
  78. Joy JE, et al. Institute of Medicine. Multiple sclerosis: Current status and strategies for the future. Washington, DC: The National Academies Press. 2001;177–240.
  79. WebMD. Fight MS fatigue. Available at: https://www.webmd.com/multiple-sclerosis/ms-fatigue. Accessed July 2020.
  80. Irish LA, et al. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev 2016;22:23–36.
  81. Simpson R, et al. Mindfulness based interventions in multiple sclerosis – a systemic review. BMC Neurol 2014;14:15.
  82. MS International Federation. Fatigue: an invisible symptom of MS. Available at: http://www.msif.org/wp-content/uploads/2020/04/MS-FATIGUE-BOOKLET-WEB.pdf. Accessed July 2020.
  83. Mulligan H, et al. Perceived impact of a self-management program for fatigue in multiple sclerosis. Int J MS Care 2016;18:27–32.
  84. Tur C, et al. Fatigue management in multiple sclerosis. Curr Treat Options Neurol 2016;18:26.
  85. WebMD. The benefits of cognitive therapy for MS. Available at: https://www.webmd.com/multiple-sclerosis/cognitive-therapy-benefits. Accessed August 2020.
  86. van Kessel K, et al. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med 2008;70:205–13.
  87. Shaygannejad V, et al. Comparison of the effect of aspiring and amantadine for the treatment of fatigue in multiple sclerosis: A randomized, blinded, crossover study. Neurol Res 2012;34:854–8.
  88. UpToDate. Approach to the adult patient with fatigue. Available at: https://www.uptodate.com/contents/approach-to-the-adult-patient-with-fatigue. Accessed November 2020.
  89. CCOHS. Fatigue. Available at: https://www.ccohs.ca/oshanswers/psychosocial/fatigue.html#:~:text=Acute%20fatigue%20results%20from%20short,is%20not%20relieved%20by%20rest. Accessed November 2020.
  90. MS International Federation. What is MS fatigue? Available at: http://www.msif.org/wp-content/uploads/2020/04/MS-FATIGUE-BOOKLET-WEB.pdf. Accessed November 2020.
  91. MS Society of Canada. Cognition and MS. Available at: https://mssociety.ca/library/document/LrvdiAzUK01SbsCcafFt938eQhNP2IJ7/original.pdf. Accessed August 2020.
  92. MS Society of Canada. Mood & cognition in MS: What You Can Do. Available at: https://www.mstrust.org.uk/life-ms/wellbeing/thinking-and-memory-problems https://mssociety.ca/uploads/files/mood-and-congition-in-ms-EN.pdf. Accessed August 2020.
  93. MS Society of Canada. Stress and multiple sclerosis. Available at: https://mssociety.ca/library/document/bl4nKmqMU28riIFkpvGzjdCVP9s3huRJ/original.pdf. Accessed August 2020.
  94. Thomas PW, et al. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev 2006;1:CD004431.
  95. Sumowski JF, et al. Cognition in multiple sclerosis. Neurology 2018;90:278–88.
  96. Perez-Martin MY, et al. Efficacy of short cognitive training program in patients with multiple sclerosis. Neuropsych Dis Treat 2017;13:245–52.
  97. Jonkman LE, et al. Gray matter correlates of cognitive performance differ between relapsing-remitting and primary-progressive multiple sclerosis. PLoS One 2015;10:e0129380.
  98. Cleveland Clinic. Multiple sclerosis (MS): Impaired cognition. Available at: https://my.clevelandclinic.org/health/diseases/14455-multiple-sclerosis-ms-impaired-cognition. Accessed July 2020.
  99. Lynch SG, et al. The association between cognitive impairment and physical disability in multiple sclerosis. Mult Scler 2005;11:469–76.
  100. VeryWellHealth. An overview of cognitive impairment in multiple sclerosis. Available at: https://www.verywellhealth.com/cognitive-impairment-in-ms-2440794. Accessed July 2020.
  101. DeLuca J, et al. Treatment and management of cognitive dysfunction in patients with multiple sclerosis. Nat Rev Neurol 2020;16,319–32.
  102. Healthline. Cog fog: How to deal with this frequent MS symptom. Available at:  https://www.healthline.com/health/multiple-sclerosis/cog-fog-science-and-tips#1. Accessed July 2020.
  103. Gal RL, et al. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev 2015;8:CD001430.
  104. Healthline. Coping with vision changes. Available at:  https://www.healthline.com/health/multiple-sclerosis/vision-disturbances#coping. Accessed August 2020.
  105. Healthline. Uhthoff’s phenomenon: Understanding overheating. Available at: https://www.healthline.com/health/multiple-sclerosis/uhthoffs-phenomenon. Accessed August 2020.
  106. National MS Society. Vision problems in multiple sclerosis. Available at: https://www.nationalmssociety.org/nationalmssociety/media/msnationalfiles/brochures/brochure-vision-problems.pdf. Accessed July 2020.
  107. MS Society of Canada. Programs and services: Disabled driver testing/retesting. Available at: https://mssociety.ca/support-services/programs-and-services/1153/disabled-driver-testingretesting. Accessed August 2020.
  108. Canadian Ophthalmological Society. Multiple sclerosis. Available at: https://www.cos-sco.ca/vision-health-information/conditions-disorders-treatments/neuroophthalmology/multiple-sclerosis/. Accessed August 2020.
