Multiple Sclerosis: Neurological Care Beyond DMTs
Disease-modifying therapies reduce relapse frequency. They do not address the mitochondrial dysfunction, oxidative damage, or metabolic depletion that drive fatigue, cognitive decline, and disease progression in MS. We treat the biology that DMTs leave behind.
Available at our St. Marys, Georgia clinic.
The Biology DMTs Don’t Reach
Multiple sclerosis is an autoimmune disease in which the immune system attacks myelin—the insulating sheath that wraps nerve fibers in the brain and spinal cord. When myelin is destroyed, electrical signals between neurons slow down or fail entirely. The result is a progressive loss of motor function, sensation, vision, and cognition that varies from patient to patient depending on where the demyelination occurs.
Disease-modifying therapies represent a genuine advance in MS care. Drugs like ocrelizumab, natalizumab, and fingolimod reduce relapse rates and slow the accumulation of new lesions on MRI. But they operate primarily by suppressing or redirecting the immune system. They do not repair damaged myelin. They do not restore mitochondrial function in energy-depleted neurons. They do not address the oxidative stress that continues to erode cellular health between relapses.
This is why many MS patients plateau. Their relapse frequency drops, their MRI stabilizes, and yet their fatigue persists, their cognition continues to decline, and their functional capacity erodes year over year. A 2019 study by Lassmann published in Acta Neuropathologica demonstrated that mitochondrial injury in demyelinated axons is a primary driver of progressive neurodegeneration in MS—a process that occurs independently of acute inflammatory relapses.
The energy crisis is measurable. Demyelinated axons require significantly more ATP to maintain signal conduction, yet the mitochondria within those axons are themselves damaged by the inflammatory environment. Mahad et al. (2015, published in the Lancet Neurology) described this as a “virtual hypoxia”—neurons starved for energy not because oxygen supply is inadequate, but because the mitochondrial machinery that converts oxygen into ATP has been compromised. When this energy deficit becomes severe enough, axons degenerate permanently. No DMT currently addresses this mechanism.
What Adjunctive Metabolic Support Looks Like
Our approach to MS does not replace your neurologist or your DMT. It fills the treatment gap that DMTs leave open. We target the metabolic, oxidative, and regenerative dimensions of the disease—the ones that determine how a patient feels and functions day to day, even when their MRI looks stable.
NAD+ intravenous therapy addresses the mitochondrial energy deficit directly. Nicotinamide adenine dinucleotide is the central coenzyme in the electron transport chain, and its availability determines how efficiently mitochondria produce ATP. In MS patients, chronic inflammation depletes NAD+ reserves through excessive PARP activation—the same DNA repair enzyme that consumes NAD+ as substrate. IV NAD+ restores the pool and allows mitochondria to resume efficient energy production. Research by Gerdts et al. (2015, published in Science) demonstrated that NAD+ depletion is a critical trigger for axonal degeneration and that maintaining NAD+ levels protects against it.
Glutathione IV therapy targets oxidative stress. Glutathione is the brain’s primary endogenous antioxidant, and its levels are measurably depleted in MS patients. Choi et al. (2018, published in Redox Biology) showed that glutathione depletion in the central nervous system correlates with disease severity and lesion burden in MS. Intravenous glutathione bypasses the gut absorption limitations that make oral supplementation unreliable and delivers the molecule directly to the systemic circulation.
Exosome therapy introduces mesenchymal stem cell-derived extracellular vesicles that carry anti-inflammatory cytokines, growth factors, and microRNAs capable of modulating the immune response at the tissue level. Li et al. (2019, published in Stem Cell Research & Therapy) demonstrated that MSC-derived exosomes reduced demyelination and promoted remyelination in experimental autoimmune encephalomyelitis models. These vesicles cross the blood-brain barrier and deliver their cargo directly to affected neural tissue.
NeuroCoaching with Dr. Drew Edwards provides structured support for cognitive adaptation, energy management, and the behavioral strategies that determine how well an MS patient navigates daily life. Dr. Edwards works with patients to build fatigue management protocols, cognitive pacing strategies, and stress-reduction practices grounded in the neuroscience of chronic disease. This is not talk therapy. It is targeted cognitive coaching built around each patient’s specific functional limitations.
A Note on Our Role in MS Care
The therapies described on this page are adjunctive. They are not substitutes for disease-modifying therapy, and we do not recommend discontinuing or delaying DMT initiation based on our protocols. Every MS patient we evaluate is expected to maintain their relationship with their prescribing neurologist. Our role is to address the metabolic and regenerative dimensions of the disease that standard immunotherapy does not target. We coordinate with your existing care team rather than replacing it.
Our Treatment Approach
Each protocol is built around the individual patient’s metabolic profile, disease stage, and current treatment regimen.
NAD+ IV Therapy
Restores mitochondrial energy production in neurons and oligodendrocytes damaged by chronic inflammation. Addresses the NAD+ depletion caused by excessive PARP activation and supports axonal preservation in demyelinated tracts.
Glutathione IV Therapy
Replenishes the brain’s primary antioxidant defense against reactive oxygen species generated by neuroinflammation. Intravenous delivery bypasses the absorption limitations that make oral glutathione supplementation unreliable in clinical practice.
