Here is My Question:
Is it possible to have multiple sclerosis with out having your lower body affected? 

Answer:
There is no rule that says the lower body must be involved for a person to have MS although it would be unusual for a person to experience MS for years without symptoms or examination findings eventually developing in the lower extremities.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Question:
How is MS treated?

Answer:
The management or treatment of MS can broken up into 6 interrelated categories:

1. Education
   
2. Secondary Prevention
3. Enhancing recovery from relapses
4. Rehabilitation
5. Symptomatic therapy
6. Disease modifying therapy
   

These categories or steps are not meant to be achieved sequentially although certain steps will come before others. Instead, they are meant to work together to help you achieve the best outcomes possible. They will also change over time so be prepared to continue learning.

I encourage you to thoroughly read everything on the treatment page for this website READ MORE 
and to utilize the HealthCare Journey tool READ MORE so you can see what steps you can take depending on whether you have not yet been diagnosed or recently diagnosed.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Here is My Question:
If my MS is inactive how often do I need to have an MRI? I am claustrophobic and so MRIs are not fun and my doctor says I need one every 5 months? I haven't had any new symptoms so why do I need MRIs so often?



Answer:
This is a great question. How often a person needs to obtain a repeat MRI really depends on the circumstances. Let’s take the easy extremes to start:

1. A person stable by clinical and MRI criteria (no relapses, worsening symptoms or new MRI lesions) after 3 years of Disease modifying therapy probably does not need an MRI more often than every 2 years or when something new happens
2. A person with MS for more than 10 years with secondary progressive disease and no relapses in over 2 years probably does not benefit from repeat MRIs at all unless their rate of worsening is very rapid

This leaves everyone in between. Current recommendations are to repeat MRIs of the brain only every year unless there is a specific reason to do them sooner; the exceptions include monitoring people with more active disease, monitoring patients in the first year of treatment with a disease modifying therapy and monitoring for the development of PML in high risk patients on Tysabri. Most asymptomatic MS disease activity is reflected by an MRI of the brain so the spinal cord is less important in most circumstances for monitoring. 

Of course, it is only useful to repeat MRIs to monitor MS  if it is done correctly. Sadly this is usually not the case in most clinical setting. For this reason, MRIs tend to be most useful in the first 5 years after a diagnosis, when it is relatively easier to determine if there is anything new. 

In the near future we will be rolling out a way for people to ensure that useful information is obtained on repeat MRIs. Stay tuned to this site to learn more.

As for claustrophobia, I hear you loud and clear. For diagnostic purposes an open MRI will usually suffice but for repeat image analysis closed systems are preferable. Most people do very well with a good dose of lorazepam (1.5 to 2.0 mg) or alprazolam (same dose) about an hour before an MRI. You will need someone to drive you home

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:
When I get stressed my MS definitely acts up. What happens in my brain when I get stressed. Why does it make my MS worse?

Answer:
It is certainly true that chronic stress activates multiple sclerosis and stress management reduces MRI measures of MS activity and improves symptoms. David Mohr at Northwestern published clinical trial results in 2012 demonstrating a very significant reduction in both enhancing lesions and new T2 lesions (white spots) on the MRIs of people with MS randomized to 16 weeks of stress management. The exact mechanism responsible for the worsening of MS and other physical and mental health conditions with chronic stress is linked to the effects of chronic stress on the hypothalamic-pituitary-adrenal axis which is generally linked to chronic low level elevations in cortisol.

Notice how I have specifically referred to chronic stress throughout this answer. Acute stress has a number of beneficial effects just like acute short courses of corticosteroids can be beneficial in MS patients. 

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Question:
Could you please tell me what impact Cebutid does for MS? 

Answer:
Cebutid is a nonsteroidal anti-inflammatory agent used to treat pain (like ibuprofen in the United states). We know of no harmful or beneficial effects in Multiple Sclerosis patients.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Here is My Question:
Is there any problem taking antibiotics while taking Plegridy?

Answer:
There is no problem taking antibiotics while taking Plegridy to treat your MS.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

#Plegridy

Question:
I'm taking Tecfidera and it is making me feel so hot. What can I do?

