Are some symptoms only related to spinal MS?

Here is My Question:
Hi from Rockford, IL.
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I have primary progressive MS. My lesions are spinal. My neurologist says that I may have silent lesions on my brain but have not been seen on MRI. I am 54, and have had to take disability because of the progression. I am a 6th grade teacher, but could not continue teaching because of stiffness, pain, and fatigue. I have noticed the last two days, my fatigue being worse than ever before, for no real reason. I am on no meds other than Tizanadine and Adderall. I am concerned. Are there symptoms that are only related to spinal MS? I feel like every time I tell my doctor about symptoms, he basically tells me...you have MS. I am a smart woman. I read an abundance MS articles, and have even written my own articles that have been published. I am just needing some advice and asking for your wisdom about my specific spinal MS. Thank you for your time today.

Answer:
Spinal cord predominant MS is more common among those with progressive MS. However, conventional MRI is insensitive to the prevalent cortical demyelination that is more prominent as a patient ages (but also can be seen early in the disease course noted in the pathology literature).

Whether or not the cortical lesions of MS contribute to the common complaint of fatigue is not clear.

Fatigue is the most common (and disabling) feature of MS.  It is present for most regardless of the form of MS a patient has.  Addressing this manifestation of the disease includes reviewing medication side effects, evaluating your sleep patterns as well as competing medical issues (low thyroid, anemia, sleep apnea, etc).  Based on that evaluation, a mitigating treatment course can be prescribed and may include a stimulant medication if appropriate.  You appear to be on a stimulant, so it may be reasonable to approach your doctor for more evaluation of your fatigue since it isn’t optimally controlled.  

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