Multiple sclerosis center preparacion para radiografia de columna lumbosacra bioimagen

I have always had some GI issues on tecfidera, tremendous flatulence, intermittent diarrhea and increased reflux but they were manageable and I did not consider them to be show stoppers.

But in the past year my reflux has become so bad that I am chronically hoarse to the point where long conversations are difficult and my singing which used to be less affected than speech is impacted. Singing is really important to me. It makes me really happy and has helped a lot in controlling depression that became chronic after I had to stop working as a neonatologist. I also take venlafaxine and have periodic courses of rtms but singing is what makes me really happy.

I have seen an ENT and there is no other vocal pathology and I am on maximal medical management including meds, diet and sleep position.


Plus I have lost 40 lbs and counting.

In august, after being sick for a month with severe nausea, increased reflux, fatigue and diarrhea so severe that I soiled myself 3 times and my K went down to 2.7. I also lost 10 lbs that I have intentionally not regained. I finally had an abdominal CT that showed mesenteric panniculitis. Symptoms gradually improved without treatment other than IV fluids and temporary oral potassium.

So I am thinking about switching from tecfidera. But I have no idea what I would like to switch to. I used to be compulsive about keeping up with the various medications. But there are so many now and I lost interest which was probably a good thing for my life.

Even though my MS has been very mild by the usual objective measures I prefer to be on a highly effective med. I don’t mind injections or infusions but interferons are out due to depression issues. I switched from tysabri because I became JCV+ with a titre of 1.48 after almost 7 years and my disease was mild and inactive.

Can you point me in a direction to research? I do not find my current neurologist helpful beyond prescribing a DM med. He shows no understanding of my issues, priorities and goals especially controlling depression.

To summarize, you are a 61 year old relapsing MS patient with GERD, asthma and depression who’s previous treatment included avonex (worsening depression), tysabri (low positive JCV index < 1.5) and tecfidera (severe persistent GI side effects) and you would like another highly effective MS treatment.

1. Gilenya (an SIP agonist and oral medication) is an option but should be used with caution (meaning pre-start specialty evaluation and good follow-up) because of age (potential cardiac arrhythmia issues) and asthma

2. Ocelizumab or rituximab (both anti CD20 monoclonal antibodies) are options but require caution at 61 with potential breast cancer risk and less information on long term risks

3. Tysabri is my favored option, since you already know that this is well tolerated and effective based on your prior experience. We now know that administering tysabri with an extended dosing interval of 6 to 8 weeks dramatically lessens the risk of PML, and in practice we have not seen a significant drop in efficacy with these dosing intervals. There is a planned clinical trial about to start that is designed to prove that extending the tysabri dosing interval does not lessen the effectiveness of this treatment. Depending on your location, you could consider participating in this trial for added safety and monitoring.

Hello, I am a 50-year old diabetic woman who began tysabri treatment in 2010. For the past few years I’ve experienced frequent bouts of bacterial vaginosis. Metronidazole gel initially cured my symptoms but, is now ineffective. Do you have any advice or recommendations? My GYN and I would appreciate the insight.

Bacterial vaginosis is very common and both natalizumab (tysabri) and diabetes increase your risk of this common infection. You may or may not be able to prevent this problems from reoccurring but here are some suggestions:

You need to create an acidic environment in the vagina to nurture the growth of lactobacillus and other normal bacterial flora that suppresses the growth of yeast and harmful bacteria. You also need to decrease the amount of glucose in your urine; this glucose in the urine feeds the harmful bacteria and yeast in the vagina that upsets the normal balance of bacteria flora. Lastly, you need to keep the area dry, if possible; any problems with urinary accidents, even small amounts, will further increase the risk of infection.