  109. Cleveland Clinic. 4 Early warning signs of MS you shouldn’t ignore. Available at: https://health.clevelandclinic.org/4-early-signs-of-ms-you-shouldnt-ignore/. [accessed August 2020].
  110. Graves J and Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 2010;4:1409–22.
  111. Mayo Clinic. Multiple sclerosis. Available at: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269?p=1. Accessed July 2020.
  112. Adriana ID, et al. Management of diplopia. Romanian J Ophthalmol 2017;61:166–70.
  113. Jasse L, et al. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler 2013;19:1618–26.
  114. Serra A, et al. Eye movement abnormalities in multiple sclerosis: pathogenesis, modeling, and treatment. Front Neurol 2018;9:31.
  115. Niestroy A, et al. Neuro-ophthalmologic aspects of multiple sclerosis: Using eye movements as a clinical and experimental tool. Clin Ophthalmol 2007;1:267–72.
  116. Medscape. What is Nystagmus in Multiple Sclerosis? Available at: https://www.medscape.com/answers/1214270-166040/what-is-nystagmus-in-multiple-sclerosis-ms. Accessed July 2020.
  117. Hobson F and Rowe FJ. Management of nystagmus by surgery and botulinum toxin options: a review. Br Orthopt J 2009;6:28–33.
  118. Pula JH, et al. Diagnosis and treatment of visual disturbances in multiple sclerosis. Int J MS Care 2010;12:106–13.
  119. Healthline. Available at: https://www.healthline.com/health/kaleidoscope-vision Accessed July 2020.
  120. Kister I, et al. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain 2010;11:417–25.
  121. New Life Outlook. How common Is kaleidoscopic vision in people with MS? Available at: https://ms.newlifeoutlook.com/kaleidoscope-vision-multiple-sclerosis/ Accessed July 2020.
  122. Summit Medical Group. Vision, blind spot (scotoma). https://www.summitmedicalgroup.com/library/adult_health/oph_scotoma/ [accessed July 2020].
  123. Multiple Sclerosis Association of America. Visual Disorders. Available at:  https://mymsaa.org/ms-information/symptoms/visual-disorders/. Accessed August 2020.
  124. All About Vision. Ocular and visual migraines: What’s the difference? Available at: https://www.allaboutvision.com/en-ca/conditions/ocular-migraine/. Accessed August 2020.
  125. van Dongen RM and Haan J. Symptoms related to the visual system in migraine [version 1; peer review: 2 approved] F1000Res 2019;8:1219.
  126. Medical News Today. How does MS affect the eyes? Available at: https://www.medicalnewstoday.com/articles/325451. Accessed July 2020.
  127. Moss HE. Visual consequences of medications for multiple sclerosis: the good, the bad, the ugly, and the unknown. Eye Brain 2017;9:13–21.
  128. Panginikkod S, et al. Uhthoff phenomenon. NCIB Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470244/. Accessed October 2020.
  129.  
  130. National MS Society. Vision problems. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Vision-Problems#:~:text=In%20MS%2C%20diplopia%2C%20or%20double,muscles%20that%20allow%20eye%20movement. Accessed October 2020.
  131. Nystagmus Network. Treating nystagmus. Available at: https://nystagmusnetwork.org/what-is-nystagmus/treating-nystagmus/. Accessed October 2020.
  132. Cameron MH and Nilsagard Y. Balance, gait, and falls in multiple sclerosis. Handb Clin Neurol 2018;159:237–50.
  133. Ashizawa T and Guangbin X. Ataxia. Continuum (Minneap Minn) 2016;22:1208–26.
  134. Wilkins A. Cerebellar dysfunction in multiple sclerosis. Front Neurol 2017;28;8:312.
  135. Mayo Clinic. Ataxia. Available at: https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652?p=1. Accessed August 2020.
  136. Mount Sinai Hospital. MS Symptoms. Available at: https://www.mountsinai.on.ca/care/ebffrc/ms-symptoms. Accessed August 2020.
  137. WebMD. MS Drugs Compared. Available at: https://www.webmd.com/multiple-sclerosis/ms-drugs-comparison. Accessed August 2020.
  138. Vestibular Disorders Association. Labyrinthitis and Vestibular Neuritis. Available at: https://vestibular.org/labyrinthitis-and-vestibular-neuritis. Accessed August 2020.
  139. MS Society of Canada. Exercise and Physical Activity. https://mssociety.ca/hot-topics/exercise-and-physical-activity 1/12. Accessed August 2020.
  140. Hebert JR, et al. Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upgright postural control: A randomized controlled trial. Phys Ther 2011;91:1166–83.
  141. Hebert JR, et al. Efficacy of balance and eye-movement and eye-movement exercises for person with multiple sclerosis. Neurology 2018;27;90:e797–807.
  142. Carling A, et al. Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study. Physiother Res Int 2018;23:e1728.
  143. Carling A, et al. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled piloty study. Mult Scler 2017;23:1394–404.
  144. National MS Society. Yoga and MS. Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Exercise/Yoga. Accessed July 2020.
  145. MedFitNetwork. Why do yoga if you have multiple sclerosis? Available at: https://medfitnetwork.org/public/all-mfn/yoga-multiple-sclerosis/. Accessed July 2020.
  146. Cohen ET, et al. Feasibility and impact of an 8-week integrative yoga program in people with moderate multiple sclerosis-related disability. Int J MS Care 2017;19:30–39.
