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Here is My Question:
Is there any problem taking antibiotics while taking Plegridy? Answer: There is no problem taking antibiotics while taking Plegridy to treat your MS. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego #Plegridy Here is My Question:
I have 3 lesions on my spinal cord. What could cause this? Does this mean I have JC virus or PML? Answer: I have always hated the term, “lesions”, because it so non-specific. The literal translation is something structurally abnormal. In the context of Multiple sclerosis, a lesion usually refers to a white spot (T2 hyper intense) on MRI. These T2 hyper intensities or white spots are common in both the spinal cord and brain. In fact it is extremely rare for a person to have MS without these white spots on MRI. The good news is that PML does not typically involve the spinal cord so you do not have to be concerned about that diagnosis. If you have MS, then that is the most likely cause of the white spots on your MRI can. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I am in search of a good MS Neurologist and have found one. I phoned the reception and they need an email from my current Neurologist or doctor. She asked what sort of MS I have and I told her inactive. She said to me "okay so it is not urgent" This is in France. I notice every time i say inactive, it seems its not important to be treated. I have a lot of pain in my right leg and I need a good Neurologist just to prescribe me some medicine for this pain. So is inactive not bad enough????regardless of my pain?? How does a Neurologist look at inactive versus active? Mind you inactive can turn active so I'm confused?? Answer: The response that you received regarding your “inactive” MS statement certainly suggests a lack of understanding of the new MS Classification system. Whether a person is ‘active’ or ‘inactive’ has little to do with either the number of health problems or symptoms they are experiencing or their severity. In your particular case being ‘inactive' simply means that you have not experienced a relapse or new a lesion on MRI since your last evaluation. In fairness to your doctors we all try to prioritize appointments for patients getting rapidly worse, either from a relapse or disease progression. This does not mean your concerns are not important or even urgent. Living with significant pain can create a number of detrimental long term affects. I would suggest avoiding the ‘active’ or ‘inactive’ terms when requesting an appointment and simply state that you have severe pain related to MS and need help. Good luck Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
My GP prescribes 'Sifrol' for me. I have pain in my right leg and arm and hand and behind my eye. I know this is for restless leg syndrome but honesty I have nerve pain so how will this help me? I have taken it for one week now with no results. My problem is finding a MS Neurologist. Answer: This is an excellent question. We do not usually use a dopamine agonist like pramipexole (Sifrol is a brand) to treat neuropathic pain. You may want to suggest a trial of gabapentin or pregabalin to your general doctor. Good luck. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
Why did Biogen make Plegridy a subcutaneous shot instead of an IM one like Avonex? I'm switching from Tecfidera (which I took from 5/2014 to 5/2015) to Plegridy on June 12 because of my persistent low lymphocyte count, and I'm feeling very nervous about the possibility of injection-site reactions. I took Avonex for over 14 years (2000 to 2014), and never had an injection-site reaction. My neurologist didn't want me to go back on Avonex because I had 2 flare-ups within a 6-month period of time right before I switched to Tecfidera (however, from July of 1992 until October of 2013, I was relapse-free). I really wish Plegridy was an IM shot! Answer: My understanding is that Biogen elected to administer Plegridy subcutaneously based on market research suggesting that patients preferred subcutaneous injection. I personally disagree with this assessment. My experience has always been that patients prefer subcutaneous over intramuscular interferon shots only until they have experienced both forms of injection. With experience most patients learn that intramuscular injections are not as painful and do not create pain skin reactions as often. We are almost pre-programmed to think that a larger needle injected slightly deeper is more painful when this is not at all the case with interferons. Whether Plegridy is the best choice for you now is a different question altogether. If you had two relapses on interferon beta 1a (Avonex) within 6 months of starting tecfidera, why would pegylated interferon beta 1a produce a better response? They bind to the same receptor and have the same mechanism of action. There is certainly no evidence that Plegridy is superior to Avonex. If would seem to me that you and your physician should be considering a non interferon choice at this point in time. After all, there are a lot of treatment choices available today. Discuss this further with your MS specialist and good luck with whatever decisions you make together. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