Answer:
I invite you to read previous blogs we have written regarding flushing and Tecfidera and ways to manage it. The links are below. Good luck.

http://www.healthcarejourney.com/q--a-for-virtual-ms-center/thoughts-on-tecfidera

http://www.healthcarejourney.com/q--a-for-virtual-ms-center/how-long-should-i-take-325mg-aspirin-with-tecfidera

http://www.healthcarejourney.com/q--a-for-virtual-ms-center/i-have-ms-how-do-i-regulate-my-body-temperaturerelieve-flushing

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

#Tecfidera #flushing #tecfiderasideeffects

Question:
Do you really feel a cure for MS might be found soon? Why is it so difficult?

Answer:
A cure for any disease is possible once we understand the cause(s) of the disease. This is the main problem with finding a cure for MS at this time. We have a limited understanding of the mechanisms resulting in brain tissue damage and have only a limited ability to modify this damage with current treatments, but a cure requires a lot more information. 

Think of infectious diseases; these were incurable until we understood what caused them (bacteria, virus, fungi and parasites) and how they damaged the body. Then we had to discover how to selectively kill the microorganism without hurting the human body. This process took over 100 years. As soon as scientists discovered antibiotics, microorganisms started to evolve further to avoid being killed by these early antibiotics. Today there is a huge industry just trying to keep up with the mutations in microorganisms that allow them to evade destruction by older antibiotics. There is probably a lesson to be learned here; once we find effective treatments for MS, we may need to modify these treatments over time

So to answer your question, I have no idea when we will find a cure. I am focused on just finding better treatments.

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 that often with MS, one side of your body is impacted but mostly the legs. My question is why does the leg most of the time start to effect with people with MS? Would a medication for MS like Avonex now be better or Neurotin for pain relief in my leg?  I'm confused why the one side leg plays up in many people with MS.

Answer:
Pain of any kind is rarely a sign of new MS activity. The exceptions include the pain of optic neuritis worsening with movement of the eye and the rare patient with transverse myelitis and a swollen spinal cord In these cases, the pain seems to be caused by inflammation involving the lining of the nervous system in the area of involvement (called the meninges).

The more common chronic painful sensations in MS are referred to as neuropathic pain. This pain pain is attributed to old areas of scaring and remodeling in the nervous system.  Neuropathic pain from MS is often described as burning or burning alternating with freezing. An alternative type of neuropathic pain involves perceiving cold stimuli and pressure  applied to the leg as painful. Often these painful sensations are associated with constant or intermittent pins and needles (paresthesia), electrical shocks or jolts, jabbing sensations, itching or formications (creepy crawley sensations or sensation that water is dripping down the leg). 

Some people just describe a vague severe aching sensation deep in the leg that doesn’t appear to be coming from the bones or joints. A specific type of paroxysmal neuropathic pain is called neuralgia. This is a sudden stabbing or slashing sensation in the distribution of a nerve that occurs repeatedly during the day.

Pain with a palpable location or mechanical in nature (e.g. only with external rotation of the hip), particularly when involving a joint or a tendon, is not directly related to MS. Neuropathic pain may worsen with certain activities but will be present all the time and not directly attributable to a joint, tendon or muscle injury.

Now to answer your specific questions:

1. Why are legs involved by MS before other parts of the body? This is explained by the organization of your nervous system. All information going to the legs from the nervous system must pass down the entire length of the spinal cord whereas information going to the arms only needs to reach the upper spinal cord (the cervical region). There is simply more cumulative opportunity for pathways to be involved that will affect the legs.

2. Why does one side tend to act up more often in any individual person with MS? The most common areas for symptomatic reactivation of MS (relapses) are previous areas of involvement. Therefore, if you experience a relapse involving the right leg, future relapses are more likely to affect the right leg than the left leg.

3. Would Neurontin (gabapentin) or Avonex help? Gabapentin may be helpful if this is neuropathic pain from MS. Avonex will not be helpful for this pain.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego