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Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
Here is My Question:
Are allergy shots safe when you have MS? Also, is potent curcumin safe? It has immunomodulatory effects. Thank you. Answer: I know of no evidence that allergy shots create any harm in MS patients and they are not contraindicated in MS. I must admit, however, that few of my adult MS patients have ever reported taking allergy shots. The active ingredient in Turmeric is curcumin. Please read my previous answer on this subject at the following link http://www.healthcarejourney.com/q--a-for-virtual-ms-center/may-19th-2015 Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
Silly question-How do I know what kind of MS I have? Answer: That isn't a silly question but a great question and one that others have asked as well. Here is a previously written blog to answer your question. READ MORE Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
How concerned should I be about experiencing pins and needles that come and go on one part of my body? How do I know if this is a relapse? Thank you!! Answer: You should not be concerned about pins and needles sensations that come and go. They are annoying but do not signify a relapse. Read the blog on “Abnormal Sensations in MS” to understand this symptoms better 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 dx with RRMS for 2 year; I have been on Copaxone since diagnosis and Rituxan for another medical condition - Ocular inflammatory syndrome which is significantly improved on Rituxin. However, I've had a mild to moderate relapse on both drugs. I am considering staying on combo- but there is thought to moving on? What is your advice if could generally comment. I am considering Lemtrada. The ophtho would have to agree. Exercise, diet and spirituality are my coping methods. Thank You. Answer: It is hard to answer your question without knowing the details of your case. For the purpose of my answer I will assume you have an average case of MS and received the usual dose of rituximab (1000 mg IV X 2 doses every 6 months) in addition to the copaxone. Given these assumptions here are some issues to consider: Alemtuzumab is a great drug but causes prolonged immunosuppression and a significant risk of autoimmune disease (involving thyroid, platelets and kidneys). All of these issues can be managed. The bigger concern with someone early in the onset of MS , especially if they are relatively young with an uncertain chance of significant worsening over the next 5-10 years, is the potential for long term direct and indirect negative consequences of this treatment ? For instance, how long can you be treated and retreated with alemtuzumab and will this lead to other complications related to prolonged immunosuppression? What if you require other treatments, such as Tysabri, in the future? We know that a prior history of immunosuppression increases the risk of developing progressive multifocal leukoencephalopathy (PML) on Tysabri therapy. Therefore, treating with alemtuzumab first would create greater risks on Tysabri and potentially other DMTs as well. I would only consider Alemtuzumab in your case if I thought it likely that your disease would significantly worsen and limit your activities and ability to work and function within the next 5 years. Otherwise, I would consider an alternative disease modifying therapy. I hope this helps in your decision making. You will need to discuss your risk factors for near term disease progression with your MS specialist before you will be able to make this decision wisely. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego PLEASE NOTE: The information/opinions on this site should be used as an information resource 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. Here is My Question:
Is it possible to have multiple sclerosis without any vision involvement? The patient had demyelinating plaques in the MRI with typical clinical findings of ataxia, hyperreflexia and clonus. He never complained of visual symptoms. The optic nerve was normal. Second question: Do we treat patients with prophylaxis such as pegylated interferon if they present with a first attack with no such attacks before? Thank you. Answers: 1. Yes it is possible to have multiple sclerosis without any vision involvement. The majority of patients with multiple sclerosis will eventually have problems with their vision due to the MS but a small minority may never have vision problems due to the MS. 2. In general most multiple sclerosis specialists do recommend treating patients who have had a first attack of demyelination suggestive of MS, even if they do not meet the diagnostic criteria for MS yet. There have been several trials involving almost all of the injectable medications (interferons and glatiramer acetrate) demonstrating benefit from early treatment after the initial first attack. Dr Osborne Benjamin J. Osborne, MD, is an attending physician in the Department of Neurology and an associate professor of neurology and ophthalmology at MedStar Georgetown University Hospital.Dr. Osborne is board certified in neurology, with concentrations in neuro-opthalmology and multiple sclerosis. Here is My Question:
This is not really a question, but info on a wonderful online exercise site that i found. There is a variety of plans and levels, they are mostly free, and one can create a personal diary to follow progress - very motivating. Everyone can find something according to their shape and fitness level. I was too lazy to go to the gym, and worked on bunch of those exercises all winter and spring, and I am in a great shape! Good luck everyone, stay active! https://www.fitnessblender.com/ Ana Answer: Thanks Ana! We have put your tip on our "Tip of the Week" page. To find out more tips READ MORE If you have a tip that might help others, send it in to us! You can email us at [email protected] Here is My Question:
I was diagnosed with MS in 1992. Things have progressed and I can no longer walk or even stand up. My legs do not move and I can't even turn around in bed. Is there any hope for me or am I just waiting with no hope. Thank you, Michelle Answer: Michelle, there is always hope but what you really need is results. Try not to think in terms of cures or even walking for the time being. Instead, think in terms of baby steps and achievable goals. Meet with some people you trust and begin discussing things you could possibly accomplish with some new equipment or adjustments to your environment. Begin with finding a way to move around in the bed. Start with a small achievable goal and then move on to the next goal. Over time your successes will mount and with it your hope and chances for even bigger successes in the future. Keep us updated on your progress. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I've been injecting Copaxone 20 mg and then it's generic form for three months now (newly diagnosed RR). I have also become incredibly sick with a virus one month (lasted five days), and bacterial infections (upper respiratory, eyes; lasting 5-7 days) the subsequent two months. I've also had a week of relapses all three months. My understanding was Copaxone/Glatopa was not an immune suppressant but was instead supposed to increase the amount of healthy white blood cells and their action in my immune system, reduce relapse rates and slow lesion/disease progression. Instead, I feel as if everything's becoming worse in my body. What is happening? How can I be this sick with a virus or bacterial infection monthly, continue relapsing (though I'm relapsing a bit less) and have any sort of life? Is this common for users of this drug? I'm beside myself. Answer: There are many potential explanations for the recurrent infection but without knowing the details of your case it is hard for me to comment. What I can tell you is the following: 1. Copaxone or Glatopa does not suppress your immune system and I doubt it is responsible for the prolonged infection 2. Steroids can suppress your immune system, so if you received steroids in the past 3 months this may be your explanation 3. All disease modifying therapies like Copaxone take time to start working. It is not unusual for people to relapse in the first few months on treatment. It is the relapses beyond the first three months of treatment that create greater concern that the drug will not be effective if continued 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:
I was diagnosed in July of 1996 with MS due to bad case of recurrent vertigo and was on Avonex for 12 years before being removed and since on no recurring meds. For the last two years I have been having prolonged periods of dizziness to vertigo and have been put through couple of IV steroid treatments but recently been diagnosed with vestibular migraines and told change several things in my diet and start taking a drug topiramate and that it may take 2 months for it to clear up the dizziness. Since I know from the 9 MRIs I have had and the 4 different. Does this make sense? Answer: Paroxysmal vertigo is a symptom that is often not due to MS, even in patients known to have MS. Vestibular migraine is very common and the vertigo/dizziness usually occurs independent from the headache. The recommended treatment sounds reasonable. Good luck Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
I submitted a question last week but haven't seen an answer or see it logged anywhere so how do I know it got to your site? Answer: Good question. When we receive a question we do our best to make sure it is answered if at all possible within 2-3 days, and usually we are able to answer even before that but we do ask that people allow a week for us to answer. We can see that your question was sent in this past Monday, so it has only been 3 days. If ever someone posts a question and does not see an answer posted to this page within a week, please contact us via email (the icon is at the top corner of this page) which is what you did. At this time of year, many of our team are on vacation, so please be patient as we are doing our best. We will have an answer for you as soon as possible and it will be posted on this page of the website. Thank you for using this website and we hope it has been of value to you! -The HealthCare Journey Team Here is My Question:
How easy is MS to diagnose? After someone has an attack and they do an MRI of brain and spine, how easy are the lesions to see? If early in disease then how long would they take to show up? After 2nd attack or time frame? Answer: Generally MS is hard to diagnose with confidence early except in cases with very typical syndromes and typical MRI findings. This probably occurs in less than half of the patients in whom the diagnosis is initially considered. As many as 25 % of patients referred to tertiary MS Centers with a diagnosis have another condition or a rare variant of MS. Read through our diagnosis page on this website. Here is the link DIAGNOSIS PAGE as it has lots of information that might further answer your question. Also, in the search box in the upper right corner of the page, there is a search box. Type 'diagnosis' in this box and you will see many posts regarding the topic of diagnosis. Also, in the column to the right on this web page there are topics and you can click on 'diagnosis' to see all the many questions we have received regarding diagnosing MS. Scott Nielsen, MD wrote a blog about how long it takes to get a MS diagnosis that you might want to read as well READ MORE Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I was diagnosed 6 months ago. I have been on Tecfidera and I am due my 6 month scan this week. My neurologist is sending me for a brain scan, but no spinal scan. I am a bit confused that I am not having a spinal scan as when I was diagnosed I had 3 lesions on the spine but none on the brain. I also would like to know how do you really know if the Tecfidera is working, I could have more on the spine and still none on the brain? Answer: There is general agreement that more frequent monitoring MRI scans need only include the brain for 4 reasons: 1. New activity (New or enlarging T2 lesions or white spots) is far more common in the brain, especially new activity not producing any evident symptoms, which is the whole reason for MRI monitoring 2. When new activity involves the spinal cord it also involves the brain in well over 80 % of cases; new activity in the spinal cord is also more commonly symptomatic. 3. Community acquired MRI scans (non research scans) are inadequate for monitoring the spinal cord in most cases and provide very little additional information. In your case, monitoring the brain for new activity is easy since there was little evidence of MS (by your description the brain was “normal”) on the original MRI and anything observed on the next scan would be considered new. 4. Monitoring both the brain and spinal cord is prohibitively expensive and rarely alters treatment decisions. Remember we are not just using the repeat MRI scan for treatment decisions. We are also using your symptoms, examination findings and functional status for these decisions. If you were to exhibit new symptoms and findings related to involvement of the spinal cord, your physician would use this information to consider adjusting your treatment even if the MRI of the head revealed no new activity. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I had a clinical isolated syndrome, my MRI was negative and I still have symptoms a year later. Would you have no symptoms if it was not a clinically isolated syndrome? Answer: A clinically isolated syndrome or CIS is a single occurrence of symptoms and examination findings consistent with inflammatory demyelination in the central nervous system. A typical CIS would include optic neuritis, a brainstem syndrome or a partial transverse myelitis. Some people with a CIS go on to develop Multiple Sclerosis and some do not. We diagnosis MS when there is evidence of an inflammatory demyelinating process that reoccurs either symptomatically or by MR imaging. Recovery or lack of recovery from the CIS is not related to the risk of developing MS. In fact people with severe complete transverse myelitis have a low risk of developing MS, but often have significant residual problems that do not ever get better. Conversely, people can have little recovery from a CIS and go on to develop MS. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
Can a lumbar puncture provide a diagnosis of MS? My ms neurologist that I have saw to determine if I have ms said they won't do one as my mri were normal . Just had 2 small t2 hyperintense lesions in the subcortical white matter which she says is within the normal for my age which is 47 . Spine all clear as well . I live in canada and they don't do that for diganosis of ms . Answer: Lumbar puncture to analyze spinal fluid and help in the diagnosis of MS is done everywhere, even in Canada. Your doctor probably does not think the test is warranted in your case. For a test to be useful, it must have either a high positive or negative predictive value in your situation. Your doctor likely considered your history, exam and imaging findings and concluded that predictive value of performing a spinal tap was insufficient to warrant putting you through the procedure Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I understand that a recent study suggests benefits from taking 300 mg of Biotin daily for individuals diagnosed with progressive forms of MS. What are your thoughts on the study? If so, do you have a preferred brand or compounding pharmacy? Answer: French researcher’s did recently report preliminary phase III study results of a randomized, placebo controlled study of very high dose Biotin (labeled MD1003 this compound contains 300 mg Biotin per day) in people with secondary and primary progressive MS. The Biotin for this study is only made by the company that is funding this research for the purpose of obtaining regulatory approval for the treatment of people with progressive MS. The study results require confirmation but are quite hopeful. Biotin is a B complex vitamin (vitamin H) that we normally receive from various food sources and require for carboxylase reactions involved in normal energy metabolism and myelination. It usually comes in microgram (not milligram) quantity supplements (the max size I found online was 10 mg or 10,000 micrograms), so we have little knowledge of the effect of 300 mg doses in either humans or animals. In the French study, 154 patients were randomized to treatment with MD1003 (103 patients) or placebo (51 patients) for one year. All patients were required to demonstrate objective worsening on neurological exam in the prior 2 years and have an EDSS between 4.5 and 7. The study endpoint was the proportion of patients showing improvement on either the EDSS or the 25 foot walking time. 12.62 % of the patients randomized to MD1003 improved by the required amount by month 9 with sustained improvement continuing at the month 12 visit, whereas none of the placebo patients improved. Improvement began as early as 3 months after starting MD1003. Interestingly, MRI activity may have been high in the MD1003 group during the study although this did not reach statistical significance. Generally the MD1003 was well tolerated but does interfere with thyroid function testing, creating false positive test results in some people. The authors warn about trying to start on high dose Biotin supplements before the company completes their regulatory studies. This warning is well founded for several reasons: 1) there is no current supplement of Biotin at this dose, 2) we know little about short term safety except from this study and nothing about long term safety, 3) the authors warn about use in pregnancy but give no reason at present for this concern Stay tuned for more information. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
Is it normal for there to be three cases of multiple sclerosis on ONE street? Is there any possibility of environmental impact? I'm in Bitola, Macedonia. Thanks. Answer: That would really depend on the number of at risk individuals in the area you describe, the age distribution of the population and if any of these individuals are/were related. Assuming the number is high, the next step is to confirm the diagnosis in each case. It is quite possible that only 1 or 2 of the cases actually have MS and this would not be unusual. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
Are MS patients good candidates for interstim bladder pacemakers? My new gynecologist wonders why my urologist never recommended this to me. Answer: In general the bladder stimulators have been helpful to many MS patients, but a large number have reported a ‘wearing off’ of the benefit over two years. Thus, several urologists have cut back on using them. Benjamin M. Greenberg, MD, MHS Director, Transverse Myelitis, Neuromyelitis Optica and Pediatric Demyelinating Disease Programs Director, Neurosciences Clinical Research Center UT Southwestern Medical Center Childrens Medical Center Dallas, Texas Here is My Question:
I have asked many questions about medications, but what I have not asked is do MS symptoms normally subside after a while or stay the same? Answer: Symptoms from MS do fluctuate significantly and often subside with time. They also commonly return again in the future. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego We get this question a lot...here you go...http://www.healthcarejourney.com/q--a-for-virtual-ms-center/can-ms-patients-have-laser-eye-surgery
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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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