I Have MS and Was Symptom Free Since 2012, But Now Am Not. What Happened?

Here is My Question:
Hi there, I was diagnosed with MS in 2012 and have been symptom free since 1 month ago. Now I am experiencing symptoms again like tingling in my hands and feet. My doctor put me on a oral steroid but I don't think it's working. First, what happened that made the tingling come back and will it go away? Also, do oral steroids really work or should I have just done an IV of SoluMedrol? I have recently started Tecfidera and hoping for good results. Thank you for your time :)

Answer:
I can understand your concern but rest assured that the temporal pattern of the symptoms that you’ve described since 2012 is quite common. Although I do not know the facts of your individual case, I can make the following general comments:

• It sounds like you have relapsing remitting MS with an onset of symptoms in 2012. It also sounds like your symptoms were relatively mild at onset (i.e. tingling in the hands and feet). We would expect most individuals to recover completely within 6 months of onset with or without treatment with steroids
• Although I do not know your age, the average person with relapsing remitting MS will experience about 2 relapses every 2 to 5 years, if untreated; more frequent relapses are expected if you are younger than 30 and less relapses are expected as you get older. It is possible that your current symptoms represent a mild relapse. It is also possible that your current symptoms represent a reactivation of your prior MS symptoms (from 2012) related to any number of things like stress, infections or even hot weather. Please see my previous blog on the reason for sensory symptoms in MS patients (http://www.healthcarejourney.com/q--a-for-virtual-ms-center/ms-symptoms-why-do-they-appear-and-disappear). The job of your neurologist is to determine if these symptoms represents a relapse or one of these other possibilities. I suspect he or she thinks this is a relapse and that is why you are being treated with corticosteroids.
• Corticosteroids are administered in many different preparations, doses and dosing frequencies throughout the world. The most common treatment is equivalent to 500 to 1000 mg a day of methylprednisolone for 3 to 5 days. Some MS centers and doctors administer corticosteroids orally and some administer them intravenously. Some doctors use even smaller doses for mild relapses, although most of the evidence supports the use of doses over 500 mg methylprednisolone or equivalent doses of another steroid preparation.  It can take up to 2 weeks before you notice any benefits of corticosteroid treatment, although it is more common for people to respond in the first few days of treatment. The complete resolution of symptoms can take up to 6 months.
• It takes time for any new MS treatment (like Tecfidera) to begin working; it is not uncommon for a relapse to occur shortly after starting treatment even with the most effective therapies. We do not strongly consider these “early” relapses when determining if a therapy is working adequately to control your disease. Again, this depends significantly on your individual circumstances and characteristics.
  

I hope this answers your questions. You should certainly discuss these concerns with your MS doctor at your earliest convenience.

Rip Kinkel, MD

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