​Question:
I have MS and I'm experiencing pin like feelings in my spine. What is that?

Answer:
A lot has been written about pins and needles on this website.  Whenever you want to know about something, just type it into the search box in the upper right hand corner of this screen and you will find everything that has been written about it.  We have included the link here as well: ​www.healthcarejourney.com/apps/search?q=pins+and+needles

Dr. Kinkel has a great blog written about abnormal sensations and MS: READ MORE

Here is My Question:
What is a T2 lesion on my cervical spinal cord?

Answer:
The T2 sequence is the most recognizable MRI sequence when evaluating MS pathology.  T2 lesions representative of the demyelinating plaque of MS is white and very conspicuous.  The cervical lesion simply means that the "white scar" is in the cervical (or neck) region of the spinal cord.  Many times radiologists will designate a level in the cervical spinal cord (i.e., C1, C2,...C7) where C1 identifies the top of the cord and C7 indicates the bottom (or lowest segment) of the cervical cord.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
KP Fontana and Riverside Medical Centers

Here is My Question:
Is an elevated neutrophil count in MS with Tecfidera serious?

Answer:
​In general we do not see elevations in neutrophil counts from MS or Tecfidera. They can be seen in the setting of recent steroid use or infection.

Benjamin M. Greenberg, MD, MHS
Vice Chair of Translational Research and Ambulatory Care
Department of Neurology and Neurotherapeutics
Director, Transverse Myelitis, Neuromyelitis Optica Programs
Co-Director, Pediatric CONQUER Program
UT Southwestern Medical Center
Childrens Health
Dallas, Texas

 Here is My Question:
When will the new drug for MS be approved and when can I take it?

Answer:
I believe you are referring to Ocrelizumab (Brand Name OCREVUS) in your question. The PDUFA date (this stands for Prescription Drug User Fee Act) is March 28, 2017. This is the date by which the FDA must make a decision as to whether they will approve OCREVUS. This date is not set in stone and the FDA is allowed to extend the date for valid reasons. They already extended the OCREVUS PDUFA date from December 28, 2016 to March 28, 2017, so we are hoping there will be no further delays.

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:
Hi, I was diagnosed with MS in January. My lumbar puncture was negative and so were all other tests except my MRI which showed a very small lesion, and I had a second episode of double vision (the first episode of double vision occurred 16 years ago without a diagnosis). According to some protocol I was started with Copaxone 20mg daily. Besides painful injection sites my problem is the anxiety and nervousness (almost like panic attacks). I am 5'5 and weigh 114 lbs. I have read some research that Copaxone 20mg every other day has the same results as daily injections. For the last week I have been injecting every other day and able to get a hold of my anxiety, short term memory and poor concentration that I was experiencing. Any medical advise or anyone that has been through this? 

Answer:
Copaxone can produce an “idiosyncratic” reaction of panic, chest discomfort and a general sense of ‘doom’ that comes on shortly after injection and typically lasts minutes.  This was described in the clinical trials of Copaxone and tend to occur after the first year of therapy in ~15% of individuals. That may be what you have been experiencing, however, this type of reaction tends to occur once and less rarely on multiple occasions.  On the other hand, by what you describe, you may be experiencing anxiety and panic around the injection itself (i.e., ‘needle fatigue’).  This can be mitigated by some degree with the auto injector, although others prefer not to use this device (personal preference).

Reduced frequency dosing has been vetted with 40mg three times a week (not 20mg).  Truthfully, no one really knows what the minimal effective dose of Copaxone really is. The 40mg three times a week has a short trial looking at MRI outcomes with the standard 20mg dose which appeared to be equivalent. Use of Copaxone with off-label dosing (i.e., 20mg with administration less than daily) should be monitored carefully to ensure no subclinical disease activity (manifestations of inflammatory disease in the absence of new symptoms through the use of MRI).

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
KP Fontana and Riverside Medical Centers

Here is My Question:
Should I be concerned that I took two 240 milligrams of my Tecfidera instead of one this morning?

Answer:
First, if ever worried about taking the wrong dose of a medication please reach out to your clinician or poison control! In general, that dose of Tecfidera is not dangerous as a one time event.
 
Benjamin M. Greenberg, MD, MHS
Vice Chair of Translational Research and Ambulatory Care
Department of Neurology and Neurotherapeutics
Director, Transverse Myelitis, Neuromyelitis Optica Programs
Co-Director, Pediatric CONQUER Program
UT Southwestern Medical Center
Childrens Health
Dallas, Texas

Here is My Question:
Which is the best iron supplement that helps to sustain energy levels?

