Welcome to the Virtual MS Center!
Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
Question: Is it OK for a person with MS to take Echinacea? Answer: Here is the answer... http://www.healthcarejourney.com/q--a-for-virtual-ms-center/is-echinacea-safe-for-people-with-ms Here is My Question:
My husband was recently diagnosed with Remitting Relapsing MS in September. He has been on Glatopa for a little over 2 months. Recently, for about a month and half his fatigue has increased significantly. His doctor put him on Amantadine, he was taking one at 12pm at first and then tried one in the morning and one around 12. He was still falling asleep and felt tired but had insomnia at night. Of course he was napping for about 2 hrs when he got home from work at around 5pm. He was recently put on Ritalin 20 mg. He took one yesterday and said he blackout out for a moment. His vision went out. Is that a common side effect. It really frightened me. He said he was reading symptoms and is wondering if maybe he imagined it? Is this a good drug to take? Is 20 mg ok or would a lower dosage be better? Is there anything else he can do that will help? He is slightly overweight and also does not exercise. He has improved his eating habits but they are not ideal. Thank you for your help. Answer: Transient loss of vision is not a common side effect of Ritalin. I recommend you and your husband discuss this episode of “blackout” with the physician who prescribed it to make sure it is the appropriate medication for him. Dr Osborne Here is My Question:
I was diagnosed with MS in 1991 (57 Yrs.) and have ben very fortunate to have remained stable with little progression. I have been on Tysabri since 2008 and am JCV Virus positive with a titer of 4.8. I have seen three neurologists and all three have given me a different answer to my therapy options. I do not have any enhancing lesions on MRIs. #! - stay on Tysabri says don't qualify for Lemtrada or Rituximab based on disease - no new lesions #2 - start Lemtrada #3 - start Rituximab What is your opinion of my length of time on Tysabri? How does Lemtrada compare to Rituximab? Thank you. Answer: Great questions; I assume you are now 57 years old and you were diagnosed 25 years (diagnosed 1991). Although you state that you are stable with little progressive, your level of disability and risk factors for further disease progression is unclear from your question. For instance, we see quite a few patients with very little disability and few risk factors for disease progression even after 25 years of disease. These patients would not want to experience the side effects and potential risks of the some of the treatments mentioned. In fact some may even consider discontinuing treatment. I can tell you the following: 1. Your risk of PML on Tysabri is about 1 in 100 (high risk group). It is still unclear whether this risk significantly decreases or remains the same in patients like yourself on prolonged treatment 2. You can probably diminish the risk of PML by increasing the interval between infusions to 8 weeks. You would still require frequent monitoring. 3. Rituximab is associated with fewer risks than Lemtrada. If you are a candidate for treatment based on level of disability and risk factors for disease progression (and based on your comments I am not sure you are a candidate), rituximab would be safer. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I have been searching trying to find the answer, but after days of trying, I have yet to find it. I have recently started Plegridy and have started to develop onychoptosis. When the nails fall off, it's not bloody, but as I'm diabetic this does pose a health risk. I have been searching and searching to no avail. When I was on Copaxone, I didn't have this reaction, but now I'm on Plegridy and I've been loosing nails quite often. Is this a known side effect from interferon, or am I developing something I should see a podiatrist about? Answer: Nail fungus or nail loss is not a known side effect of interferons but is certainly common in Diabetics. You should inform your primary care doctor or diabetes specialist. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
Can MS cause small fiber neuropathy? Answer: No, Multiple sclerosis is exclusively a disease of the central nervous system and does not cause small fiber neuropathy Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
I started Aubagio two months ago and before that I was using Avonex. I have also started to walk for about 45 minutes a day. I feel kind of numbness at my left side toes. Is this related to exercise? Just MS? Is Aubagio as effective as Avonex? Answer: Anytime you have new symptoms that are concerning, please check with your clinician. In general symptoms can be a sign of a new exacerbation OR they can come and go based on prior damage that has occurred. Sometimes, symptoms such as numbness are related to things other than MS. In most instances, the symptoms are NOT a sign of new inflammation, but your clinician can guide you on whether testing will be required. In terms of comparing Aubagio and Avonex we have limited data. At a population level they are probably equivalent, but there will be some people who respond to one drug and not the other. Careful follow up is needed on any disease modifying therapy to determine if it is working for you. Benjamin M. Greenberg, MD, MHS Director, Transverse Myelitis, Neuromyelitis Optica Programs Director, Neurosciences Clinical Research Center Co-Director, Pediatric CONQUER Program UT Southwestern Medical Center Childrens Health Dallas, Texas Here is My Question:
I have history of Crohn's Disease with multiple surgeries starting about 25 years ago. I developed heavy legs and difficulty walking. Went to Neurologist about 5 years ago, had conduction tests and was told I had small nerve neuropathy. Burning, pins and needles feelings in both feet with many shocks arranging from light to very hard. Fatigue, weakness in arms and legs, vision problems progressing. Having a brain MRI showed one small lesion. Follow-up MRI proved the lesion to be non-specific. Was told its not a tumor, etc. Doctor setting me up with MS Specialist. Does this sound anything like MS or Neuropathy and Lesion from having Crohn's Disease? Answer: I am glad you are seeing another neurologist soon since much of the information provided in your question does not make sense. Let me point out the inconsistencies for you: 1. Small fiber neuropathy causes pain and decreased sensation to hot and cold and pinpricks usually in the feet or distal extremities. Autonomic symptoms are not uncommon as well. It does not cause heaviness or difficulty walking and usually is associated with normal nerve conduction studies. 2. There are many reasons for a patient with inflammatory bowel disease to develop different types of neuropathy. These include the disease itself, drugs used to treat the disease and nutritional deficiencies. A good neurologist should be able to determine if you have a neuropathy and the type. This will help determine the cause of the neuropathy, if indeed you have a neuropathy. 3. MS doesn’t affect the peripheral nervous system (not in the classical sense) and should be relatively easy to differentiate from a neuropathy Good luck Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
After HSCT is it possibly to get pregnant if I am 26 years old? Answer: Stem cell transplantation (HSCT) is currently in the research phase for individuals with multiple sclerosis (to determine safety, efficacy, and long-term risks). At present, HSCT requires various levels of chemotherapy to aid in the "re-setting" of the immune system. Chemotherapy medications do have the potential to result in "sterilization" of the patient (chemotherapy in general terms affects all dividing cells in the body, including cells in the ovaries and testes). We should learn more about HSCT through current research, but at present, I cannot answer your question with complete confidence. Even with data to come in the future, exposure to conditioning regimens with various forms of chemotherapy could increase the risk of conception difficulty. Approaches to this potential problem include harvesting ova from women and sperm donations from men prior to undergoing treatment A. Scott Nielsen Neurologist and MS Specialist at Kaiser Permanente Here is My Question:
I am 67 and in July and August I was in the hospital because I had an aneurysm. I also have MS. I was told by doctors at the hospital that it could not have been caused by my MS. Is this true? Also, I was told by one doctor, this could NEVER happen again. Then, I told him my mother had an aneurysm and then he said "well, now that I know your history" but never said anything else. After I left, I wondered "why" he said that. I would really appreciate your opinion. I certainly pray that never happens again, since I know I am very lucky to be sitting here. Would I benefit from Having an MRI yearly? Thank you so much! Answer: There is no relationship between the development of intracerebral aneurysms and Multiple Sclerosis. Aneurysms are usually found incidentally in Multiple Sclerosis patients during a routine MRI scan. An aneurysm must be a certain size before it is typically visible on a routine MRI scan, since MR angiograms are not part of our routine MRI evaluation for MS. When you say you “had” an aneurysm last August during a hospitalization, I assume this means it was either clipped during a surgical procedure or a coil was placed in the aneurysm during an interventional cerebral angiogram. If this is the case, the aneurysm should not return. It is also unlikely that new aneurysms will develop at your age. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
Thank you, Healthcare Journey Doctors, for all the help you are giving. You are providing a great resource for which many are grateful. I'd like to ask about hyperintensities in a patient over 40 with a history of optic neuritis: a) if optic neuritis occurs with nonspecific hyperintensities, is the risk of MS raised and by how much? Or is this just if the hyperintensities occur in MS specific areas?; b) in such a situation is a mild increase in nonspecific hyperintensities between mris in any way significant?; c) how likely is it the optic neuritis and nonspecific hyperintensities would have different pathologies?; d) how would you recommend treating such a patient? Is treatment by a neurologist advised? What about symptom treatment? Is it recommended to treat nonspecific symptoms of MS (eg fatigue) with meds in such a patient or should the patient look for answers elsewhere? Answer: These are excellent but complicated questions about optic neuritis and an abnormal MRI brain with white matter hyperintensities. In general, having one WM lesion that looks like a demyelinating lesion (based on shape, size and location) increases the risk of developing MS over the next 5 years to about 75-80% Having no WM lesions in the setting of optic neuritis is associated with a lower (25%) risk of developing MS in the next 5 years. Most MS specialists recommend treating patients with WM lesions and a history of optic neuritis with one of the approved immunomodulatory drugs for MS (for example, an interferon, glaitramer acetate, or one of the oral medication for MS). In patients with no WM lesions, most neurologists would not recommend treatment. Regarding "non specific" WM lesions, the significance of these findings are not clear in patients without a diagnosis of MS yet. One has to take in to consideration other diseases that might cause non specific WM lesions, such as diabetes mellitus, hypertension, heart disease, migraine headaches, prior traumatic brain injury, etc. I would not recommend treatment of non-specific symptoms such as fatigue without first seeing a general physician (primary care doctor) to rule out other potential causes of "fatigue" (such as hypothyroidism, vitamin B12 deficiency, etc.). Benjamin Osborne, MD Associate Professor Departments of Neurology and Ophthalmology Georgetown University Hospital Here is My Question:
Can Tecfidera cause gastroparesis? Answer: I am not aware of Tecfidera “causing” gastroparesis. The GI side effects may be worse in those with gastroparesis. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego |
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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