Exosome Therapy
MSC-derived extracellular vesicles deliver anti-inflammatory signaling molecules and microRNAs that modulate the local immune environment and promote oligodendrocyte precursor cell activity in demyelinated regions.
NeuroCoaching
Structured cognitive and behavioral coaching with Dr. Drew Edwards. Builds personalized protocols for fatigue management, cognitive pacing, stress reduction, and adaptive strategies tailored to each patient’s functional profile.
Brain Health Lab Panels
Comprehensive metabolic and inflammatory testing that identifies nutrient deficiencies, oxidative stress markers, mitochondrial dysfunction indicators, and hormonal imbalances contributing to fatigue and cognitive decline beyond what MS alone explains.
Myers’ Cocktail IV
Intravenous magnesium, B-complex vitamins, and vitamin C delivered directly to the bloodstream. Supports neuromuscular function, energy metabolism, and immune regulation in patients whose nutrient absorption is compromised by chronic disease.
Our Diagnostic Approach
Most MS patients arrive with extensive MRI histories documenting lesion count and location. That imaging is essential for monitoring disease activity, but it tells only part of the story. We add layers of evaluation that standard MS follow-up does not typically include.
Our metabolic lab panels measure markers that directly affect how MS patients feel and function: oxidative stress levels, glutathione status, mitochondrial function markers, inflammatory cytokine profiles, vitamin D levels, B12 and folate status, hormonal panels, and nutrient cofactors required for myelin synthesis and neuronal energy production. Many MS patients are profoundly deficient in nutrients that directly affect disease trajectory, and these deficiencies are rarely tested in routine neurological follow-up.
When clinically indicated, we also obtain advanced neuroimaging beyond standard lesion-counting MRI. PET scanning can map regional metabolic activity to identify areas of hypometabolism that correlate with cognitive symptoms even when structural MRI shows no new lesions. This distinction matters because many MS patients with stable MRI findings still experience progressive cognitive decline driven by metabolic mechanisms that conventional imaging does not capture.
The diagnostic results guide therapy selection. An MS patient with severe glutathione depletion and mitochondrial markers consistent with energy failure receives a different protocol than one whose primary findings involve inflammatory cytokine elevation and nutrient malabsorption. The workup determines the protocol—not the other way around.
Related Treatments
NAD+ IV Therapy
Restore mitochondrial energy production in neurons and oligodendrocytes damaged by chronic neuroinflammation. NAD+ is the primary substrate for ATP synthesis and a critical cofactor in DNA repair pathways activated by autoimmune injury.
Exosome Therapy
Extracellular vesicles that cross the blood-brain barrier and deliver anti-inflammatory signals, growth factors, and regulatory microRNAs to demyelinated neural tissue.
Glutathione IV Therapy
Replenish the brain’s primary antioxidant to counteract the oxidative damage that accelerates axonal degeneration in demyelinated tracts. Intravenous delivery ensures bioavailable concentrations.
What to Expect
Clinical history and symptom assessment
Estimated time: 30 minutes
Dr. Orr reviews your MS diagnosis history, current disease-modifying therapy, relapse history, and current symptoms including fatigue, cognitive changes, motor deficits, sensory symptoms, and bladder or bowel dysfunction. He assesses disease activity and functional impact.
Neurological examination
Estimated time: 30 minutes
A comprehensive exam evaluates motor strength, sensory function, coordination, gait, reflexes, cranial nerves, and cognitive performance. Dr. Orr uses standardized disability scales to quantify your current neurological status.
Imaging and laboratory review
Estimated time: 30 minutes
Dr. Orr reviews your most recent brain and spinal cord MRI for new or enlarging lesions, orders updated imaging if needed, and evaluates laboratory markers of disease activity and treatment response.
Treatment optimization
Estimated time: 30 minutes
Dr. Orr evaluates whether your current disease-modifying therapy is adequate and discusses any adjustments. He introduces adjunctive treatments that may include IV glutathione for neuroprotection, NAD+ therapy, and strategies to address fatigue, cognition, and mobility.
Comprehensive management plan
Estimated time: 20 minutes
Dr. Orr develops a plan that coordinates with your existing MS care team and includes monitoring schedules, symptom management strategies, rehabilitation referrals, and brain-health interventions aimed at slowing disease impact and improving daily function.
Frequently Asked Questions
Are your treatments a replacement for disease-modifying therapy?+
No. Disease-modifying therapies are the standard of care for MS and should not be stopped. Our treatments are additional, targeting the metabolic, inflammatory, and energy-production problems that standard MS drugs do not address. We work alongside your MS care team.
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No. We are explicit about this with every patient. Disease-modifying therapies remain the standard of care for relapsing-remitting multiple sclerosis and should not be discontinued based on anything we offer. Our protocols are adjunctive. They target the metabolic, inflammatory, and oxidative dimensions of MS that DMTs do not directly address. We work alongside your existing neurologist and MS care team, not in place of them.
