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 37.

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Q : 1 12/09/2009	My husband was just diagnosed with MS and is experiencing double vision. His doctors have said that this will go away. Is this true? The doctor wants to start him on a injection called Betaseron, how safe is this medicine and is it the best one out there? Without examining your husband it is difficult to answer your question regarding your husband's double vision with absolute certainty. Some patients have their double vision resolved totally while others continue to have difficulty to a slight degree. In addition, if your husband initially had severe double vision which has rapidly improved over a short period of time, then his doctors may be confident that it will resolve completely. However, there is still no way to be absolutely sure about that and patients have to be followed closely. Some patients who have continued problems with double vision can solve the problem by wearing a patch over one eye, and this would also be recommended by his physician. As far as treatment is concerned, Betaseron is an effective treatment and has an efficacy in suppressing MS disease activity that is similar to other therapies that would be recommended for individuals who have relapsing-remitting MS.
Q : 2 11/01/2009	I was diagnosed with superimposed multiple sclerosis and left homonymous hemianopia in both eyes. What does superimposed MS mean? A left homonymous hemianopia (LHH) can occur for several reasons and MS is one of them. It is certainly possible that MS is the cause of the LHH in your case, which would make it the primary cause of your vision problem and not really "superimposed." I suggest that you speak with your neurologist about whether there might be another cause for the LHH. If there is no other cause for it then the LHH should be considered a significant clinical abnormality that has resulted from your MS.
Q : 3 09/30/2009	I recently learned that the Epstein-Barr virus can cause MS? Is there a way to treat or prevent this? At this time, there is no available treatment that targets the virus that will benefit a person's MS. The reason is that the EBV infection causes changes in a person's immune system that results in a greater chance of that individual getting MS. Although traces of the virus can still be detected and the infection can persist, it does not appear that more virus is made at times when people have an exacerbation or when a person's disease is progressive. For those reasons, treating the virus itself is not likely to have a significant effect a person's MS.
Q : 4 08/28/2009	I have just watched your MS update show from Sept 2008 and was very impressed. I have recently read in the UK press about blood pressure pills working against MS. Have you heard of this and do you have any opinions on it? I have been on copaxone for the last 18 months and have been well with no relapses. How are you finding its performance against the interferons? There is a class of drugs on the market that are used to treat hypertension called ACE (angiotensin converting-enzyme) inhibitors. These compounds prevent the breakdown of proteins that are produced by the body which raise the blood pressure. It turns out that there are also receptors for these protein breakdown projects which are located on cells that promote inflammation in MS. By blocking the production of these products in studies performed in the mouse model of MS, activation of these cells were inhibited and cells that can be protective of MS were produced. It is not known whether the effect of this drug in these studies would be different in the presence of Copaxone of interferon-beta. Further studies are required to answer this question. Also, the experiments that were performed with the ACE inhibitor were done in mice and not in humans. Since not all trials that work in the mouse model are found to be effective in humans, it is important that the appropriate clinical trials are done before recommending it as a treatment for MS.
Q : 5 07/19/2009	How necessary is the lumbar puncture for diagnosis of MS? MRIs seem pretty clear, and am worried about the risk & pain of puncture. Will skipping the puncture greatly effect my doctor's ability to choose the correct medications, etc? It is often not necessary to perform a lumbar puncture to make a diagnosis of MS. However, in some cases the test is necessary to rule out certain conditions and alternative diagnoses. You should only go on treatment if you definitely have MS. Therefore, I suggest that you speak with your physician regarding the necessity of your having the test performed in order to rule out the diagnosis.
Q : 6 06/03/2009	I was advised a year ago that I have RRMS but i have had a steady decline in my abilities since then and the neurologist is just giving me medications for spasms, bladder issues and Provigil for weakness when walking. I would like to know if i should consult with another neurologist for my care. There are several drugs that are available for the treatment of MS. You would benefit from discussing these medications and the reasons they haven't been recommended to you with your neurologist. In addition, a second opinion could be obtained from a different neurologist regarding the various options that exist for treatment and to potentially start treatment with one of the drugs.
Q : 7 05/14/2009	I've recently had a few medical problems. My doctor had me do a Cat Scan (head), MRI (head), which required an MRA and a CTA (neck). I also had 4 vials of blood taken and tested. All of these tests came back normal. I have many symptoms of MS (minor) and am wondering if I did have MS, would any of the tests I had done show it? Multiple sclerosis is what we refer to as a "diagnosis of exclusion." That is, there are a number of diseases which can cause the same symptoms and findings on some tests as what can be seen in MS. A MRI is very sensitive for detecting lesions in the central nervous system (brain, spinal cord and sometimes the optic nerves) and if this test is normal then it is unlikely that a person has the diagnosis of MS. Sometimes the MRI scans can show very mild abnormalities that would not be anything to be concerned about if the patient was not having symptoms. In a situation such as this, MS can be very difficult to diagnosis. I would recommend that you contact your neurologist and discuss this with them. If there is still some uncertainty, you can be referred to a neurologist who is a MS specialist for a second opinion.
Q : 8 04/06/2009	I am a Afo-American female who was diagnosed with MS at 38 years old. I have remitting relapsing MS and I am currently taking Rebif 22mg,this is the third medication I have tried which seems to work better for me. My question is what are Afro Americans doing about their hair because I was told not to perm my hair any longer. Do you have any suggestions or can you refer me to other Afro-Americans females who have problems with the texture of their hair since starting treatment? One side effect that has been described with interferon therapy is hair loss, which may be worsened by the chemicals that are in permanents. The website for the National MS Society is developing links to chat rooms where African American patients can have the opportunity to connect and discuss questions like yours with individuals who have similar problems and concerns. The Web address for the National MS Society is www.nmss.org. I would also suggest that you contact a dermatologist for advice for how your can address this concern.
Q : 9 02/11/2009	Do you have any theories on or objections to the usage of stem cell treatment for MS Patients? Stem cells are indeed a promising approach to the treatment of MS. There remains much that has to be understood in order to apply this technology and I, as others, look forward to when it can be applied safely and effectively to the benefit of patients. With continued research I look forward to that day becoming a reality.
Q : 10 01/19/2009	I know that MS attacks the CNS, what effects does it have on the brain itself? MS is caused by inflammation mounted against central nervous system tissue. This can cause the development of plaques or tissue scars. MS can also affect the spinal cord and optic nerves, which are also a part of the central nervous system. The consequences of MS are damage to myelin in these areas and also degeneration of the nerve cells, which are called neurons. More information can be obtained at the web site for the National Multiple Sclerosis Society (www.nmss.org).
Q : 11 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 : 12 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 : 13 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 : 14 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 : 15 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.

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