I smoke cigarettes but don't drink. Is it safe to be on Ampyra if I'm a smoker? Answer: There are no contraindications or warnings regarding smoking and Ampyra. In the absence of data, we suggest you speak with your physician about your situation. As you probably already know, smoking is bad for MS, and while it is difficult to quit it is highly recommended to do so. Here is a previous blog about smoking and MS. http://www.healthcarejourney.com/q--a-for-virtual-ms-center/smoking-and-multiple-sclerosis Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Here is My Question:
I'm thinking of stopping Copaxone. I'm considering not doing anything, quite frankly. Is it always necessary to treat MS? I'm just quite tired of the lack of caring on the doctor's part and taking the injections. My issues are mostly cognitive. I'm so depressed, I just want to quit. Maybe if I could stop thinking about the whole thing, I would feel better! Again, does one ALWAYS have to go on a DMD? I can't take Rebif, Gilenya and I hate the bumps from Copaxone. Answer: You have a lot of company when it comes to being tired of giving yourself injections and wondering whether you need to be on a disease modifying therapy at all. The most common reason for stopping long term injectable DMTs is "injection fatigue” combined with depression. Nothing is more important that treating your depression. In order to effectively manage your MS using DMTs (assuming they are warranted in your case) your doctors must help you with your depression and your outlook. Let me also be clear that this is a group effort; your doctors may or may not be able to prescribe effective anti-depressants and help you find a good therapist (both important); you must also take responsibility for improving your mental health and outlook. This may involve exercising more regularly, eating better, stopping smoking or using unnecessary drugs, reengaging in activities of interest to you and reconnecting with people in and outside of your family. To answer your question more directly, not everyone needs to be on a disease modifying therapy, although I have no idea if this statement applies to you. What I do know is that everyone needs to work on enhancing their own innate "self efficacy" (see prior Blogs) so they have the tools to deal with MS over time or any vicissitude of life. Good luck to you Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question: I started to get tension headaches at the age of 14 yrs old and from the age of 17 yrs I had one every day to this day. Around 14/15 yrs of age I got glandular fever. At age 13 I had a head on collision car accident and broke my upper leg and thumb and spent 2 months in hospital. After that time I struggled with my health, especially my headaches. When I was diagnosed with MS 3 yrs ago it sort of solved the puzzle. I had my first attack 3 yrs ago with my eye. I am 43 yrs old now. My question is can you have MS for years without having an attack???? My neurologist said I have had MS for years. I think I've had it since around 17 yrs of age but I never had a attack, unless my headaches were a MS attack?? Answer: It is widely recognized now that MS usually exists for years if not decades before a person develops identifiable symptoms. There is even a new descriptive category for patients identified by random MRI scanning for other reasons (often headaches) during the asymptomatic stage, called a 'radiologically isolate syndrome' or RIS. Most recent studies suggest that about 1/3 of people with RIS will go on to develop clinically evident multiple sclerosis within relatively short follow-up periods. It is quite possible that the percentage of people with RIS who develop MS will increase as they are followed for more than a decade. An MS diagnosis is frequently predated by unusual though non specific symptoms including headaches, tingling sensations, mental fogginess and fatigue. However, these symptoms are so common in otherwise healthy individuals as to render them of limited diagnostic utility in isolation. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I have been on Gilenya for 3yrs. Several months ago I was diagnosed with breast cancer. My neurologist took me off Gilenya while I was going through treatments for cancer (lumpectomy and radiation). I'm now cancer free. My neurologist said I shouldn't go back on Gilenya because of my previous cancer diagnosis. He put me on another drug but the side effects bothered me so he took me off it. He now wants to put me back on Gilenya. I also tested positive for JC virus. I just read about the concern of Gilenya and the possibility of causing PML. Should I be concerned about going on Gilenya since I've had cancer and tested JC virus positive? Answer: The incidence of PML in MS patients receiving Gilenya since its approval in 2010 is extremely low. There is no evidence that JC virus antibody studies predict the risk of PML on Gilenya or any therapy other than Tysabri. There is also no clinical evidence from post marketing studies that Gilenya interferes with the ability of your immune system to provide adequate surveillance against the recurrence of cancer, although this remains a theoretical concern with this treatment. Risks are always relative and must be interpreted in the context of what makes you comfortable or uncomfortable. Although I know nothing about your MS, it is quite likely that your risk of MS worsening without effective treatment is much higher than your risk of developing PML or experiencing a recurrence of cancer as a result of treatment with Gilenya. You and your doctors have a better idea of the following information that is needed to help you with this decision: 1. What is the severity of your MS and your risk of becoming significantly disabled in the near term (i.e. next 5 to 10 years)? The higher the near term risk the greater the importance of initiating treatment with a highly effective treatment now. However, if you are already significantly disabled with problems walking and classified as either secondary or primary progressive MS, there is little evidence that Gilenya will be beneficial. In this situation the risk:benefit ratio may be reversed. A good way to think about this is to consider the last time you experienced your age, the last time you experienced a typical relapse and the manner in which MS has worsened over time; generally, if you are over 50, have not experienced a typical relapse in more than 2 years and have noticed slow worsening of you condition over a period in excess of 6 months, you have either secondary or primary progressive MS. 2. How effective was Gilenya during your prior three years of treatment with this drug? If it was only partially effective, perhaps another therapy is more appropriate at this time 3. What is your risk of cancer recurrence? If it is considered a very small risk based on cancer type, stage and treatment then there is less concern? Hope this helps Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego My Question:
I know that Avonex and Plegridy are exactly the same drug and so they both have same side effects, but I am wondering if those effects last 1 day only as Avonex or do they last more? Thank you Answer: Plegridy is a re-engineered form of interferon beta 1a, the same molecule in both Avonex and Rebif, with a polyethylene glycol residue attached. This increases the effective mass or size of the molecule and decreases the clearance of the drug from your body. This has positive and negative effects; on the positive side you can take the drug less often and with more consistent and prolonged biological effects. There also seems to be less neutralizing antibody formation; on the negative side, side effects tend to be more prolonged and sometimes delayed in onset. I have had patients report flu like side effects lasting up to 4 days after injection, which can be managed by prolonging the use of ibuprofen or acetaminophen. This problem decreases over time, much like the flu like side effects decrease over time with Avonex. Titration of the dose over the first 4 weeks is also helpful. In my experience the injection site reactions are a little more problematic. These are often delayed in onset, beginning a day after injection, and then can worsen over several days. This requires icing and steroid creams until this improves over time. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego #Plegridy Question: How much turmeric is needed to be effective? Answer: We do not as yet know the ideal dose of Turmeric acid, since we do not know if it is an effective treatment for MS. It has been studied in a number of human inflammatory conditions, such as arthritis and inflammatory bowel disease, and reported to have some positive effects. Most authorities recommend 400 to 600 mg capsules or tablets three times a day. It is usually mixed with black pepper or piperine to enhance absorption, so make sure one of these components are listed in the ingredients on the supplement bottle. Turmeric is generally well tolerated although some people report mild nausea. There are potential drug interactions so make sure you tell your doctor if you are planning to take this supplement. These interactions include but are not limited to the following:
Hope this information helps. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