It is not at all clear why natalizumab (tysabri) is associated with an increased risk of vaginosis but this seems to be a reproducible finding. If your MS is well controlled on natalizumab (tysabri), you may consider extending the interval between infusions to every 8 weeks. This may allow for more recovery time. Many individuals who are JC virus antibody positive increase the interval between infusions, because this change in the dosing interval has been shown to dramatically lower the risk of PML. Most MS specialists have not noticed a significant decrease in the efficacy of natalizumab (tysabri), when you increase the dosing interval. In fact a clinical trial is planned to prove that increased dose intervals do not alter the effectiveness of tysabri

My latest MRI report stated: 11 foci of hypertensity (FLAIR) predominately in the subcortical white matter of the cerebrum bilaterally. Of course it goes on to state that nothing abnormal was found on other sequences…

I’ve never had a migraine (ruled out by neuro) and don’t have primary or secondary vasculitis (ruled out by rheumatology twice). My MS specialist felt my symptoms suggested multiple sclerosis.

My question is: how likely is microvascular ischemic disease in a patient who is 35 and has no risk factors? No family history of strokes, no personal history of diabetes, normal (to low) blood pressure, normal lab work (for almost anything you can imagine to rule out MS), low stress lifestyle, etc.

​the MRI report also mentioned that this amount of hyperintensities is not atypical of a patient of my age. I was under the impression that 1 lesion per decade was at the upper limit of normal until the 60’s, then these changes begin to become apparent.

In general, microvascular changes in 35 year olds with no risk factors are rare, but can happen. Sometimes family history contributes, sometimes the changes are not microvascular changes but enlarged perivascular spaces. The key is the interpretation and getting another neurologist or neuroradiologist to review controversial mris (ie second opinions) is often a good idea.

In 2012 I had an episode of severe vertigo and my eyesight even changed overnight. Then over the years I had weeks here and there when my face would go numb or I had pins and needles here and there.

I’m also having short term memory issues. An MRI in 2014 of my brain and neck on a 1.5 T only came back with nonspecific white matter…. Then in january of this year my body started going haywire with numb legs, spasms, speech slurring when hot, forgetting what I was doing right in the middle of something, tongue tremors, facial numbness again, zaps along face, zaps around ear, and now burning sensations in legs constantly, leg and arm weakness, internal vibration feelings, twitches etc.

I had a spinal tap done and there was no bands but the CSF index was flagged high but just at the mark where it would be flagged. The notes on the CSF panel state that there are reactive lymphocytes and plasma cells present.

I am in limbo and need this to stop. My doctor is saying small fiber sensory neuropathy. I just don’t see how! The portion of the CSF index states this provides support for the diagnosis of MS. I did have mris this year and there were two active high intensity spots and a few non active spots. Should I seek further diagnosis? The medicine she prescribed gabapentin or something like that even made my burning sensations worse…

You are certainly experiencing a wide variety of unpleasant symptoms but I could not diagnose either MS or a small fiber neuropathy based on your description.

Remember, MRI findings and CSF findings must be interpreted in the context of your age, other medical conditions, symptom history and findings on examination. It takes a good doctor to piece this all together. If CSF findings or mris were diagnostic of anything, you really wouldn’t need a neurologist. Perhaps all you need is a second opinion. Why not ask this doctor to send you for a second opinion?

I’m dragging myself to bed between 10 and 11pm nightly (can’t go any earlier). I am up between 3:30 and 4am for a variety of reasons (not often MS symptom related…I’m a light sleeper), and I can’t go back to sleep. Once I’m up, that’s it! By mid-day, I’m a walking zombie. I can’t function without caffeine around 2 or 3pm. Wash. Rinse. Repeat.

I am already on 100mg amantadine in the morning and 50mg before 1pm , but it hasn’t really done much. Sleeping pills make daytime drowsiness so horrible.

Managing daytime fatigue and sleepiness must begin with a thorough evaluation of altered or disrupted sleep. You can only beat the proverbial, “dead horse” so much with caffeine and stimulants . It sounds like you have longstanding problems as a light sleeper but were able to compensate in the past. Common problems to address include the following:

• poor sleep hygiene: this includes no caffeine or stimulants past afternoon, no alcohol, taking time to meditate or practice mindfulness before bed; sleeping in a dark quiet room (no TV) and getting out of the bed (and room) if not asleep in a reasonable amount of time

• frequent awakenings: these have many causes including anxiety with rumination, depression, urination frequency, discomfort or spasms, noisy sleeping partner, problems with your sleep environment or sleep disorders (sleep apnea for instance). Your doctor should be able to help with this assessment or you may need an evaluation in a sleep clinic