Here is My Question:
I have a new lesion that is listed as possible encepholomalacia in the thalamus that is new from last MRI 7 months ago. Is this from MS?

Answer:
This could be from MS or another process. Without knowing your case or seeing your images it is not possible to answer your question.

Revere P (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’ve had numbness in my limbs for the last 6 years, but since last one month it has increased, and I've been using a walker since last one year. Please help & tell me any remedy.

​Answer:
It sounds like you need to see a neurologist to start.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#MS
​#multiplesclerosis

Here is My Question:
When do I need to take action to come off Ocrevus if it’s not working and I’m deteriorating at much more aggressive rate since I’ve gone on Ocrevus. What are my next options then?

Answer:
When to stop Ocrevus depends on several factors including your age, disease type, disability level, prior treatments and complications while taking Ocrevus. You would benefit from an evaluation by an MS specialist to help you with this decision. If it helps, I typically encourage my patients to set specific goals before initiating a treatment. This makes it easier to determine when it is time to stop treatment or consider another treatment. Many of the options after treatment with Ocrevus include participation in various ongoing clinical trials. Your MS specialist can tell you how to find out about clinical trials in your area for patients with your disease characteristics.
Good luck

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#Ocrevus

Here is My Question:
Can Kesimpta cause hair loss?

Answer:
Ofatumumab (Kesimpta) is not associated with hair loss.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#Kesimpta

Here is My Question:
How to decrease blood levels of JCV?

Answer:
I believe you are asking how to decrease your JCV index level ( a blood test to determine antibodies directed against the JC virus), if you are positive. There is no reliable method for decreasing your JCV index level. Several studies suggest that treatment with B cell and T cell depleting agents (e.g., rituximab, ocrelizumab, ofatumumab and alemtuzumab) can decrease the value of your JCV index and treatment with natalizumab and fingolimod can increase the value of your JCV index. The significance of these associations is unclear currently.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#JCVindex​

Here is My Question:
I have long standing Type 1 diabetes and MS. How to I determine the etiology of my foot cramps between MS vs periperal neuropathy? I have had foot cramping in years past, but it resolved- it is now more consistently present. I usually get routine MRI’s done year.y- which have shown no change. I am an RN and knowing how to differentiate the symptoms is important to me.

Answer:
PS Foot cramping is common in both diabetics and people with MS. See my last response

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego​

Here is My Question:
Hello (again)- I just submitted a question regarding T1D and MS symptoms of foot cramping/numbness. I forgot to add that I have had T1D for 49 years- with reasonable glucose control- I wear a pump/cgm. The MS was formally diagnosed 10 years ago, but I may have actually had it starting since the age of 18. I am now almost 60. Only took Tecfidera briefly as it caused hypoglycemia. No changes on MRIs done yearly and to this point no severe disabling- only intermittent numbness/pain/fatigue.

I am wondering how best to have work up done to evaluate MS vs T1D neuropathy vs sacral lumbar issue...Thanks so much for your insights.

Answer:
It should be fairly easy to differentiate MS related sensory symptoms from diabetic neuropathy or lumbosacral polyradiculopathies (Lumbar canal stenosis, for instance). Remember, Multiple Sclerosis does not affect the peripheral nervous system which is the source of symptoms in people with either diabetic neuropathy or lumbosacral nerve root compression or injury. Peripheral nerve disease or injury can be evaluated with nerve conduction studies and electromyography, a procedure commonly performed by neurologists specializing in neuromuscular disease. The next step would be to see this type of specialist.

Good luck

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#multiplesclerosis
#lumbosacral

Here is My Question:
I have MS and had fillers in my face 8 weeks ago. She hit a bone or nerve with one. Since then l have been on antibiotics for 3 weeks but my face is aching from eye to jaw. Also I have the cold/ burning down that side. I usually get symptoms on that side but only for a few days. This has now been 2 weeks and cold and wind make it so much worse.

Answer:
Hello
Your message does not specifically state a question. It sounds like you underwent minor plastic surgery ("Filler") and now have an infection with pain. Please contact the physician who performed the procedure on you.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

Here is My Question:
What are the possibilities and effectiveness for the new DMT “BTK inhibitors” being developed? Are there any studies that someone in San Diego might be able to sign up for? For those already on BCell depleters like Rituxan or Ocrevus, would they eventually be able to take a BTKi? How far off do you think we might be in seeing this drug come out?

Answer:
BTK, which stands for Bruton Tyrosine Kinase, inhibitors are a promising new class of treatment capable of regulating B cells and microglial activity in the central nervous system without depleting or destroying these cells. There are many phase III studies underway for both relapsing MS, Secondary Progressive MS and Primary Progressive MS. Preliminary phase II studies in relapsing MS showed significant effects on MRI activity and no unusual or serious safety concerns. Phase II studies are required before moving on to phase III studies which determine the clinical effectiveness and  safety of a drug in a larger number of people with MS.
Tolebrutinib, a BTK inhibitor made by Sanofi, is furthest along in development with results possibly available in 2023. 

UCSD is recruiting relapsing patients for a trial of Evobrutinib (a BTK inhibitor made by Merck) and  progressive (both secondary and primary) patients for trials of Tolebrutinib.
If you go to the Clinicaltrials.gov web site you can look up any MS clinical trial and find out how to obtain information on possible participation and the location of study sites.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

#multiplesclerosis
#BTKinhibitor
#DMT