During an exacerbation, what is happening to the nerve cells to cause the body to respond? Answer: During an MS exacerbation, some unknown event or stimulus within a circumscribed region of your nervous system precipitates an inflammatory reaction. This inflammatory cycle includes breakdown of the blood brain barrier (often but not always identified briefly by contrast enhancement after an MRI) and recruitment of inflammatory cells (lymphocytes and macrophages) to the region. This less to further inflammatory injury to myelin and neural elements. Many of the initial symptoms of a relapse are caused by temporarily malfunctioning of neural elements that recover quickly. Resolution of other symptoms require clearance of myelin debris, remyelination and repair of synaptic connections. This can take weeks or months to complete. Axons that are transacted (cut in half) are irreversibly injured and cause permanent tissue damage and sometimes permanent symptoms. The inflammation is eventually brought under control spontaneously, damaged tissue is cleared of debris, oligodendrocyte progenitor cells (the ones that make myelin) are recruited to the site of injury and attempt to repair demyelinated axons (with some partial success), dendrites sprout from neurons to create new connections and an astroglial scar is formed. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
I was recently diagnosed with R/R MS and began taking Tecfidera on 03/31/15. On 04/20/15 I started to notice hair loss which continues each time I wash my hair. I know it is not listed as a side effect however there have been no other changes to my routine or diet other than the Tecfidera. I see numerous comments on the MS Connection website about other MS patients with hair loss attributed to Tecfidera which caused them to stop taking it, including a concerning comment that the hair did not seem to regrow once the drug was stopped. My questions are, have you had other patients report hair loss with Tecfidera? If so did the hair loss subside with time or do you believe that this is a side effect that would typically subside with time? If so how long is reasonable to wait and see? If the hair loss does not subside and I stop the medication, would the hair loss typically regrow or would the hair lost potentially be permanent? Lastly, my second choice for medication was Copaxone, which also does not list hair loss as a side effect however I saw MS Connection comments regarding hair loss with this drug as well. I would hate to stop the Tecfidera only to find the same problem with Copaxone. Do all MS drugs have the potential to cause hair loss or is it perhaps caused by the MS itself? Any advice is greatly appreciated. Answer: Hair loss is a common concern expressed by many people when they visit their doctor. Unless your hair is falling off in massive amounts and leaving large patches of bald skin, as occurs after many forms of chemotherapy and called anagenic effluvium, you are likely experiencing a condition called Telogen Effluvium. To understand this better you need to know a little about the normal hair growth cycle. In most people 80-90 % of hair follicles are in an active growth stage (called the anagenic stage) and the rest are in a resting stage (called the Telogen phase) getting ready to fall off and make way for new growth. Any number of events including post emotional stressors, diet changes, hormonal changes, post partum, nutrient deficiencies, medical conditions (esp. thyroid disorders) and many medications can push a greater number of hair follicles suddenly into the Telogen phase. Interestingly, the hair does not immediately fall out when this occurs; instead, the hair follicle stops growing and involutes over 2 to 4 months before it falls out. The loss of hair or hair thinning is usually complete within 6 to 9 months after the condition that caused you to experience Telogen Effluvium. As soon as a hair falls off the new hair follicle begins to grow, but it takes months before this becomes noticeable. People with telogen effluvium will notice more hair on their brush and their pillow in the morning and the hair. A typical person will lose about 100 hairs per day whereas a person with telogen effluvium will lose 300-500 hairs a day. The hairs that you collect will have the typical appearance of a hair that has gone through the telogen phase. Most noticeable, is the small white hub at the end of the hair that was attached to the scalp. It is most important to understand that Telogen Effluvium is almost always a temporary condition though it takes time to recover. Let’s return now to your question. You started Tecfidera on 3/31/15 and began to notice hair loss 20 days later. Telogenic Effluvium that begins this rapidly would also be expected to recover within 6 months, often without even stopping the medication. This is certainly the case with Teriflunomide. It is more typical for the hair loss to only become noticeable 2-4 months after the onset of the causative event, and then continue unless the offending condition is reversed or stopped. It is impossible for me to determine if there is a causal link between the initiation of treatment with Tecfidera and hair thinning. We can only determine cause and effect from placebo controlled trials and this was not an observed side effect attributable to Tecfidera in clinical trials. If your hair loss is severe and bothersome to you then you have a number of choices. First, ask your doctor if there are other potential causes of hair loss. For instance, antidepressants or recent stressors are common causes. If there no other identifiable causes you have some choices to make: 1. If your doctor thinks you are a good candidate for minoxidil, you can continue on Tecfidera, and take minoxidil for the next 6 months to stimulate hair growth. 2. You can stop Tecfidera and take another medication for your MS but don’t expect the hair loss to stop until it has run it’s course. I hope this helps. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
