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Ask The Expert Archive

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Multiple Sclerosis Archive Questions

Below are Dr. Royal’s answers to Multiple Sclerosis questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 59.

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Q : 1

My daughter has MS. Within the past six months she has pain in her right shoulder and tremors of the right hand. Her neurologist nor primary care physician have been able to prescribe a treatment to relieve her condition. Have you experienced other individuals with this condition and is there a treatment?

These symptoms can be caused by MS. In order to determine what would be the best treatment for them, it would be necessary for your daughter to have an appointment at our MS Center. To schedule an appointment she can call 410-328-5605.

Q : 2

I read that beta-interferons haven't been especially beneficial for patients with MS. My sister was just diagnosed and her doctors want to start her on Interferon. Any recommended drugs that work best?

The beta-interferon drugs have been shown to be effective in one-third to one-half of patients (depending on the study that one refers to). Therefore, these drugs are indeed effective. Treatment with other drugs that are more effective is associated with greater risks of toxicity. These increased risks make those drugs less appropriate for a newly diagnosed patient.

Q : 3

I've had many symptoms that all point to MS. I've had various blood tests and MRIs with/without contrast on the head, cervical and thoracic spine. Everything has come back normal. I've been going back and fourth from my general practitioner and neurologist with no answers or direction. What should be my next step?

MS can be very difficult to diagnose. However, it would be very unusual for a person with MS to have a negative MRI scan. Your neurologist may want to continue to follow you over time to see if you develop findings that are consistent with the diagnosis of MS, or he/she may consider testing to evaluate you for other reasons why you have developed your symptoms. You may want to also consider seeking a second opinion from a MS specialist. Information on who in your region is a specialist can be obtained by contacting the National Multiple Sclerosis Society (website:

Q : 4

Is there any correlation between MS and cardiac arrhythmia? I have MS, high blood pressure, an under active thyroid, and PVCs. My doctor says my PVCs have something to do with the "electrical" system of my heart which regulates the heart beats. Would my MS have something to do with this?

There are specific areas of the brain that do, indeed, control electrical activity that is sent to the heart. Generally, abnormality related to this occurs in patients who have had a stroke, but it can also be a problem in patients with MS. One thing that can happen is that the heart can beat very slowly, which can lead to the occurrence of abnormal heartbeats, such as PVCs. A slow heart rate can also result from hypothyroidism and sometimes medication that is used to treat hypothyroidism can cause some people to develop PVCs. These are important issues that need to be addressed by your doctors as they go about trying to understand how your MS might be causing these problems.

Q : 5

I had three numbing attacks in my left leg. I have undergone steroid treatment in the hospital, but this time I still have a tickling feeling in my foot. Should I get additional treatment or will this go away?

Sometimes the symptoms from an attack may not resolve immediately and may take more time, even months before they resolve completely. For that reason, you may want to hold off on another treatment with steroids, which cannot prevent future attacks, and speak with you physician about treatments that can decrease the chances of another attack occurring.

Q : 6

Why is MS so difficult to diagnose and are the current tests (e.g. evoked potentials, lumbar puncture) reliable?

The reason MS is so difficult to diagnosis is that the abnormalities that can occur, both clinical and on results on laboratory testing, can also be found in other diseases. For this reason, additional testing is often necessary to investigate these other possible diagnoses. Occasionally, however, even with such extensive testing, the diagnosis may not be clear. For more information about issues related to the diagnosis of MS you can go to the website for the National Multiple Sclerosis Society (USA) at

Q : 7

I found out at 17 that I had MS. I had a spinal tap as well as about 7 or so MRIs. I have been experiencing some odd things lately. I have had what I would call seizure-like shakes every once in a while for the past few years. Can these be caused by MS or do I need to be tested for something else?

MS can cause people to develop a number of symptoms which can include shaking spells. Such shaking is rarely caused by seizures, but more commonly they result from what are referred to as tremors. In order to know what is the cause of your shakes, I suggest that you make an appointment to be seen by your neurologist. Your neurologist will be able to determine the cause from performing a neurological exam and, if necessary, by doing some additional testing, such as an EEG.

Q : 8

Can sciatica mask itself as MS?

