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Can I get lip fillers if I have multiple sclerosis? Answer: Yes 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. Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #multiplesclerosis #MS
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Is Lemtrada effective in treating MS? Answer: Lemtrada (alemtuzumab) is very effective in early relapsing forms of MS but is typically reserved for individuals with a high risk of relapse and progression and is rarely used as first line therapy. It does have significant risks and should only be prescribed by an expert in MS management after consideration of other available highly effective DMTs. Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #multiplesclerosis #MS #Lemtrada Here is My Question:
With MS can I take Nucala? Answer: We have not seen any harmful effects from using Nucala in people with MS. That being said, it is doubtful that enough people with MS have taken Nucala to observe any rare side effects. This should not be used if you harbor a parasitic infection or take Helminth therapy for your MS. Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #multiplesclerosis #MS #Nucala Here is My Question:
What is the best medicine for MS? Answer: There is no particular "best" DMT for MS. There are certain high efficacy treatments, but the most appropriate medication requires balancing risks in particular individuals, required benefits based on disease stage and other disease characteristics. Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #DMT #MS #multiplesclerosis Here is My Question:
Does Kesimpta cause hair loss? Answer: Hair loss is not a side effect of Kesimpta Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #Kesimpta #hairloss #multiplesclerosis #MS Here is My Question:
My mother had PPMS and passed away 4 years ago. I contracted Covid in April 2022 and recovered from it. But in Dec 2022, I started experiencing tingling feet, pins and needles in my hands and feet, muscle spasms in my body, hand tremors, heavy feeling in my left arm and legs, cognitive issues and low mood. My brain MRI shows several lesions. My Spinal cord MRI has no lesions and lumbar puncture shows no OCB since I am probably early in the disease course. Do I have to wait until my spinal cord shows lesions ( which means I will have irreparable walking/ balance issues) or positive OCB ( 10% MS patients have no OCB) before I can get diagnosis and treatment for MS? Answer: Excellent question. Establishing a diagnosis of MS is not always easy. You are correct that some individuals do not have oligoclonal bands in the CSF and this may be associated with a type II or III pathological subtype by Claudia Lucchinetti's criteria. I would suggest another opinion with an MS specialist. The amount of information provided in your email is not sufficient to provide more information Good luck Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #multiplesclerosis #MS  #MS #multiplesclerosis
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Hello, I am a 35 year old mother of a 7.5 month old baby born last June. In April of 2021 I was diagnosed with Clinically Isolated Syndrome which I understand means that I’ve only had one episode of MS. (Which was optic neuritis, which made me temporarily blind in one eye) I was subsequently on Glatopa until I got pregnant in September of that year, and have been off medication while had the baby and was breastfeeding until yesterday, Feb. 10th, when I received a transfusion of Truxima 500mg. What I want to know is how long should I wait until it is safe to breastfeed again? And when will it be safe to start trying to get pregnant again? Thank you for your help! Answer: The safety of breastfeeding in people with MS after a rituximab infusion (or any of the anti-CD20 monoclonal IgG antibodies) was recently published in case series in the Journal of Neurology, Neurosurgery and Psychiatry, a British medical journal. Similar data was presented at last year's American Academy of Neurology Meeting. The data collected shows that shortly after (even within days) a rituximab infusion, there is minimal rituximab found in breast milk and no evidence that the small amount present in breast milk is absorbed in the GI tract of infants or lowers their B cell counts. This result makes a lot of sense; most IgG antibodies are transferred from the mother to the infant prior to birth. During the first 2 weeks of breast feeding, the breast milk, called colostrum, is higher in antibodies than the subsequent breast milk, so we would not recommend antibody therapies like rituximab during this period. Most of the antibodies transferred in breast milk are IgA antibodies (over 90%) with IgG antibodies representing only 5 to 6% of immunoglobulin. Since rituximab and all other anti-CD20 monoclonal antibodies are IgG antibodies, very little is transferred to human breast milk in the first year of breast feeding. The amount of IgA and IgG in breast milk increases somewhat in the second year of breast feeding but it is less common to breast feed this long in the US. Any Rituximab IgG in breast milk is quickly digested by the lower pH in the stomach and digestive enzymes. Remember, IgG is just a protein source, and it will not be active unless absorbed intact into the blood stream. In normal circumstances this is unlikely There are possible exceptions to this rule. If you have a premature infant or an infant with a GI tract disorder, they may absorb enough rituximab to lower B cell counts at least temporarily. It is unknown if this is the case or if it is the true, this would be harmful We have successfully treated women with MS breast-feeding post-partum with both rituximab and ocrelizumab to prevent post-partum relapses in high-risk patients. We wait 2 to 3 weeks to allow the mother to recover