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Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
Question:
My doctor ordered 3 MRIs. My brain, cervical, & lumbar. My out of pocket expenses are over $3000. Are all 3 necessary when I have no new symptoms in over 10 years? Answer: That is a very good question. Most people with MS only need repeat MRI scans of the brain, unless your doctor has a specific reason (and there are good reasons) to get repeat MRI scans of the spine. I would suggest asking him why you need all three studies and make an informed decision. For instance, you could start with just the MRI of the brain and stop there if there are no changes. Good Luck Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Is it possible to distinguish symptoms of MS from symptoms that someone without MS would have with disc herniations/bulges from T6 through T11, and tears from L4-S1. I don’t “want” surgery, plus it’s not even an option since I do have MS, but I’m only 32 walking around like I’m in my 70s and I worry what I’ll be like in the years ahead based on both issues. Despite MRIs indicating I’ve had MS for years, I had no clue. All of my “MS symptoms” did come about right after a car accident (driver-side impact that completely shattered my driver-side window and caused 10k in damage). I feel like it’s not just a coincidence and it’s so much harder to try and figure out the best way to treat the MS if more is going on. I’m at my wits end. Answer: Disc issues that affect the peripheral nervous system typically cause lancinating pain (called radical at pain) that your physician can tease apart from MS. Also, nerve conduction studies can confirm that type of injury. MS does not contra-indicate surgery. A. Scott Nielsen MD MMSc Neurologist and MS Specialist at Kaiser Permanente Question:
My daughter has to get booster vaccines for middle school this summer. Is there any concern for her getting vaccines and me being treated with Ocrevus? DTAP and MenACWY-D? Answer: All of the middle school age vaccines and boosters you mention are inactive vaccines meaning there are no live viruses. Therefore, it is completely safe for you to be around people receiving these vaccines after Ocrevus treatment Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Has anyone ever taken two 240 mg tecfidera pills by accident? Answer: People with MS have certainly taken 2 tablets of tecfidera (480 mg) at the same time by mistake, but this dose has not been studied. There should be no particular harm, although you may experience more GI side effects and flushing shortly after taking this dose. Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Question:
Are there specific lab tests that should be run during Ocrevus treatment and if so at what intervals? My concern is being immunocompromised. Are there any supplements or vitamins that can be taken to safely combat this risk? In theory - how long can a patient safely be on a drug like Ocrevus? Answer: All patients must be tested for Hepatitis B before starting Ocrevus; we also recommend testing for Hepatitis C since so many people are infected with this virus and not aware of it. We also check CD19 counts before treatment and quantitative immunoglobulin levels (IgG, IgA, IgM). Ocrevus works by destroying the CD19 + (CD20 +) lymphocytes in circulation and knowing the baseline count is helpful in determining dosing intervals at a later date. We want to know baseline immunoglobulin levels since Ocrevus can cause immunoglobulin deficiency and make you more susceptible to infections, particularly upper respiratory infections. Some people even have immunoglobulin deficiency before starting Ocrevus and this is useful to know ahead of time. Lastly, we check a complete blood count (CBC with auto diff) and complete metabolic profile before starting treatment and before every subsequent treatment. There are no supplements to help with preventing infections. Infections are relatively rare with Ocrevus and more common if you are older, have other risk factors like pulmonary disease or frequent UTIs or spend anytime in a wheelchair. Good luck Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Question:
I am in limbo with my diagnosis situation. My initial symptoms was an “MS Hug” if I can call it that, and tremors for years. Then I was better. Then on 4/1/18 I had a sudden episode of amnesia for days and extreme intolerable temperature sensitivity and tremors again. My MRI on 5/15/18 showed multiple lesions in periventricular, subcortical, and subepidnjmal. I now have a new symptom of confusion, worse tremors and I was unable to find my way home a few days ago. I went to the ER and the new MRI wasn’t compared to old but they said it was similar. They gave me the new McDonald criteria from 2017 and wouldn’t I meet that if I have had > 2 attacks and lesions in >2 areas including periventricular and subcortical (juxtacortical now includes all cortical)?. I just want to get treated ASAP. I’m only 36. I’m seeing my neurologist Tuesday but she’s not using the criteria. Should that be used in this case? Answer: I can feel your frustration as I read you message. I suspect without knowing your case or examining you, that the problem with establishing a diagnosis in your case is a reflection of the non specific nature of your symptoms, not a reflection of diagnostic criterion. The truth is that the diagnostic for MS has not changed except for very specific and characteristic cases. Let me explain using your case as an example. The symptoms you describe are not very specific for MS and would not be considered attacks or events. 1. The problem with the term "MS hug" is that it implies that this symptom is only caused by MS. In fact this is a fairly non specific symptoms which may or may not reflect any kind of problem affecting the spinal cord. 2. Tremors are more commonly caused by things other than MS. Only a very specific tremor, called an intention tremor, is commonly caused by MS. Even then the tremor is almost always associated with other symptoms caused by problems in the brainstem or cerebellum, important areas in your brain. 3. Acute onset of amnesia and acute geographic disorientation (“not finding my way home”) would be very unusual in an MS patient. These symptoms are more commonly associated with seizures, limbic encephalitis, or transient global amnesia. Lastly MRI scans are notoriously non specific for a diagnosis of MS, except when they meet certain specificity criteria and occur in a specific clinical setting. Location is only one component of the specificity criteria so I can not really comment on your description of the findings. The main diagnostic issue in your case is to identify and account for any unusual or uncertain features AND exclude other disorders that may produce your symptom complex. A good neurologist will do this and not over-emphasize diagnostic criteria (McDonald criteria) that are only meant to characterize people for clinical research. Good luck Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego |
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