Here is My Question:
I am 54 years old and have been diagnosed with MS for10 years though in hindsite I realize I how symptoms for 10 years prior.

My question is about changing to a different DMT after two years on Copaxone. I’m of thin build and have just run out of options for injection sites.

I have for the last 6 years had no activity on my MRI but have slowly progressed, so now my neurologist believes more progressive disease.

I was on Beta seron for three years, Tysabri three years ( jc negative) and Copaxone one for 2 years. My neurologist wants me now to take Tecfidera. I’m conflicted as what to do and if this really is the best path forward. 

Thank you.

Answer:
I’d suggest speaking to your neurologist about one of the b-cell biologics (Ocrevus, rituximab) or possibly siponimod (similar to gilenya).  These therapies have shown ability to slow down the rate of progression (particularly in individuals with signs of recent inflammatory disease activity.

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

Here is My Question:
Does Difan Flex medicine contain cortizone?

Answer:
Difen Flex does not contain cortisone, but rather Diclofenac which is a Non Steroidal Anti Inflammatory medicine.

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

Here is My Question: 
Are hyperintense signals in the subcortical region of brain a sign of MS?? 

Answer:
Hyperintense signals on certain MRI sequences can be seen in MS and a variety of other conditions. To determine if the changes are due to MS depends on the size, shape, location and total pattern seen on a MRI. There are many things that can cause sub cortical changes on a brain MRI other than MS, so the context matters a lot.
 
Benjamin M. Greenberg, MD, MHS, FAAN, FANA, CRND
Vice Chair, Translational Research and Strategic Initiatives
Director, Transverse Myelitis and Neuromyelitis Optica Program
Co-Director, Pediatric CONQUER Program
Department of Neurology and Neurotherapeutics
Department of Pediatrics
UT Southwestern

Queston:
I am 23 and have MS. I have been on Ocrevus for the past year. I have had a flu shot. My understanding is that getting a pneumonia vaccine is safe for people with MS. Is it still safe to get a pneumonia vaccine while on Ocrevus? If so, which should I get, PCV13 or PPSV23 and if both in which sequence? Is it best to get the pneumonia vaccine just before my next infusion or after?

Answer:
It is certainly safe to receive the vaccine, other than the small risk of some allergic reaction.

We do not know how effective the vaccine will be in people on Ocrevus or other B cell depleting therapies. Evidence in children with immunodeficiency suggest that the Memory B Cell subset, which is depleted by Ocrevus and other B cell therapies, is required for effective immunization against pneumococcus and it generally takes longer than 6 months for the memory B cell population (CD19+, CD27+ cells) to return after an Ocrevus infusion. In high risk populations (older patients and those with splenectomy) we would immunize before starting treatment. As a 23 year old you many have been immunized in childhood, since they started childhood immunizations in 2001. You may want to check your pediatric records.

As long as you are not significantly disabled or immunocompromised and as log as you still have a high functioning spleen, I would not consider you in the high risk group.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
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: 
Have you ever heard of Autohemotherapy? I know it’s something not well known but can it be used to fight MS. 

Answer:
Autohemotherapy has been around for over 100 years, more commonly used in Europe. There is no good evidence (not even class III) of benefit in MS, but very few studies are reported. Mostly just anecdote at this time.

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: 
My glutamine level is low. I am vegetarian and wonder if that could be part of it or could it be something else? 

Answer:
Glutamine is considered a conditionally essential amino acid, which means that your body is able to synthesize it, but it becomes essential under periods of physical and emotional stress, systemic illness, high metabolic activity or severe deficiency in the diet. It is synthesized primarily in muscle and levels are related to muscle mass with lower levels occurring with lower muscle mass or muscle wasting disease. It is also the amino acid in the highest concentration in your blood stream. A low level could be due to measurement error (a common reason), metabolic stress, muscle wasting or diet deficiency. Supplementation and muscle strengthening is effective at improving this deficiency

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

This My Question:

Is this neurotrophic keratitis?

I was diagnosed with MS in 2013, symptoms in 2011. I have several areas of demyelination on brain MRI and c-spine at C1 and C5-6. I was seen by ophthalmology in 2016 for eye redness without discharge. I had keratitis and was given steroid drops. I was recently seen again and diagnosed with keratitis with corneal ulcer and treated with steroid eye drops.

I have had similar issues in the past two years but did not seek treatment because there was no drainage, it was not that uncomfortable and resolved in 3-5 days on its own. I asked my ophthalmologist if this was related to MS and was not given an answer. I do not wear contacts, have not injured my eyes. I did have lasik surgery about 10 or so years ago. My eyes may get a little dry but I have never been diagnosed with dry eye. I will see my neurologist in January, is there anything I should be asking him to evaluate or is not related to MS?

Answer:
This would only be considered neurotrophic keratitis if you have damage to your trigeminal nerve, leading to denervation of the cornea (lack of sensation in the cornea).

Typically in MS trigeminal nerve issues manifest not as neurotrophic keratitis but rather as trigeminal neuralgia, an extremely painful form of headache/facial pain.

Usually with neurotrophic keratitis, the trigeminal nerve dysfunction causes numbness/lack of sensation and this lack of sensation in the face and in particular the cornea leads to the keratitis.

You can see a cornea specialist or neuro-ophthalmologist to try to figure this out.

Benjamin Osborne, MD
Associate Professor of Neurology and Ophthalmology
Director, Neuromyelitis Optica (NMO) and Neuro-Ophthalmology Clinics
Associate Director of the NIH/Georgetown Neurology Residency Program
Medstar Georgetown University Hospital

Here is My Question: 
What would you recommend for a patient on Ocrevus and trying to conceive? I read that Rituxan is not associated with birth defects. I am on folic acid supplementation. Thanks! 

Answer:
While we have no data on this, the drug itself leaves a human after 6-8 weeks so some feel it is ok to get pregnant 8 weeks past last dose.

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

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 there any correlation between someone taking glatiramer acetate injections and having frequent (checked every three years) large colorectal polyps? I recently had a colonoscopy with the removal of a large polyp and was told that this could be a factor on size and frequency. I had never heard this before so I thought I would ask for some clarification. Thank you. 

Answer:
I can not conceivable think of how glatiramer acetate (i.e. either copaxone or glatopa) could contribute to GI polyp formation or polyp size. This also has never been reported in the literature

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