  147. Brichetto G, et al. The effect of Nintendo® Wii® on balance in people with multiple sclerosis: a pilot randomized control study. Mult Scler J 2013;19:1219–21.
  148. Prosperini L, et al. Home-based balance training using the Wii balance board: A randomized, crossover pilot study in multiple sclerosis. Neurorehabil Neural Repair 2013;27:516–25.
  149. Ozkul C, et al. Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial. Eur J Integr Med 2020;35:101092.
  150. Maggio MG, et al. Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes. J Clin Neurosci 2019;65:106–11.
  151. MS Society of Canada. Rehabilitation. Available at: https://mssociety.ca/managing-ms/living-with-ms/ms-care/rehabilitation-in-ms. Accessed August 2020.
  152. Frohman EM, et al. Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Mult Scler J 2003;9:250–55.
  153. Johns Hopkins Medicine. Benign paroxysmal positional vertigo (BPPV). Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv. Accessed July 2020.
  154. Verywell Health. An overview of vertigo in MS. Available at: https://www.verywellhealth.com/vertigo-in-multiple-sclerosis-2440805 [accessed July 2020].
  155. Merck Manuals. Dizziness & vertigo. Available at: https://www.merckmanuals.com/en-ca/home/ear,-nose,-and-throat-disorders/symptoms-of-ear-disorders/dizziness-and-vertigo. Accessed August 2020.
  156. NCBI. Characteristics and Management of Major Symptoms. Available at: https://www.ncbi.nlm.nih.gov/books/NBK222388/. Accessed July 2020.
  157. Truini A, et al. A mechanism-based classification of pain in multiple sclerosis. J Neurol 2013;260:351–67.
  158. Zadeh AR, et al. Mechanism and adverse effects of multiple sclerosis drugs: a review article. Part 2. Int J Physiol Pathophysiol Pharmacol 2019;11:105–14.
  159. NIH. Peripheral neuropathy fact sheet. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet. Accessed July 2020.
  160. National MS Society. Pain & itching. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain. Accessed August 2020.
  161. Foley PL, et al. Prevalence and natural history of pain in adults with multiple sclerosis: Systemic review and meta-analysis. Pain 2013;154:632–42.
  162. Gebhardt M, et al. Headache in the first manifestation of multiple sclerosis – prospective, multicenter study. Brain Behav 2017;7:e00852.
  163. Zagon IS and McLaughlin PJ. Multiple sclerosis. Perspectives in treatment and pathogenesis. Brisbane: Codon Publications; 2017.
  164. Spine Health. Cold and heat therapy for sciatica. Available at: https://www.spine-health.com/conditions/sciatica/cold-and-heat-therapy-sciatica. Accessed July 2020.
  165. Monro R, et al. Disc extrusions and bulges in nonspecific low back pain and sciatica: Exploratory randomised controlled trial comparing yoga therapy and normal medical treatment. J Back Musculoskelet Rehabil 2015;28:383–92.
  166. VeryWellHealth. An Overview of headaches in MS. Available at: https://www.verywellhealth.com/headaches-in-multiple-sclerosis-2440798. Accessed July 2020.
  167. MedicalNewsToday. What is Lhermitte’s sign?. Available at: https://www.medicalnewstoday.com/articles/323889#causes-of-lhermittes-sign. Accessed August 2020.
  168. Stefano GD, et al. Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options. J Headache Pain 2019;20:20.
  169. Shayestehazar M, et al. A survey of severity and distribution of musculoskeletal pain in multiple sclerosis patients; a cross-sectional study. Arch Bone Jt Surg 2015;3:114–18.
  170. O’Connor AB, et al. Pain associated with multiple sclerosis: Systemic review and proposed classification. Pain 2008;137:96–111.
  171. VeryWellHealth. The MS hug. Available at: https://www.verywellhealth.com/multiple-sclerosis-hug-2440802. Accessed July 2020.
  172. MS International Federation. MS pain. Available at: https://www.msif.org/about-ms/symptoms-of-ms/pain/. Accessed July 2020.
  173. Luwimi IA, et al. Pathophysiology of Paresthesia. Paresthesia. InTech; 2012.
  174. VeryWellHealth. What does MS pain feel like? Available at: https://www.verywellhealth.com/overview-of-pain-as-a-symptom-of-multiple-sclerosis-2440808. Accessed July 2020.
  175. National MS Society. Acupuncture. Available at: https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Acupuncture. Accessed August 2020.
  176. National MS Society. Massage and bodywork. Available at: https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Massage-and-Body-Work. Accessed August 2020.
  177. Adamec I, et al. Erythromelalgia as a manifestation of autonomic nervous ystem involvement in multiple sclerosis. Mult Scler Relat Disord 2016;8:1–3.
  178. Halabchi F, et al. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol 2017;17:185.
  179. WebMD. When should I use heat or ice for pain? Available at: https://www.webmd.com/pain-management/when-use-heat-ice#1. Accessed July 2020.
  180. Galey T, et al. Sensory abnormalities in MS: Patient descriptions of “macrosomic illusions”. Int J MS Care 2004;4:144–7.
  181. Medical News Today. MS hug: What you Need to Know. Available at: https://www.medicalnewstoday.com/articles/320146. Accessed July 2020.
