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 27.

1

2

---

Q : 1 08/13/2008	I am experiencing a relapse. I have tingly feeling in my legs after I exercise. My hands have the sensation of feeling like sand paper. My relapse seems to be getting better in some places and worse in others. Will the sensations go away? Is it normal to have some things get better and others get worse? Thank you for your question. Your symptoms that you are experiencing are those that commonly occur in patients with MS. If they have not been previously present and occur with a relapse, it is possible that they may resolve completely. There is no way to guarantee this, however. It is also possible that during the course of a relapse some symptoms may begin to resolve as others appear. When this happens, treatment with intravenous and oral steroids can often help in promoting more rapid resolution or improvement of the symptoms.
Q : 2 08/12/2008	My sister has MS. She was diagnosed about seven years ago, with symptoms of limping and fatigue. She eventually had problems with walking and getting around and was given a cane, then a walker to use. She had a really bad exacerbation in October 2007 and had to be hospitalized for several months. Right now, she is in the hospital again because she had a seizure. She cannot go to the bathroom on her own so she wears diapers and uses a catheter. These are her symptoms: she cannot walk, cannot move her legs, terrible shaking, slurred speech, memory loss, not recognizing family. When she is home from hospital, all she does is lay in bed, she is fed through a tube in her stomach but she can eat food if it is chopped very fine. Her doctor put her on Copaxone after she had her last attack but she was on it years ago and taken off because of her white blood cell count. I am not happy with the care she is receiving and was wondering if you could recommend something we could do, or if you are willing to evaluate her or recommend someone. MS can have a very aggressive course in come patients and it may be require treatment with medications other than the interferons or Copaxone. Some patients in your sister's situation may benefit from being treated with the drug Tysabri. One of our neurologists here at the Maryland Center for MS will be happy to provide a second opinion regarding the appropriate treatment for your sister's MS. You or one of your family members can call the Center at 410-328-5605 for information about setting up a consultation. -Dr. Royal
Q : 3 02/11/2008	Is it possible that an experimental meningitis vaccination that was administered in the 1960's cause multiple sclerosis? To date, none of the FDA-approved meningitis vaccinations have been shown to be associated with the development of MS. Of course, it is important to know which vaccination you received and whether it was felt to meet the FDA's standards for safety including whether it was shown to be associated with the development of brain inflammation) and whether it was effective at preventing meningitis. It is also important to consider how long after the vaccination your MS symptoms first appeared and whether your symptoms have been associated with the specific type of immune response that would be activated by the vaccine. These questions are among those that can be explored by your MS neurologist.
Q : 4 02/04/2008	I have a real-life family from an equatorial country with strange occurrences of MS. First individual (Patient A)-Female, mid 20's, is sick with the disease and dies at the age of 30. A couple of years before she dies, her younger sister (Patient B) displays symptoms, and is now in her late 50's, completely immobile. Also: the patients' mother's maternal cousin (Patient C) has had the disease for 20 years, and is also immobile. Now, Patient B's son, in his mid 20's is starting to show symptoms. How strong is the genetic link for MS? Thank you for your question. There is a very strong genetic link that underlies the risk that is associated with an individual developing MS. Environmental factors are important, as well. One would expect that this family would be a very low risk for developing the disease, which makes this family very unusual and raises questions regarding specific exposures that may have been occurred here in the U.S. and, possibly, an alternative diagnosis. There is an ongoing study of MS genetics which has been analyzing samples from patient from high and low risk groups with the goal of identifying MS-related genes. I am happy to discuss this family with you or to see the family or one of its members in consultation. My office can be reached by calling 410-328-7601. -Dr. Royal
Q : 5 02/01/2008	I have an MS evaluation scheduled at the University of Maryland but I have a question in the meantime. I have extreme amounts of pain in my neck, down my spine, my left elbow and down through my legs. I was given a 7-day steroid pack to help with inflammation but would this prevent you from detecting MS when I come in? I know steroids tend to mask the problem and I want to make sure it can be detected. I have also had two brain scans which haven't shown any legions but my doctors seem to think that other tests may futher clarify this because my symptoms are so similar. Can you help with these concerns? Your being treated with steroids will not pose a problem with the evaluation that you will have when you come here for your appointment. Steroids can be an effective short-term treatment for new or recurring MS symptoms and can provide patients with significant relief. These drugs work by decreasing the amount of inflammation, and thereby, the duration, of such symptoms. Such treatment may also suppress the amount of enhancement that can be seen on your MRI scan. However, the treatment that you received will not alter the overall course your disease and should not impact your evaluation here.
Q : 6 12/01/2007	My sister has had MS for over 30 years. She is 64 years old, recently widowed after 42 years of marriage. She is elgible to retire in March of 2008. We have found that she has very limited focus and attention span. It has become apparent in going though personal matters that the lack of focus has been a problem for many years. What if anything can we do to assist her in this area and what medical treatment might be of help? About half of patients with MS develop cognitive difficulties, and this seems to be the case with your sister. It is a good idea for her to undergo a formal evaluation of her MS status, to be sure that her difficulties are not due to medical issues other than her MS, as well as formal neuropsychological testing. If she if found to have significant MS-related impairment then it will be important to optimize her MS meds in order to try to slow further decline. Patients can also benefit from treatment of certain MS-related symptoms, such as fatigue. Otherwise, mild improvement may result from treatment with Aricept, which is a drug that is used to treat patients with Alzheimer's disease. Patients such as your sister also often benefit from support like that which you are providing (or from another care-giver) and from counseling with the goal of helping them to maximize their ability to perform activities of daily living in the context of their impairment. -Dr. Royal