What does your MS evaluation include?+
We review your imaging and treatment history, perform a detailed neurological exam, and order advanced metabolic and inflammatory blood panels. The goal is to find treatable factors contributing to fatigue, brain fog, or symptom progression beyond what your current medications control.
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We begin with a detailed neurological examination and review of your existing imaging and treatment history. From there, we order advanced neuroimaging if indicated, along with a comprehensive metabolic and inflammatory lab panel that includes markers of oxidative stress, mitochondrial function, and nutrient status. The goal is to identify treatable factors that may be contributing to fatigue, cognitive decline, or symptom progression beyond what your DMT controls.
How does NAD+ IV therapy help MS patients?+
MS involves damage to the energy-producing machinery inside nerve cells. NAD+ is the key molecule those cells need to produce energy. IV NAD+ restores levels that have been depleted by chronic inflammation. Many patients report improvements in fatigue and mental clarity.
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Multiple sclerosis involves significant mitochondrial dysfunction in both neurons and oligodendrocytes. NAD+ is the central coenzyme in mitochondrial energy production, and its levels decline under conditions of chronic inflammation and oxidative stress. IV NAD+ restores the substrate these organelles need to produce ATP efficiently. Patients frequently report improvements in fatigue and cognitive clarity after completing an infusion protocol, though individual responses vary.
What is exosome therapy and how does it apply to MS?+
Exosomes are tiny signaling packets derived from stem cells. They carry anti-inflammatory molecules and growth factors that can calm the immune response and support tissue repair. In MS, they target the ongoing brain inflammation that persists even when relapses are controlled.
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Exosomes are extracellular vesicles derived from mesenchymal stem cells. They carry anti-inflammatory cytokines, growth factors, and regulatory microRNAs that can modulate the immune response and support tissue repair. In the context of MS, exosome therapy targets the neuroinflammatory environment that persists even when relapse frequency is controlled by DMTs. Preclinical research has shown that MSC-derived exosomes reduce demyelination and promote oligodendrocyte precursor cell activity.
Do you treat all types of multiple sclerosis?+
We evaluate patients with all forms of MS. Our treatments are most commonly used in relapsing-remitting and early secondary progressive disease, where the metabolic and inflammatory factors we address are most responsive to intervention.
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We evaluate patients across the MS spectrum, including relapsing-remitting, secondary progressive, and primary progressive forms. Our adjunctive protocols are most commonly applied in relapsing-remitting and early secondary progressive disease, where the metabolic and inflammatory targets we address are most modifiable. We conduct a thorough evaluation before recommending any protocol to ensure that our approach is appropriate for your specific disease stage and treatment history.
How long is the treatment program?+
The initial program runs three to five consecutive days with diagnostic testing, a review with Dr. Orr, and a full course of IV therapies. Some patients return for follow-up infusions based on their response.
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Our Intensive Brain Health Program is typically delivered over three to five consecutive days. During that window, patients receive diagnostic testing, a comprehensive review with Dr. Orr, and a full course of IV-based and supportive therapies. Some patients return for follow-up infusion cycles at intervals determined by their clinical response. Dr. Edwards provides ongoing NeuroCoaching support that can continue remotely after the initial visit.
How do you coordinate care with my existing MS neurologist?+
We work alongside your MS neurologist, not in place of them. Your existing provider continues to manage disease-modifying therapy and relapse treatment. With your consent, we share our findings and communicate throughout the process.
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We work alongside your MS neurologist. Disease-modifying therapy decisions and relapse management remain with your primary provider unless you choose to transfer care. Our role is to provide interventions that standard MS care does not include: metabolic biomarker analysis, mitochondrial assessment, IV therapies targeting cellular repair, and regenerative interventions. With your consent, we share findings and communicate throughout the process.
Does insurance cover any of your MS treatments?+
Diagnostic tests like MRI and blood work are documented for out-of-network reimbursement. IV therapies including NAD+, glutathione, and exosomes are not covered by insurance. We provide superbills for all services.
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Diagnostic evaluation, blood work, and standard brain imaging are documented and submitted for out-of-network reimbursement. Standard tests like MRI and EEG are typically reimbursed. IV therapies including NAD+, glutathione, and exosomes are not covered by insurance. We provide superbills for all services. Our patient coordinator can review your specific plan.
Can your treatments help with MS fatigue specifically?+
MS fatigue is one of the most disabling symptoms and responds poorly to standard treatment. NAD+ IV addresses energy production at the cellular level, and glutathione IV targets the oxidative stress damaging myelin. Many of our MS patients report that fatigue and brain fog improve most noticeably.
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MS fatigue is one of the most disabling symptoms, and it responds poorly to conventional treatment. NAD+ IV therapy addresses the energy production deficit at the cellular level. Glutathione IV therapy targets the oxidative stress that damages myelin and mitochondria. Many of our MS patients report that fatigue and cognitive fog improve most noticeably with treatment.
Your MS Care Shouldn’t Stop at Immune Suppression
If your DMT is controlling relapses but fatigue, brain fog, and functional decline are still progressing, the missing piece is metabolic. Dr. Orr and the team at The Neurogenesis Project evaluate and treat the cellular damage that immunotherapy does not reach. We are accepting new MS patients in St. Marys, Georgia.