from the delivery and get used to breast feeding. While the numbers in our experience are small (less than 10), this has been well tolerated and effective. We do not treat mothers with post pregnancy complications or with premature infants. Overall, there is no consensus yet on this issue. Our policy in medicine has always been to avoid medications in mothers during pregnancy or post-partum when breast-feeding unless the benefits outweigh the risks. This is something you will have to decide after weighing the risks and discussing further with your MS specialist. If you have fewer risk factors for post-partum relapses, then you may want to just pursue exclusive breast feeding. There is some mounting evidence that exclusive breast feeding may lower the risk of post-partum relapses; but remember, exclusive breast-feeding means while the infant receives no other nutrition other than breast milk. Revere P (Rip) Kinkel, MDProfessor of Neurosciences Director of the Multiple Sclerosis Program University of California San Diego #breastfeeding #multiplesclerosis #MS #MSandbreastfeeding Here is My Question:
I was diagnosed with ME about 9 years ago but probably had for a few years prior. However, over the last couple of years I have started having extreme numbness and pins and needles, often causing weirdly pain, in my right hand/arm, especially after rest. I have an electric shock feeling going through both my hands several times a day also. Occasionally a tight feeling around my rib cage. My feet have become number as well as occasionally face numbness and other areas of my body. Otherwise just the typical fatigue, brain fog, muscle aches etc etc that I have with ME. My question is, do you think I may have MS not ME? My right arm is the worse and getting more severe. Struggling to use at times. I am awaiting a neurologist appointment. Answer: Myalgic Encephalomyelitis (ME) is often associated with abnormal sensations, including painful sensations. Determining whether these symptoms are potentially related to Multiple Sclerosis (MS) requires a thorough evaluation with an MS specialist. 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, I HAVE A QUESTION IN REGARDS TO VITAMINS TO BE TAKEN POST RITUXIMAB INFUSION. I CURRENTLY TAKE 5000 IU OF D3 DAILY BUT IS THERE ANY OTHER VITAMINS I SHOULD TAKE OR AVOID POST INFUSION? THANKS IN ADVANCE!! Answer: You should continue to take your normal vitamins and medications before, during and after your Ocrevus infusions. It is a good idea to delay an infusion for at least 2 weeks, if not longer, if you are ill with an infection (including a COVID infection) or just received a vaccination. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #Ocrevus #rituximab #multiplesclerosis Here is My Question:
Does teriflunomide make me shake? Answer: Teriflunomide should not make anyone shake or experience any unusual involuntary movements. Tremors and other forms of involuntary movements are common symptoms of multiple sclerosis. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #teriflunomide #multiplesclerosis #MS Here is My Question:
Hello! I’m a 39 year old female. In September I began having a whooshing sound in my left ear. Met with an ENT who diagnosed me with Pulsatile Tinnitus and had an ultrasound on my ear and neck. Everything was normal. They did an MRI and found my ear to be fine, but found a lesion on another part of my brain. Told me to schedule an appointment with a neurologist, which I did. Appointment was scheduled 3 months out. Then the week before Christmas, I woke up to my left eye unable to open due to pain. It hurt when I moved my eye. No redness, no swelling. Extremely light sensitive and blurry. Got in to see an eye doctor. Everything looked fine other than my vision was lower than it was. Diagnosed me with optical neuritis. Did the test to check my peripheral vision, and that came back significantly decreased in my left eye. Told me to meet with a neurologist, which I already had scheduled. A few days later, my eye was seeing large blue/green spots. Persisted for about a day. Randomly get headaches behind my left eye down through my neck. My neurology appointment is set for the end of this month. Does this sound like it could be or lead to MS? What steps would be taken next to find out? Thank you so much for your time!! Answer: It sounds like you experienced optic neuritis. The colored (blue/green) spots are called phosphenes and are common with optic neuritis. This is from irritation of the optic nerve and retina by the inflammation. Pulsatile tinnitus is common and rarely caused by vascular malformations or narrowing of the carotid artery. This is probably the reason they did the MRI before you experienced the visual problems I hope your vision improves soon. The neurologist or neuro-ophthalmologists will help you discover what caused your optic neuritis. There are many causes other than Multiple sclerosis. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #MS #opticneuritis Here is My Question:
I have painful cramps in my left foot that effect my big toe to move in an outward position away from the other toes. How can I alleviate them? Answer: For cramps in the foot do the following:
Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #MS #multiplesclerosis #footcramps Here is My Question:
Can I take the morning after pill while on Tecfidera? Answer: You can certainly take the 'morning after pill' on Tecfidera, but as always check with your doctor as I do not know of your particular health history. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #tecfidera #morningpill 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. Here is My Question:
I actually stopped taking it for 4 years. I was totally fine and still am. I take liposomal glutathione, b12 and D3 and iron every day and am on a pescetarian (and mostly paleo) diet. I also do a lot of yoga and swimming. ...has anyone ever heard of someone being misdiagnosed with MS? I think my initial diagnosis was actually a reaction to a mix of vaccines I had before a vacation. Answer: Misdiagnosis of MS is very common. For many years now, approximately 10-20% of patients referred to our MS Center with a diagnosis of MS do not fulfill necessary criteria for this diagnosis. In many cases the reason for misdiagnosis is misinterpretation of and/or over-reliance on MRI findings. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #MS #multiplesclerosis #msdiagnosis Here is My Question:
Is there a site where my MS diagnosis of 15 years can be treated? There are no local MS doctors and I have no reliable transportation to travel to another town. I'm in Decatur, AL Answer: You need an MS specialist who you can see in consultation at least once a year and who will work with your local primary care doctor or general neurologist. I would suggest traveling to the Vanderbilt University Multiple Sclerosis Center to see either Drs. Harold Moses or Ram Sriram or any of the other MS specialists in the program. Your local doctor should be able to provide a referral to their center. When I look up the travel distance from Decatur Alabama to Nashville it says it is only a 1 ½ hour drive. You can also contact the National Multiple Sclerosis Society for a list of certified compressive Multiple Sclerosis program within a reasonable driving radius. Good Luck 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:
I WANTED TO KNOW IF A MRI WITH CONTRAST IS NEEDED TO SEE AND/OR DETECT ACTIVE LESIONS AND PML ACTIVITY. I'VE ONLY HAD ONE MRI DONE WITHOUT CONTRAST. I TRIED LOOKING ON HERE AT PREVIOUS MRI QUESTIONS BUT I COULDN'T FIND A QUESTION SIMILAR TO THIS. THANKS IN ADVANCE! Answer: Good question. An active lesion is defined as a new or enlarging non-enhancing lesion or an enhancing lesion. Strictly speaking it is not necessary to use contrast (i.e. gadolinium ) to detect active lesions since all enhancing lesions in MS are associated with a non-enhancing lesion on a non-enhanced study. Contrast can make it easier to identify active lesions, particularly in those people with lots of MS lesions. The problem with using non-enhanced studies to detect active lesions is the need to compare the image with a prior image done in a similar manner. Since you can only say that the new or enlarging lesion occurred since the last MRI was done, it is difficult to determine when the new lesion occurred. This is why MRIs are often done every 6 to 12 months in people with early relapsing MS. New MS lesions tend to enhance for only a short period of time (a few days to 4 weeks), so an enhancing lesion is more predictive of very recent activity, unless the unenhanced MRI is obtained at short intervals (e.g., every 1-3 months). In practice it is usually not that important to know if a new lesion developed in the past month or the past 6 months, if you are using the MRIs to monitor the response to a disease modifying therapy. However, it is important to obtain a baseline MRI after starting the therapy. Contrast is also not required to detect PML. In fact, most PML does not show enhancement on an MRI scan unless and until your body mounts an immune response to the infection. Diffusion weighted images (particularly DWI trace images) in combination with FLAIR T2 weighted images are most useful for surveillance detection of asymptomatic PML. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #PML Here is My Question:
When getting Covid while on Ocrevus, should we expect to gain less protective antibody production, as is the case when getting the vaccine? I'm assuming that actual response would be impacted by b levels, from when the infusion took place, etc.? (We know that b depleting therapies like Ocrevus will inhibit antibody creation when taking vaccines.) Answer: There are virtually no systematic studies about SARS-CoV-2 antibody responses post COVID-19 infection in people with MS (pwMS) on different disease modifying therapies, including Ocrelizumab. Most of out information comes from studies of antibody production after vaccination. This information can be summarized as follows:
It is important to remember that you can not assume a SARS-CoV-2 antibody response will be protective against infection. Many arms of the immune system not measured with an antibody assay, especially T cell mediated immunity, are important in the immune response that creates protective immunity. Furthermore, not all antibodies are able to neutralize the SARS-CoV-2 virus, a step necessary for protection. There are studies showing an association between IgG antibodies directed against the spike protein and the ability to neutralize the virus, but this type of neutralizing antibody assay is not routinely done in clinical practice. We continue to recommend updated SARS-CoV-2 boosters in pwMS on anti-CD20 therapy. Many sources recommend waiting at least 3 months after an infusion to get a booster, but it is likely that your immune response to vaccination will improve if you can wait 6 or more months or obtain an additional booster when you are able to be off anti-CD20 therapy for more than 6 months. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis Here is My Question:
Does anyone still get flushing from Tecfidera after taking it for several years? Answer: Flushing can persist even after many years of treatment with Tecfidera or any of the Fumarates. The frequency of flushing decreases over the first 3 months but there are some people who continue to experience flushing with one or both doses. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #MS #Multiplesclerosis #Tecfidera #flushing |
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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