  182. Very Well Health. The Multiple Sclerosis ‘Hug’. Available at: https://www.verywellhealth.com/multiple-sclerosis-hug-2440802. Accessed July 2020.
  183. National MS Society. Pain & Itching. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain. Accessed August 2020.
  184. Ju ZY, et al. Acupuncture for neuropathic pain in adults (review). Cochrane Database Syst Rev 2017(12): CD012057.
  185. Miller L, et al. The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler J 2007;13: 527–33.
  186. National MS Society. Acupuncture. Available at: https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Acupuncture. Accessed August 2020.
  187. Zagon IS and McLaughlin PJ. Multiple sclerosis. Perspectives in treatment and pathogenesis. Brisbane: Codon Publications; 2017.
  188. WebMD. Steroids for MS Flares. Available at: https://www.webmd.com/multiple-sclerosis/treating-iv-steroids. Accessed October 2020.
  189. Powell DJH, et al. Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights. J Behav Med 2017;40:772–83.
  190. Schumacher GA, et al. Problems of experimental trails of therapy in multiple sclerosis: Report by the panel on the evaluation of experimental trials of therapy in multiple sclerosis. Ann N Y Acad Sci 1965;122:552–68.
  191. Garg N, Smith TW. An update on immunopathogenesis, diagnosis, and treatment of multiple sclerosis. Brain Behav 2015;5:e00362.
  192. Lovblad KO, et al. MR imaging in multiple sclerosis: Review and recommendations for current practice. AJNR Am J Neuroradiol 2010;31:983–89.
  193. Chiappa KH. Pattern-shift visual, brainstem auditory and short-latency somatosensory evoked potentials in multiple sclerosis. Neurology 1980;30:110–23.
  194. Engelborghs S, et al. Consensus guidelines for lumbar puncture in patients with neurological diseases. Alzheimers Dement (Amst) 2017;8:111–126.
  195. Merck Manuals. Multiple sclerosis (MS). Available at: https://www.merckmanuals.com/en-ca/home/brain-spinal-cord-and-nerve-disorders/multiple-sclerosis-ms-and-related-disorders/multiple-sclerosis-ms#. Accessed July 2020.
  196. Scolding N. The differential diagnosis of multiple sclerosis. J Neurol Neurosurg Psychiatry 2001;71:ii9–15.
  197. Kale N. Optic neuritis as an early sign of multiple sclerosis. Eye Brain 2016;8:195–202.
  198. The Canadian Association of Optometrists. Comprehensive eye exams: Vital for more than just your vision. Available at: https://opto.ca/health-library/comprehensive-eye-exams-vital-for-more-than-just-your-vision. Accessed July 2020.
  199. Polman CH, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292–302.
  200. Thompson AJ, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17:162–73.
  201. Medina LD, et al. Patient-reported outcomes in multiple sclerosis: Validation of the quality of life in neurological disorders (Neuro-QoL™) short forms. Mult Scler J Exp Transl Clin 2019:5:1–11.
  202. Learmonth YC, et al. Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis. BMC Neurol 2013;13:37.
  203. Institute for Quality and Efficiency in Health Care (IQWiG). What happens during a neurological examination? Available at: https://www.ncbi.nlm.nih.gov/books/NBK348940/. Accessed June 2020.
  204. Neurological Advisor. In multiple sclerosis, hand strength may indicate disease status. Available at: https://www.neurologyadvisor.com/conference-highlights/cmsc-2017/in-multiple-sclerosis-hand-strength-may-indicate-disease-status/. Accessed June 2020.
  205. Healthline. What’s the connection between MS and optic neuritis? Available at: https://www.healthline.com/health/multiple-sclerosis/optic-neuritis  [accessed June 2020]
  206. MS Society of Canada. Takeaways from the Canadian MS Working Group 2020 Treatment Optimization Recommendations. Available at: https://mssociety.ca/takeaways-from-the-canadian-ms-working-group-2020-treatment-optimization-recommendations. Accessed July 2020.
  207. Healthline. Why an MRI is Used to Diagnose Multiple Sclerosis. Available at: https://www.healthline.com/health/multiple-sclerosis/images-brain-mri. Accessed July 2020.
  208. Ontario’s MRI and CT Expert Panel. Ontario Best Practice Guidelines for Managing the Flow of Patients Requiring an MRI or CT Examination. Available at: https://collections.ola.org/mon/23006/292809.pdf. Accessed July 2020.
  209. MS Society of Canada. Diagnosis. Available at: https://mssociety.ca/about-ms/diagnosing-ms. Accessed June 2020.
  210. Palace J. Making the diagnosis of multiples sclerosis. J Neurol Neurosurg Psychiatry 2001;71(Suppl II):ii3–8.
  211. Johns Hopkins Medicine. Sensory evoked potentials studies. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sensory-evoked-potentials-studies. Accessed June 2020.
  212. WebMD. Multiple sclerosis and evoked potential tests. Available at: https://www.webmd.com/multiple-sclerosis/evoked-potential-tests. Accessed July 2020.
  213. Pokryszko-Dragan A. Assessment of visual and auditory evoked potentials in multiple sclerosis with and without fatigue. Neurol Sci 2015; 36:235–242.
  214. Sunnybrook health sciences centre. Frequently asked questions: EEG & EP. Available at: https://sunnybrook.ca/content/?page=bsp-eeg-esp-faq. Accessed July 2020.