Answer:
When it comes to Iron supplements, the question to ask is, “which supplement will not cause constipation.” I tend to recommend Ferrous Sequels or similar over the counter products to avoid constipation. It is also important that you not consume coffee, tea or dairy products within 1-2 hours of taking iron supplements; these substancesl decrease the absorption of iron

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:
I have just been diagnosed as having MS. There were lesions on my scan and spinal fluid was also positive and I have been prescribed Tecfidera. Because of the lesions, should I be concerned of long term disability? Is there any correlation?

Answer:
White matter brain lesions have a modest correlation to disability; however, the so called T1-black hole lesions have a stronger correlation to disability.  You can ask your neurologist about that as some individuals have very low burden of this type of lesion.  Other prognostic factors for disability in the future include short inter-attack interval (short time between relapses), motor/weakness attacks, spinal cord and brainstem lesions on MRI, etc.

Perhaps the most important factor for disability is a patient who is not on, or not compliant with, a disease modifying therapy when they are good candidates for treatment.

A. Scott Nielsen MD MMSc

Here is My Question:
Does hot yoga help with MS?

Answer:
Many individuals with MS are sensitive to heat. Heat often exacerbates the symptoms of MS.  For our classes dedicated to those with MS, we keep the temperature around 72 to 74 degrees. In fact, we tell our students if they are feeling heat building from the yoga to take a break and to let us know so that we can modify the class sequencing to adapt to student needs. 

Mindy Eisenberg
yogamovesms.org

Here is My Question:
How do you treat radiology isolated syndrome? Especially the muscle tightness. Also, is this the same as CIS?

Answer:
Radiographically isolated syndrome, by definition, means that there are no symptoms that can be attributed to MRI findings. The MRI was obtained for reasons other than neurologic symptoms from MS but finds lesions consistent with demyelination. Treating this condition is a very personal decision based on MRI patterns and possibly CSF findings. Symptoms that need management are usually ascribed to other conditions and managed according to those guidelines. CIS is a condition where there has been a documented clinic event.
 
Benjamin M. Greenberg, MD, MHS
Vice Chair of Translational Research and Ambulatory Care
Department of Neurology and Neurotherapeutics
Director, Transverse Myelitis, Neuromyelitis Optica Programs
Co-Director, Pediatric CONQUER Program
UT Southwestern Medical Center

Here is My Question:
I've had multiple sclerosis for 26 years now. I got my dog when she was a puppy about 10 years ago period she weighs about 55 pounds. I've trained her to help me climb stairs and do small tasks. I plan on moving into my boyfriend's apartment building. They allow pets there but they have to be under 35 pounds. If I register her to be a service dog online, would that be enough to grant me access to the apartment complex? 

Answer:
This is difficult to answer as laws pertaining to service animals can vary by state.  Moreover, registration of service animals will also vary by state (including what qualifies as a service animal).  I suggest you search online with your state and local government offices regarding service animal laws and service animal registration to help you answer your question.  If you are having difficulty finding the answers, you can ask your neurologist and/or case manager/social worker to help answer your question.  Another source of help would be your local chapter of the National MS Society.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
KP Fontana and Riverside Medical Centers

Question:
My daughter was diagnosed with MS 2 years ago.  She should be taking her MS medication, but I don't think she does and if I ask her about it she gets upset. I try to speak with her about eating well and reducing stress but again she gets upset if I bring anything up regarding her MS. I'm afraid that ignoring her MS will result in things getting worse.  What should I do to help?

Answer:
Please read this blog about people with MS not following their doctor's recommendations:
http://www.healthcarejourney.com/q--a-for-virtual-ms-center/why-do-some-people-with-ms-stop-following-their-doctors-recommendations

Here is My Question:
I'm being told I have MS. I don't have any lesions on my brain but aging spots. My lumbar puncture was cloudy. I have severe tingling and mobility issues. I'm on b12 injection monthly and 5000 strength d3 daily and fish oils. My doctor is speechless.

Answer:
I am not sure what question you are asking. If you or your doctor are not sure of the diagnosis, I suggest a consult with an MS specialist, assuming your current doctor is a general neurologist.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
200 West Arbor Dr
Medical Offices North MC 8687