Some symptoms that occur with sciatica can be similar to what is seen with MS. However, the two are very different. For example, sciatica is frequently associated with back pain and pain radiating down the leg from the hip/buttock region to the foot. Patients can also develop numbness and tingling of the leg and weakness. Leg numbness and tingling can also occur with MS, but pain of this type would be very unusual for MS. The findings on MRI are often also different. Whereas MS will show bright lesions of the central nervous system, which includes the spinal cord and brain, sciatica involves the peripheral nervous system and is cause by a disk herniation pressing on a nerve root (although, in severe cases, compression may also involve the spinal cord).

Q : 9

My son is interested in marrying a girl who's sister has MS. There are two girls and one boy in the family, and the boy is in good health. Should I be concerned about MS reccurring in their children, and grandchildren if they get married?

MS does have a tendency to run in families and it is a common situation for a person to have a relative with MS. The risk of the disease occurring in a sibling of a person with MS is less than 1 percent and the current risk for future children and grandchildren is lower than that (since neither presumed future parent has the diagnosis of MS). There are other diseases that occur more commonly than MS in people with certain risk factors.

Q : 10

My daughter has been having numbness tingling and burning in the upper and lower extremities along with a stiff neck. She is scheduled for an MRI. Does this sound like MS or something that mimics it?

There is a large number of conditions that can mimic MS. Certainly, these symptoms can result from MS as well as a number of conditions that can cause similar problems. These include Lyme disease, a peripheral neuropathy - the list goes on and on. I suggest meeting with your daughter and her MS neurologist to discuss these possibilities in the context of her symptoms, findings on examination and the results of tests that she may have had to date. If questions remain, your daughter could seek a second opinion. The neurologists at the Maryland Center for MS would be happy to provide a second opinion on your daughter's case (she can call 410-328-5605 to discuss setting up an appointment).

Q : 11

Is it possible to have MS flare ups every day? My mother-in-law was recently diagnosed with MS and she claims that her symptoms happen for couple of hours, every day, especially at night.

It would be very unusual for a person with MS to have flares every day. It is common, however, for MS symptoms to wax and wane on a day-to-day basis. This can occur because of exposure to heat; some people develop worsening symptoms with even minor activity. It may also be a sign that a certain symptoms need to be controlled with medication. Your mother-in-law should contact her neurologist to discuss her symptoms to be sure that they are not being caused by occasional flares of MS and to discuss possible treatments to control them.

Q : 12

Is it possible to have MS if a lumbar puncture was negative and showing some demyelation process? My symptoms started approximately 10 years ago and only in the past year have they gotten worse and more frequent. My doctor ruled out lupus, sjogren's, B12 deficiency and lyme.

MS can be very difficult to diagnose and a lumbar puncture is only one test that can aid in making the diagnosis. In general, the longer a person has MS the more likely the lumbar puncture result will be positive. It is important to combine information from a number of tests to make the diagnosis of MS. If you would like a second opinion concerning your diagnosis you can call 1-800-492-5538 to make an appointment with one of our neurologists.

Q : 13

In MS, does lhermitte's always get worse with heat or exercise? I have this symptom and other tingling that usually goes away when I exercise or take a hot shower.

Lhermitte's can worsen with exercise and heat. However, if a person also has muscle spasms with the Lhermitte's, then movement or heat may provide relief.

Q : 14

My friend was diagnosed with MS about 11 years ago. He had one episode and the MRI showed lesions. He took the Betaseron injections consistently for about 9 years and stopped on his own for a year. He did not inform his doctor, and he didn't have any episodes during that time. Does he really need the Betaseron any longer? He started taking it again, in a renewed sense of not wanting to get ill. Should he see a different doctor? What could be happening here that he is the same with and without the medication?

It is certainly good that your friend has not had significant progression of his MS. However, MS is a very unpredictable disease and an attack or change in the disease course can happen at any time. When such events occur, patients, in most cases, are not able to fully regain any function that might have been lost. Also, drugs such as Betaseron appear to be effective in about a third of patients. Therefore, your friend has been very fortunate to have obtained a good response from the medication. For these reasons it is a good idea for him to continue taking his Betaseron injections.

Q : 15

My doctor said that I may need a blood patch following a lumbar puncture. How is a blood patch performed?

A blood patch is performed in order to apply pressure to the area where a person had a lumbar puncture. This may provide relief from a post-lumbar puncture headache by stopping leakage of spinal fluid from that site or by working through some other mechanism. A blood patch is performed by removing blood from the patient's vein, like when the patient has a blood test, and injecting the blood into an area near where the spinal tap was performed. This area is also just above a tough membrane called the dura; below the dura is where the spinal fluid is located. This procedure can be very effective in providing relief from a post-lumbar puncture headache.

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