  215. Sakka L, et al. Anatomy and physiology of cerebrospinal fluid. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:309–16.
  216. Mayo Clinic. Lumbar puncture (spinal tap). Available at: https://www.mayoclinic.org/tests-procedures/lumbar-puncture/about/pac-20394631?p=1. Accessed July 2020.
  1. Paty DW, et al. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. Neurology 1993;43:662–7.
  2. Giovannoni G, et al. Brain health: Time matters in multiple sclerosis. Mult Scler Relat Disord 2016;9(Suppl 1):S5–48.
  3. Stankiewicz JM, et al. An argument for broad use of high efficacy treatments in early multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2020;7:e636.
  4. MS Society of Canada. Treatments. Available at: https://mssociety.ca/managing-ms/treatments/medications. Accessed May 2020.
  5. MS Society of Canada. Symptom management. Available at: https://mssociety.ca/managing-ms/treatments/medications/symptom-management. Accessed August 2020.
  6. MS Society of Canada. Rehabilitation. Available at: https://mssociety.ca/managing-ms/living-with-ms/ms-care/rehabilitation-in-ms [accessed August 2020]
  7. MS Society of Canada. Disease-modifying therapies. Available at: https://mssociety.ca/managing-ms/treatments/medications/disease-modifying-therapies-dmts. Accessed May 2020.
  8. National MS Society. Managing relapses. Available at: https://www.nationalmssociety.org/Treating-MS/Managing-Relapses. Accessed October 2020.
  9. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics 2013;10:97–105.
  10. Burks JS, et al. Rehabilitation challenges in multiple sclerosis. Ann Indian Acad Neurol 2009;12:296–306.
  11. Murphy R, et al. Neuropsychiatric syndromes of multiple sclerosis. J Neurol Neurosurg Psych 2017;88:697–708.
  12. Ben-Zacharia A, et al. Impact of shared decision making on disease-modifying drug adherence multiple sclerosis. Int J MS Care 2018; 20(6):287–297.
  13. National MS Society. Adherence. Available at: https://www.nationalmssociety.org/Treating-MS/Medications/Adherence. Accessed May 2020.
  14. Cohen BA, et al. Therapy optimization in multiple sclerosis: A cohort study of therapy adherence and risk of relapse. Mult Scler Relat Disord 2015;4:75–82.
  15. Hupperts R, et al. The STAR study: A real-world, international, observational study of the safety and tolerability of, and adherence to, serum-free subcutaneous interferon β-1a in patients with relapsing multiple sclerosis. Clin Ther 2014;36:1946–57.
  16. MS Society of Canada. Working with your MS healthcare team. Available at: https://mssociety.ca/managing-ms/living-with-ms/ms-care/working-with-your-ms-healthcare-team. Accessed August 2020.
  1. National MS Society. Research & news progress. Available at: https://www.nationalmssociety.org/Research/Research-News-Progress. Accessed August 2020.
  2. MS Society of Canada. Wellness & lifestyle. Available at: https://mssociety.ca/managing-ms/living-with-ms/wellness-and-lifestyle. Accessed July 2020.
  3. MS Society of Canada. Exercise and physical activity. Available at: https://mssociety.ca/hot-topics/exercise-and-physical-activity?query=mental%20health. Accessed July 2020.
  4. Canadian Society for Exercise Physiology (CSEP). Canadian physical activity guidelines. Available at: https://csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_0-65plus_en.pdf. Accessed August 2020.
  5. Government of Canada. Physical activity and your health. Available at: https://www.canada.ca/en/public-health/services/being-active/physical-activity-your-health.html. Accessed August 2020.
  6. Canadian Physiotherapy Association (CPA). 2012 Description of physiotherapy in Canada. Available at: https://physiotherapy.ca/sites/default/files/site_documents/dopen-en.pdf. Accessed August 2020.
  7. National MS Society. Rehabilitation. Available at: https://www.nationalmssociety.org/Treating-MS/Rehabilitation#section-1. Accessed August 2020.
  8. MS Society of Canada. Rehabilitation. Available at: https://mssociety.ca/managing-ms/living-with-ms/ms-care/rehabilitation-in-ms. Accessed August 2020.
  9. National MS Society. Heat and temperature sensitivity. Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Heat-Temperature-Sensitivity. Accessed August 2020.
  10. MS Society of Canada. Symptoms. Available at: https://mssociety.ca/about-ms/symptoms. Accessed August 2020.
  11. National MS Society. Building better balance. Available at: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Resources_Support/Effect-of-MS-on-Balance.pdf. Accessed August 2020.
  12. National MS Society. A resource for healthcare professionals: physical therapy in multiple sclerosis. Available at: http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Clinical_Bulletin_Physical-Therapy-in-MS-Rehabilitation.pdf. Accessed August 2020.
  13. Carling A, et al. Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study. Physiother Res Int 2018;23:e1728.
  14. Carling A, et al. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled piloty study. Mult Scler J 2017;23:1394–404.
  15. Hebert JR, et al. Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upgright postural control: A randomized controlled trial.  Neurology 2018;90:e797–807.
  16. Hebert JR, et al. Efficacy of balance and eye-movement and eye-movement exercises for person with multiple sclerosis.  Phys Ther 2011;91:1166–83.
  17. MS Society of Canada. Physical Activity Guide for People With MS. MS Society of Canada Web site. Available at: https://mssociety.ca/library/document/qR3n1N5M2hYdsUx4TOrIzAm8lQ0XDZVp/original.pdf. Accessed August 2020.
  18. Carling A, et al. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled piloty study.  Mult Scler J 2017 (Appendix);23:1394–404.
  19. Nilsagård YE, et al. Balance exercise program reduced falls in people with multiple sclerosis: A single-group, pretest-posttest trial. Arch Phys Med Rehabil 2014;95:2428–34.
  20. The Mayo Clinic. Fitness. Available at: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670?p=1. Accessed August 2020.
  21. MS Society of Canada. Physical Activity Guide for People with MS. Available at: https://mssociety.ca/library/document/qR3n1N5M2hYdsUx4TOrIzAm8lQ0XDZVp/original.pdf. Accessed August 2020.
  22. National MS Society. Yoga and MS. Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Exercise/Yoga. Accessed August 2020.
  23. Government of Canada. Canada’s Food Guide: Section 1. Available at: https://food-guide.canada.ca/en/guidelines/section-1-foundation-for-healthy-eating/. Accessed August 2020.
  24. MS Society of Canada. Diet. https://mssociety.ca/hot-topics/diet?gclid=EAIaIQobChMIpYfS-66H6wIVMxh9Ch2mXwzYEAAYASAAEgK7p_D_BwE. Accessed August 2020.
  25. Government of Canada. Canada’s Food Guide: Section 2. Available at: https://food-guide.canada.ca/en/guidelines/section-2-foods-and-beverages-that-undermine-healthy-eating/. Accessed March 2020.
  26. Tryfonos C, et al. Dietary supplements on controlling multiple sclerosis symptoms and relapses: Current clinical evidence and future perspectives. Medicines 2019;6:95.
  27. Sand IK, et al. The role of diet in multiple sclerosis: Mechanistic connections and current evidence. Curr Nutr Rep 2018;7:150–60.
  28. Evans E, et al. An overview of the current state of evidence for the role of specific diets in multiple sclerosis. Mult Scler Relat Disord 2019;36:101393.
  29. Chenard CA, et al. Nutrient composition comparison between the low saturated fat Swank diet for multiple sclerosis and healthy U.S.-style eating pattern. Nutrients 2019;11:616.
  30. Wahls T, et al. Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial. Trials 2018;19:309.
  31. Yadav V, et al. Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial. Mult Scler Relat Disord 2016;9:80–90.
  32. Sand IK, et al. Randomized-controlled trial of a modified Mediterranean dietary program for multiple sclerosis: A pilot study. Mult Scler Relat Disord 2019;36:101403.
  33. WebMD. Do multiple sclerosis and alcohol mix (page 1)? Available at: https://www.webmd.com/multiple-sclerosis/features/do-ms-alcohol-mix#1. Accessed March 2020.
  34. WebMD. Do multiple sclerosis and alcohol mix (page 2)? Available at: https://www.webmd.com/multiple-sclerosis/features/do-ms-alcohol-mix#2. Accessed March 2020.
  35. Alcohol.org. Alcohol and slurred speech. Available at: https://www.alcohol.org/effects/slurred-speech/. Accessed June 2020.
  36. McKay KA, et al. Adverse health behaviours are associated with depression and anxiety in multiple sclerosis: A prospective multisite study. Mult Scler J 2016;22:685–93.
  37. Murphy R, et al. Neuropsychiatric syndromes of multiple sclerosis. J Neurol Neurosurg Psychiatry 2017;88:697–708.
  38. Quesnel S and Feinstein A. Multiple sclerosis and alcohol: A study of problem drinking. Mult Scler 2004;10:197–201.
  39. MS Society of Canada. Employers guide. Available at: https://mssociety.ca/en/pdf/EmployersGuide.pdf. Accessed August 2020.
  40. Leslie M, et al. Patterns in workplace accommodations for people with multiple sclerosis to overcome cognitive and other disease-related limitations. Neuro Rehabilitation 2015;37:425–36.
  41. Government of Canada. Employment equity. Available at: https://www.canada.ca/en/employment-social-development/programs/employment-equity.html. Accessed June 2020.
  42. Kasser SL, et al. Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships. Disabil Health J 2017;10:207–13.
  43. Powell DJH, et al. Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights. J Behav Med 2017;40:772–83.
  44. WebMD. Can you still work with MS? Available at: https://www.webmd.com/multiple-sclerosis/ms-and-work. Accessed June 2020.
  45. Indeed.com. 10 Questions to ask yourself before applying for a job. Available at: https://www.indeed.com/career-advice/finding-a-job/questions-to-ask-before-applying-for-a-job. Accessed June 2020.
  46. National MS Society. Successful job interviewing. Momentum Magazine 2008. Available at:  https://www.nationalmssociety.org/Programs-and-Services/Resources/Successful-Job-Interviewing-(-pdf)?page=1&orderby=3&order=asc. Accessed June 2020.
  47. MS Society of Canada. Talking about MS with employers. Available at: https://mssociety.ca/managing-ms/newly-diagnosed/talking-about-ms/employers#:~:text=Talking%20About%20MS%20With%20Employers,are%20asking%20for%20job%20accommodation. Accessed June 2020.
  48. Schneiderman N, et al. Annu Rev Clin Psychol 2005;1:607–28.
  49. National MS Society. Taming stress in multiple sclerosis. Available at: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Taming-Stress.pdf. Accessed May 2020.
  50. MS Society of Canada. Rehabilitation. Available at: https://mssociety.ca/managing-ms/living-with-ms/ms-care/rehabilitation-in-ms. Accessed August 2020.
  51. American Psychological Association. Coping with stress at work. Available at: http://www.apa.org/helpcenter/work-stress. Accessed May 2020.
  52. WHSC. Work Stress. Available at: https://www.whsc.on.ca/Files/What-s-New/Work-Stress_WHSC-Resource-Line.aspx. Accessed June 2020.
  53. National MS Society. Fatigue. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Fatigue. Accessed May 2020.
  54. Multiple Sclerosis Association of America. Fatigue. Available at: https://mymsaa.org/ms-information/symptoms/fatigue/. Accessed May 2020.
  55. MS Society of Canada. Talking about MS with employers. Available at: https://mssociety.ca/managing-ms/newly-diagnosed/talking-about-ms/employers. Accessed April 2020.
  56. National MS Society. Whom should I tell? Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Work-and-Home/Employment/Disclosure-Decisions/Whom-Should-I-tell. Accessed May 2020.
  57. MS Society of Canada. Employers guide. Available at: https://mssociety.ca/en/pdf/EmployersGuide.pdf. Accessed August 2020.
  58. MS Society of Canada. Fatigue info sheet. Available at: https://mssociety.ca/library/document/rJfL1dpR3wsaAEvX284B5ITCnVQxy67S/original.pdf. Accessed August 2020.
  59. Nilsagard Y and Bostrom B. Informing the children when a parent is diagnosed as having multiple sclerosis. Int J MS Care 2015;17:42–8.
  60. Petrikis P, et al. Quality of life and emotional strain in caregivers of patients with multiple sclerosis. J Clin Neurol. 2019;15:77–83.
  61. Foley FW and Beier M. Assessment and treatment of sexual dysfunction in multiple sclerosis. Available at: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Clinical_Bulletin_Sexual-Dysfunction-in-MS.pdf. Accessed May 2020.
  62. MS in focus: Special focus on the family. Issue 3. Available at: https://www.msif.org/wp-content/uploads/2014/09/MS-in-focus-3-Family-English.pdf. Accessed June 2020.
  63. Young CA, et al. Sexual functioning in multiple sclerosis: Relationships with depression, fatigue and physical function. Mult Scler 2017;23:1268–75.
  64. MS International Federation. Family life. Available at: https://www.msif.org/living-with-ms/family-life/. Accessed May 2020.
  65. National MS Society. Relationships. Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Relationships. Accessed May 2020.
  66. Foley FW, et al. Rehabilitation of intimacy and sexual dysfunction in couples with multiple sclerosis. Mult Scler 2001;7:417–21.
  67. Schmidt EZ, et al. Sexuality in multiple sclerosis. J Neural Transm 2005;112:1201–11.
  68. Domingo S, et al. Factors associated with sexual dysfunction in individuals with multiple sclerosis. Int J MS Care 2018;20:191–7.
  69. Balsamo R, et al. Increased risk of erectile dysfunction in men with multiple sclerosis: an Italian cross-sectional study. Cent European J Urol 2017;70:289–95.
  70. Döring A, et al. Exercise in multiple sclerosis – an integral component of disease management. EPMA J 2011;3:2.
  71. Sa MJ. Psychological aspects of multiple sclerosis. Clin Neurol Neurosurg 2008;110:868–77.
  72. Koch T, et al. Constructions of sexuality for women living with multiple sclerosis. J Adv Nurs 2002;39:137–45.
  73. Dobson R, et al. UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines. Pract Neurol 2019;19:106–14.
  74. MS Society of Canada. Pregnancy. Available at: https://mssociety.ca/managing-ms/womens-health/pregnancy. Accessed June 2020.
  75. Michel L, et al. Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatry 2012;83:796–802.
  76. Alirezaei S, Ozgoli G, et al. Evaluation of factors associated with sexual function in infertile women. Int J Fertil Steril 2018;12:125–9.
  77. John Hopkins Medicine. Multiple sclerosis and pregnancy. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms/multiple-sclerosis-and-pregnancy. Accessed May 2020.
  78. Bove R and Gilmore W. Hormones and MS: Risk factors, biomarkers, and therapeutic targets. Mult Scler J 2018;24:17–21.
  79. Confavreux C, et al. Rate of pregnancy-related relapse in multiple sclerosis. N Engl J Med 1998;339:285–91.
  80. Giovannoni G, et al. MS Brain Health: Time matters in multiple sclerosis. Available at: http://msbrainhealth.org/perch/resources/time-matters-in-ms-report-may16.pdf. Accessed June 2020.
  81. MS International Federation. Childhood MS a guide for parents. Available at: https://www.msif.org/wp-content/uploads/2016/06/Childhood-MS-A-Guide-for-Parents-email-version.pdf. Accessed June 2020.
  82. National MS Society. Pediatric MS. Available at: https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS/Pediatric-MS. Accessed May 2020.
  83. Silva P. Canadian study of MS-prone family proves that in rare cases, multiple sclerosis is inherited. Available at: https://multiplesclerosisnewstoday.com/2017/04/21/ms-study-canadian-family-mutations-proves-multiple-sclerosis-inhe/. Accessed June 2020.