My question is how long will 'Cymbalta'60 mg, for neuro pain take to work? I asked my doctor and he told me for pain it takes longer. I have been taking them now 18 days and getting desperate to know if I am wasting my time. My doctor is away and my neurologist and I feel helpless.....pain is not getting any less. My mood is changing not for the better, but not sure if its this medication or just me feeling down from the pain, my husband has his operation next week and my boys have exams...meaning at home all the time. I lost hope.......Thank you in advance. I appreciate this web site very much. I feel I have someone I can ask. Answer: Tim Vollmer in Denver published a placebo controlled study on the use of Cymbalta (duloxetine) for MS related Neuropathic pain in 2014. Those patients who responded began to see benefits at 1 week and definitely noticed benefits by 2 weeks. The numbers need to treat to achieve a 30 % reduction in pain (what is considered meaningful) was 8. This means that 8 people must be treated with this drug to achieve a 30 % reduction in pain for 1 person. I usually add pregabalin (Lyrica) if a patient is not beginning to respond by 2 to 4 weeks. Talk to your doctors about adding another medication. If you are not tolerating the Cymbalta you should also discuss stopping it with your doctors. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I'm a 49 year old female, and several months ago my vision seemed off! At first I though it was my glasses however it kept getting worse until February 3rd when driving to work everything was double, cars, lights, people, everything!! I left work and drove myself to the doctor (bad idea) but I made it and haven't driven sense. I was admitted to the hospital for a whole battery of test including a cat scan and an MRI which eliminated all the usual suspects and was told it was probably viral and should clear up in a few weeks but it didn't. So here I am 3 months later with no diagnosis and more symptoms. My left leg is now numb with itching and pain! I use a cane and walker to get around because my balance is affected, my short term memory and speech are off, and my eyes are dancing from side to side, and we won't talk about the other stuff. The 2nd MRI with a better machine shows 3mm ovoid T2 hyperintense focus posterior superior right temporal lobe, 3mm T2 hyperintense focus posterior inferior right temporal lobe, and 4mm T2 hyperintense focus right lateral midbrain. MRI conclusion says appearance is nonspecific but differential consideration particular given the hyperintense focus in the right lateral midbrain includes demyelinating process/multiple sclerosis. My neurologist says the lesions are not indicative of MS but has no other diagnosis. I'm sure my story is a common one with no definitive test for multiple sclerosis diagnosis can be a process off elimination. But as the patient the scariest part of this journey is the uncertainty off not knowing! I think an MRI with dye or spinal tap would give me a diagnosis but my neurologist is following a different path of physical therapy and a referral to a doctor to run test in cognitive issues. I already know my brain is messed up and physical therapy for what? I feel a neurologist who specializes in this disease would be able to see what is really wrong with me therefor I now have an appt on july 14th to see Dr. Kinkel himself, on cancellation list for first avail! what test do I need to get a diagnosis? Am I too old? Also I have had numbness in my arm for years, was that the beginning? and the heat knocks me out another MS sign? Any thoughts on this issue would be greatly appreciated, thank you. Answer: MS is a very good possibility and it may well be that you would benefit from additional testing. I am glad to hear you are scheduled to see me but why do you have to wait until July 14th? We have openings at Hillcrest and probably in La Jolla much earlier than July 14th. I would suggest calling my clinic coordinator, Shivon Carreno, at 619-543-5443. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