Q : 7 11/13/2007	If my brother was diagnosed with MS should I be worried about possibly getting it? Thank you for your question. Assuming that your sibling is not your twin, your general risk of getting the disease would be expected to be about 1 in 100. MS is a complex disease with results from interactions between genetic factors, the environment, and other influences. Though you risk would be expected to be higher than that for somone without a family member with MS, it is, nevertheless, low.
Q : 8 01/19/2007	I have had MS for 28 years and have recently developed epilepsy. Both these conditions have been properly diagnosed but they tell me that the combination is rare. Why? Generally, people with MS develop lesions that are in deeper areas of the brain within white matter. In contrast, seizures typically result from abnormal electrical activity that involved brain gray matter, which lines the brain surface. MS and epilepsy, as individual diagnoses, are not uncommon in the general population. It is possible for them to occur together just by coincidence. In addition, patients with MS can develop lesions that are localized either near or at the surface of the brain, which can increase the risk of seizures developing.
Q : 9 12/29/2006	Can you have muscular dystrophy and multiple sclerosis at the same time? It is possible for the two diseases to occur in the same patient. In fact, there are at least two cases reported in the medical literature where this has occurred.
Q : 10 11/19/2006	I was diagnosed as having MS in 1978 and recently my legs have been getting weaker (I have to hold onto something to pull myself up or have to bend right down and push myself up, even getting out of the car). Is this an MS problem or just getting older? I am 53, female and I do outside yard work and clean a house with stairs. Are my legs just tired? Your symptoms are likely due to progression of your MS. With time, patients can also develop worsening spasticity, which can make it difficult to ambulate. These are issues that you can discuss with your neurologist. Physicians at the Maryland Center for MS would also be happy to provide a second opinion concerning the management of your MS.
Q : 11 06/19/2006	I am 34 years old (as of yesterday) and I have been suffering from systemic numbness, burning, twitching, muscle spasm, muscle stiffness, headaches, and muscle weakness. I had a "fainting spell" a couple of years ago. Never loss consciousness but my legs and arms felt like they weighed a ton and my legs collapsed under me. A few months later I was back in the hospital because of facial numbness that covered the enire left side of my head. I also feel like my memory and thinking are as sharp as before. This is especially hard since I graduated with honors and am now an Executive Director of a nonprofit. A few months ago, I had a brain MRI which came back "normal". I also had Grave Disease which was diagnosed and treated by RAI in Jan 2005. My TSH levels are normal but my body isn't. My question is how bad do these symptoms have to get before I can get a diagnosis? I don't want to have MS but if I do, I want to get treatment ASAP. I don't want to be any worse than I have to be. The fatigue, occassional limping, and facial twitches are so frustrating. It is so heart breaking to hear "you're normal" when I know I will go home and lay in bed and my body will jerk and move which ever way it wants whenever it wants. Any ideas on what to do next? MS can be a very elusive diagnosis. On the other hand, other conditions can be associated with symptoms that can occur in patients with MS. It is difficult to say, based on the information that you provided, whether you do or do not have MS. You are certainly welcome, however, to contact that MS Center here at the University of Maryland for a second opinion concerning your diagnosis.
Q : 12 06/09/2006	What are your thoughts on Botox therapy for spasticity in MS patients? Have you heard of any successful stories? Botox can be used very successfully in patients with significant spasticity. It is most effective when used to inject selective individual muscles.
Q : 13 02/27/2006	I am a 25 year female and was diagnosed with MS in 2003. I am currently taking Betaseron. I have not had physical exacerbation in over 18 months; however, my last MRI showed a few new lesions. I feel good and would like to get pregnant this summer. Should I be concerned about my MRI changes and hold off on getting pregnant? Disease-modifying drugs such as Betaseron might reduce the number of exacerbations and the number of lesions that may appear over time; however, these occurrences may not be inhibited completely. Also, many women notice an improvement in their MS with pregnancy. These issues can be discussed in more detail with you neurologist. One the neurologists from our MS Center here at the University of Maryland would be also happy to see you in consultation and to also discuss this with you in greater detail after reviewing your history and examination.
Q : 14 02/22/2006	I have had an "attack"-- where my vision was very blurred and I was severly fatigued. I was given predisone and IV steriods for five days. I felt better until returning to work full time. Now the fatigue is back and blurred vsion is occuring some of the time. Could the fatigue be from the bacolfen and Neurotin? Or would this still be considered an attack? Certain medications, such as baclofen and Neurontin, can cause some patients to feel more fatigued, especially when they are given at higher doses. However, to know whether new or recurrent symptoms are due to a new attack requires an assessment of the time interval and associated factors related to the onset of the symptoms (fever, infection, heat exposure, etc.) as well as whether the symptoms are associated with new MRI lesions. These issues can be sorted out by your neurologist. Neurologists in our MS Center would also be happy to provide a second opinion by seeing you in consultation.
Q : 15 02/22/2006	I know MS will destroy the myelin sheaths. What does this interfere with and what would be the consequence? By damaging the myelin sheaths, MS can cause people to develop any number of symptoms including weakness, abnormal sensation, balance difficulties, and impaired vision (the list of possible difficulties that can result is very long). For many people, MS can result in acummulating disability, but others may have a benign form of the disease. The rate of disease progression and disease severity over time may also be less in patients treated with one of the disease modifying drugs (interferons, glatiramer acetate). More information about this can be obtained by, of course, speaking with your neurologist as well as by visiting the website for the National Multiple Sclerosis Society (www.nmss.org) or by calling you local Multiple Sclerosis Society chapter and asking that they send you literature on the subject.

1

2