  84. Westerlind H. Modest familial risks for multiple sclerosis: A registry-based study of the population of Sweden. Brain 2014;137:770–8.
  85. US National Library of Medicine. Multiple sclerosis. Available at:https://ghr.nlm.nih.gov/condition/multiple-sclerosis#inheritance. Accessed June 2020.
  86. National MS Society. What causes MS. Available at: https://www.nationalmssociety.org/What-is-MS/What-Causes-MS#section-4. Accessed June 2020.
  87. Great Ormond Street Hospital. Multiple sclerosis: information for families. Available at: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/multiple-sclerosis. Accessed June 2020.
  88. Murphy R, et al. Neuropsychiatric syndromes of multiple sclerosis. J Neurol Neurosurg Psychiatry 2017;88:697–708.
  89. Johns Hopkins Medicine. Multiple Sclerosis and mental health: 3 common challenges. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms/multiple-sclerosis-and-mental-health-3-common-challenges. Accessed July 2020.
  90. Marrie RA, et al. Estimating annual prevalence of depression and anxiety disorder in multiple sclerosis using administrative data. BMC Res Notes 2017;10:619–625.
  91. Chwastiak LA and Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin North Am 2007;30:803–817.
  92. Healthline. Advancing MS: Coping with depression, stress, and anger. Available at: https://www.healthline.com/health/multiple-sclerosis/depression-stress-anger. Accessed July 2020.
  93. Mayo Clinic. Managing depression in MS. Available at: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/managing-depression-in-ms/faq-20111498. Accessed July 2020.
  94. Mayo Clinic. Managing anxiety in MS: What works? Available at: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/managing-anxiety-in-ms/faq-20112504. Accessed July 2020.
  95. WebMD. The benefits of cognitive therapy for MS. Available at: https://www.webmd.com/multiple-sclerosis/cognitive-therapy-benefits. Accessed July 2020.
  96. Hind D, et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: A systemic review and meta-analysis. BMC Psychiatry 2014;14:5.
  97. Kiropoulos LA, et al. A pilot randomized controlled trial of a tailored cognitive behvaioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis. BMC Psychiatry 2016;16:435.
  98. MS Society of Canada. Programs and services – community mental health agencies. Available at: https://mssociety.ca/support-services/programs-and-services/953/mental-health. Accessed July 2020.
  99. MS Society of Canada. Mental health helpline. https://mssociety.ca/support-services/programs-and-services/1150/mental-health-helpline. Accessed July 2020.
  100. CAMH. Anxiety medication. Available at: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/anti-anxiety-medications-benzodiazepines. Accessed December 2020.
  101. CAMH. Anxiety disorders. Available at: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/anxiety-disorders. Accessed July 2020.
  102. Anxiety Canada. Social anxiety disorder. Available at: https://www.anxietycanada.com/disorders/social-anxiety-disorder/. Accessed July 2020.
  103. Butler E, et al. A systemic review of anxiety amongst people with multiple sclerosis. Mult Scler Relat Disord 2016;10:145–68.
  104. Anxiety Canada. Understanding panic attacks. Available at: https://www.anxietycanada.com/articles/understanding-panic-attacks. Accessed July 2020.
  105. CAMH. Anti-anxiety medications. Available at: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/anti-anxiety-medications-benzodiazepines. Accessed July 2020.
  106. Henry A, et al. Anxiety and depression in patients with multiple sclerosis: The mediating effects of perceived social support. Mult Scler Relat Disord 2019;27:46–51.
  107. Freeman D, et al. The effects of improving sleep on mental health (OASIS): A randomised controlled trial with mediation analysis. Lancet Psychiatry 2017;4:749–58.
  108. Magnavita N and Garbarino S. Sleep, health and wellness at work: A scoping review. Int J Environ Res Public Health 2017;14:1347.
  109. MS Society Canada. Programs and services. https://mssociety.ca/support-services/programs-and-services/1150/mental-health-helpline. Accessed May 2020.
  110. Freeman J, et al. “A non-person to the rest of the world”: Experiences of social isolation amongst severely impaired people with multiple sclerosis. Disabil Rehabil 2019;18:1–9.
  111. MS Society of Canada. Peer Support Groups. Available at: https://mssociety.ca/support-services/programs-and-services/support-and-self-help-groups. Accessed July 2020.
  112. MS Society of Canada. Friendly Visiting. https://mssociety.ca/support-services/friendly-visiting. Accessed July 2020.
  113. Fasczewski KS, et al. I ride for MS: The impact of bike MS participation on motivation for physical activity in individuals with multiple sclerosis. Disabil Health J 2020;13:100853.
  114. Shavazi MA, et al. Online social support for patients with multiple sclerosis: A thematic analysis of messages posted to a virtual support community. Int J Community Based Nurs Midwifery 2016;4:188–98.
  115. MS Society of Canada. Information and resources. Available at: https://mssociety.ca/support-services/caregivers/information-and-resources. Accessed July 2020.
  116. MS Society of Canada. MS knowledge network. Available at: https://mssociety.ca/support-services/ms-knowledge-network. Accessed July 2020.
  117. MS Society of Canada. Find services in your area. Available at: https://mssociety.ca/support-services/programs-and-services. Accessed July 2020.
  118. MS Society Canada. Support services. Available at: https://mssociety.ca/support-services. Accessed May 2020.