There is a treatment for people with MS having HSCT, stem cells done in Russia, Singapore, the main countries as of yet. There is a long waiting list and it is not very cheap. My concern is the small percentage of deaths and complications. My MS is not active although I seem to have neuro pain and other issues, but not bad enough to have this treatment as of yet. Although the woman that started all this called Kristy Cruise who was on 60 minutes in Australia, has had everyone following her in her footsteps. Her MS was inactive but had her treatment in Russia with success. My question is what do you think of HSCT treatment and how will this treatment effect the "anxious" people? Answer: Hematopoietic stem cell transplants (HSCT) have featured prominently in the news for the past year but have been used for over 15 years to treat rare cases of aggressive MS at several centers in the US, Canada and Europe. This is not an approved indication for the treatment of MS and therefore not covered by insurance. Because of the prohibitive costs in the US, Canada and Europe, many people are traveling to Singapore and other countries able to provide HSCT and other medical procedures at a lower cost and, in some cases, fewer complications by well trained specialist. I am not aware of the facilities available in Russia. The real issue is whether HSCT are ready to be used on a wider scale in the treatment of MS. I believe that based on the current evidence, the answer is no. However, people should be able to make there own decision on this issue, as there is evidence to support HSCT in certain cases. My usual response is to advise people on the degree to which I think they may or may not benefit from this treatment. Discuss this with your physician as I do not know the specifics of your case. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences 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:
I have the flu, vomiting, diarrhea and can hardly move. Will my MS get better soon? Answer: Gastrointestinal flu viruses, often make MS symptoms worse for direct or indirect reasons. Direct reasons may include fever or activation of your immune system; secondary reasons can include dehydration, electrolye imbalances and failure to absorb needed medications. More severe GI infections can cause bleeding and severe anemia. The most important thing is to notify your doctor and make sure your underlying “Flu” symptoms are due to a common virus and not some other condition. Most GI flu that cause vomiting and diarrhea last no more than a day or two. Other than this recommendation, it is most important that you stay well hydrated and keep your temperature down. If your mobility is significantly affected and you are finding it harder to take care of yourself, you may need to go into the hospital for treatment. Hope you feel better soon. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
Is my neurologist confused? When my neurologist looked at my MRI he advised me that my MS was not active. When asked about my spine, he replied all was good but the radiologist were not sure. So I asked him again if it was not active and his response was again they were not certain. My diagnosis of my MRI 3 yrs before my recent one, was indeed just in my brain. Now I am wondering if in fact it is also in my spine? Can a Neurologist be confused???? Answer: There is always a level of uncertainty about the outcome of any test in medicine. This uncertainty can exist on several levels 1. The test may have a high degree of normal variability in a population and is not very specific for any condition. A physician who does not take this into consideration may use the test incorrectly and create confusion regarding the diagnosis. 2. There can be technical limitations of a test. For instance, adequate interpretation of an MRI scan can be limited by artifacts from movement, pulsation or metal objects. This is particularly a problem when trying to interpret an MRI of the spinal cord. A poorly trained observer may interpret and artifact as an MS lesion or vice versa. 3. The test is obtained in the wrong population and interpreted incorrectly. For instance, white spots on an MRI in a elderly patient rarely means MS but is more often (but not always) associated with MS in people under 35. The bottom line is that MRIs must be interpreted by experienced individuals and the interpretation must take into account an expert clinical evaluation. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Question:
Is it OK to take milk thistle and Tecfidera? Answer: Milk thistle has been studied extensively in people with liver disease and diabetes and it may be beneficial in the treatment of these conditions. Some have advocated it’s use in people with MS to reduce oxidative stress associated with chronic inflammation in the central nervous system. We have no information available at present to either support this recommendation or recommend against the use of Milk Thistle. Specifically, there are no reports of any harm occurring in people with MS who take Milk Thistle. Like any other ingested substance there may be some people who do not tolerate Milk Thistle or are allergic to Milk Thistle. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego |
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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