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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.
CLICK HERE TO ASK YOUR QUESTION!

CAN YOU TAKE FINASTERIDE IF YOU HAVE MS?

10/30/2019

 
Here is My Question:
I was wondering can you take finasteride with MS and is it safe to use with other various MS medications?

Answer:
There is no contraindication for the use of finasteride in Multiple Sclerosis patients.

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

IF I HAVE A COLD SHOULD I STOP TAKING TECFIDERA?

10/25/2019

 
​Here is My Question:
If I have cold should I stop taking Tecfidera?

Answer:
For most people there is no reason to stop Tecfidera for a minor infection like a cold. You should inform your doctor so they at least know about your infection.

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

Why is my white blood cell count low?

10/25/2019

 
Here is My Question:
My neuro is planning Rituximab for me and I have got all the tests prescribed by him done. Everything is normal, I have even taken the vaccinations he advised me to but the WBC test wasn't normal in the sense that my WBC or TLC count came out to be low each time I got it done (the values being 3900 and 4400, wherein the B cell count was high which anyways would get depleted after the infusion leaving me with very little immune system to fight any possible infections in case my WBC count remained low) and my doctor has advised me to wait for the count to normalize. But why it is low at the very first place (as I have been drug-free for the past 1.5 years) ? I mean a period that long is good enough for wash out.

Answer:
There are many reasons for a mildly low white blood cell count (WBC). The numbers you provide (3900 and 4400) are actually fairly normal WBC.

You didn’t actual provide a total lymphocyte count (TLC), so I can not comment on whether that count is low.

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

What imaging protocol should be included with the MRI to visualize the trigeminal nerve and brain stem better?

10/25/2019

 
Question:
What imaging protocol should be included with the MRI to visualize the trigeminal nerve and brain stem better?

​
Answer:

The imaging protocol for assessment of cranial nerves usually includes  typical T2 and T1 weighted images with or without gad preferably with 3D thin sections, plus a balanced gradient echo image. The name of the balance gradient echo image varies according to the MRI manufacturer; the GE sequence is called FIESTA, Seimen’s is called FISP and Philips’ is called Balanced-FFE.

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

How long do I have to wait after my last infusion of Ocrevus to switch back to Tecfidera??

10/14/2019

 
Here is My Question:
How long do I have to wait after my last infusion of Ocrevus to switch back to Tecfidera??

Answer:
The answer to this depends on the MS disease response (not MS symptoms) to the Ocrevus as well as your immune system response (determined by blood testing).  In general, combination treatments are not overwhelmingly better than mono therapy in MS, but we can see increased risk with combination therapy (ie, PML).  By monitoring the immune system through blood testing over time, your physician can determine when your b-cells are returning (typically after 6 months).

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

can a painful achilles tendon be related to MS?

10/14/2019

 
Here is My Question:
Can a painful and tight achilles tendon be related to MS or possible worsening of walking? I have MS and have issues with my feet especially my right. I get numbness in my foot after walking a distance. I’ve recently started having Achilles area pain and had a popping. Went to an Ortho and they said it is likely MS related and could lead to foot drop etc. is the something you’ve seen with MS? If so, does it usually precede the foot drop issues? My pain is usually when I point my toe, not flex them up. I also have weakness when pushing the Gas pedal etc with that same movement. Thanks!

Answer:

A tight Achilles and popping is a musculoskeletal issue and not directly related to MS. Spasticity of muscle can occur due to MS but is not a tendon issue. I’d suggest you speak with your neurologist or get another opinion (from a podiatrist or sports medicine physician).

A. Scott Nielsen MD MMSc
​Neurologist and MS Specialist at Kaiser Permanente

IS IT OK TO TAKE OCREVUS AND MIRENA TOGETHER?

10/7/2019

 
Here is My Question:
Is it OK to take Ocrevus and Mirena together?

Answer:

There are no specific problems associated with the use of Ocrevus in people with a hormone releasing IUD like Mirena.

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

does trigeminal neuralgia in MS usually mean a definite pons lesions or brain stem lesions?

10/7/2019

 
Here is My Question:
I have had MS for about a year and a half. I have developed many symptoms and it just won’t let up. My question is about trigeminal neuralgia. I have been having a severe shooting aching burning pain on and off in the right side of my face and I’m about 90% sure it’s trigeminal neuralgia. It is very typical of what I’m reading. I have an MRI scheduled next week. I was wondering, does trigeminal neuralgia in MS usually mean a definite pons lesions or brain stem lesions? Can any of the other lesions in the brain cause this pain? I haven’t had any brain stem lesions but I do have cortical and juxtacortical and spinal cord lesions. My highest spinal cord lesions is in C2. I also didn’t have any cerebellum lesions. Should I expect to have pons lesions now?

Answer:
Both Trigeminal neuralgia (TN) and atypical facial pain are common in MS patients. Trigeminal neuralgia is most often a paroxysmal (rapidly coming and going often multiple times a day), lancinating (like a knife or ice pick) pain in the jaw or maxillary region usually triggered by touch, chewing or talking.

Trigeminal neuralgia in MS patients can be due to vascular compression of the trigeminal nerve as it is exiting the brainstem, a demyelinating plaque of the trigeminal nerve exit zone or both. 
We can often see MS involvement of the brainstem in patients with trigeminal neuralgia, but only if high field (3 Tesla) magnets are used with the correct sequences. Typical MRI scans often do not clearly show the area involved by your MS that is causing the trigeminal neuralgia.

TN is very treatable so I hope you get relief soon.


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

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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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  • Home
  • About Us
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • Seminar Registration
  • Health & Wellness
  • Blogs
    • Physician Blog >
      • Healthcare Provider Blog
    • Physical Therapy Blog
    • Patient Blog
    • Caregiver Blog
    • Research Blogs >
      • "Ask Dr. Debbie" Research Blog
      • Multiple Perspectives In Multiple Sclerosis Research Blog
  • About MS
    • What is MS?
    • Diagnosis
    • Treatment
    • MS Tips
  • Symptoms
    • Balance and Walking Issues
    • Breathing/Respiratory
    • Bowel Dysfunction
    • Cognitive Dysfunction
    • Crying/Laughing Uncontrollably (PBA)
    • Depression and Anxiety
    • Dizziness/Vertigo
    • Dysphagia
    • Fatigue
    • Foot Drop
    • Hearing or Smell or Taste Changes
    • Heat Sensitivity
    • Leg Weakness
    • Loss of Hand Dexterity and Coordination
    • Memory and Mutliple Sclerosis
    • Migraines
    • Numbness/Tingling/Altered Sensation
    • Nystagmus and Oscillopsia
    • Pain
    • Sexual Dysfunction
    • Sleep Issues
    • Spasticity/Spasms/Cramps
    • Speech/Swallowing
    • Urination/Bowel Problems
    • Vision
  • MS Clinics
  • MS Topics
    • Pregnancy and Infertility
    • Caregivers and Family Members
    • Employment and MS
    • Medical Costs and Insurance
    • Pediatric Multiple Sclerosis
  • Register With Us
  • Terms of Use/Privacy/HIPAA
  • MS HealthCare Journey