Here is My Question:
Hi, I was diagnosed with MS in January. My lumbar puncture was negative and so were all other tests except my MRI which showed a very small lesion, and I had a second episode of double vision (the first episode of double vision occurred 16 years ago without a diagnosis). According to some protocol I was started with Copaxone 20mg daily. Besides painful injection sites my problem is the anxiety and nervousness (almost like panic attacks). I am 5'5 and weigh 114 lbs. I have read some research that Copaxone 20mg every other day has the same results as daily injections. For the last week I have been injecting every other day and able to get a hold of my anxiety, short term memory and poor concentration that I was experiencing. Any medical advise or anyone that has been through this?
Copaxone can produce an “idiosyncratic” reaction of panic, chest discomfort and a general sense of ‘doom’ that comes on shortly after injection and typically lasts minutes. This was described in the clinical trials of Copaxone and tend to occur after the first year of therapy in ~15% of individuals. That may be what you have been experiencing, however, this type of reaction tends to occur once and less rarely on multiple occasions. On the other hand, by what you describe, you may be experiencing anxiety and panic around the injection itself (i.e., ‘needle fatigue’). This can be mitigated by some degree with the auto injector, although others prefer not to use this device (personal preference).
Reduced frequency dosing has been vetted with 40mg three times a week (not 20mg). Truthfully, no one really knows what the minimal effective dose of Copaxone really is. The 40mg three times a week has a short trial looking at MRI outcomes with the standard 20mg dose which appeared to be equivalent. Use of Copaxone with off-label dosing (i.e., 20mg with administration less than daily) should be monitored carefully to ensure no subclinical disease activity (manifestations of inflammatory disease in the absence of new symptoms through the use of MRI).
A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
KP Fontana and Riverside Medical Centers
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