Exacerbations

[steve]

Dear Docs: I'm a 34yr old male currently awaiting my first MRI (March). Back in Sept 99 I had an episode lasting 4 days (numb big toe, pins & needles, dizziness) then nothing until just before Christmas when it all kicked in. It started with a trembling sensation in my right arm (though no visible tremor), and a heavy feeling around my right ankle (almost as if someone had tied weights to it). The trembling sensation stopped after a couple of days to be replaced by episodic tingling on both hands, and slight numbing sensation on my face, but in different areas. These sensory spells never happened at once, and each never lasted for more than a day (and normally with 3/4 days between happenings. Meanwhile my ankle, shin and knee on my right leg were becoming quite stiff.
All the tingling sensations basically ceased around mid-Feb, but my right leg continued getting worse (I also had slight dizziness and occasional numbness/tingling at different points on my face. both sides). I had a neuro exam 2/23 which was normal, however a day after this my left leg started displaying the exact same symptoms as the right until it was actually worse than the right within 4 days. I repeated some of the tests that the neuro had done, and there was definite muscle weakness in the left leg. Suddenly two days ago there was a vast improvement. I still have stiffness in my left leg, and the heaviness around my right ankle, but the weakness has gone. I hope you can help with a couple of queries.
I know there is no such thing as normal with MS, but do exacerbations develop in this way? primarily regarding the gradual worsening, and new areas of the body rapidly evolving the exact same symptoms. If this is MS, does this mean that there are a number of lesions i.e the fact that all my extremities are displaying symptoms? How long after an exacerbation does it take for things to settle down and get a true feeling for any damage?

Thank you for your time.

[CCF Neuro[P] MD, RPS]

Dear Steve:

Sorry to hear about your symptoms.  One can see symptoms as yours in MS, although they are not the common symptoms (only sensory).  It is difficult to know how you tested muscle strength your self.  Nonetheless, you may or may not have MS.  The symptoms of relapsing and remitting symptoms is the hallmark of MS.  Usually the symptoms are not bilaterally the same but change.  However, the same defect can and usually does reoccur in each event.  The length of time between exacerbations and the duration of each event are entirely patient specific.  The closer together the exacerbation, usually the worse the disease, but not always.  It depends on where the lesions are occuring in the brain (non-vital area and vital area).  

What did the CSF studies show?

I hope your MRI scan is clean.

Sincerely,

CCF Neuro MD

[o]

K

[steve]

Dear Doc: Thanks for your informative response. As yet, I have only had a neuro exam (two weeks ago). No CSF studies. I take it this will be dependent on the MRI results?.

Although the symptoms have regressed, I still have the stiffness around both ankles, occasional dizziness and slight facial tingling. Re the muscle weakness. I repeated the neuro tests where he used each leg to push/pull against something, and the left leg was definitely weaker, but in general I could feel my left knee giving way now and again. This wasn't constant however and varied from day to day. Some days I could not perceive the weakness but the stiffness remained.

My main query was regarding why my left leg suddenly worsened over the last five days of the episode, mimicing the right leg symptoms, when for the previous two months I had had no left leg symptoms. Does this possibly indicate a new lesion becoming active.

Thanks again for your time.

[CCF Neuro[P] MD, RPS]

Dear Steve:

Self examination is filled with problems.  I would only trust if the weakness is so profound that daily living is affected by the weakness.  Otherwise, an impartial examiner is the only true way to measure muscle strength.  The CSF is usually done before the MRI here at the Clinic but each place has it's own protocol.  

Sincerely,

CCF Neuro MD

[nancy]

This is an off the wall question, but someone told me that sacroilitis is a not well known auto-immune disorder.  Is that true and if so what causes it?  My mother was dx with it, and we do have other autoimmune illnesses, but mainly in the siblings as brother with ms, rheumatoid and sister with mg.

Thanks for any information  you may have to offer on this subject.

Nancy

[CCF Neuro[P] MD, RPS]

Dear Nancy:

I am not sure the exact intent of the question.  Sacrolitis is the inflammation of the scaral cartilage/bone.  This is just a term to describe the pathology of the area.  There are many diseases that can give you this.  RA is one of them as other autoimmune diseases.

Sincerely,

CCF Neuro MD

[Barb]

I am a 53 year old woman. Five years ago I had strange attacks that lasted about a 3 month period. The symptons were numbness and tingling in my hands and right leg,dizziness,fatique,ringing in the ears ,numbness in my face,one episode of incontinence and the feeling of electric currents cursing up and down my body.These symptoms were not all present at the same time but would come and go. I was going through a period of stress at the time and the doctor diagnosed it as such.
In the last five years I have had several operations. Hysterectomy(prolapsed uterus), bladder opertion(dropped), gall bladder removed and an appentectomy. Also, about 3 years ago I suffered a severe blow to the top of my head and I again had dizziness, nausea and numbness arms and legs. About 1 yr after that the chiropractor adjusted my neck and a felt a severe pain on the right side of my neck and again the symptons returned. I am again experiencing numbness, dizziness ETC but this time no blow on the head to blame it on.The doctor then did an MRI which showed lesions. All nuerological tests show O.K. What are your thoughts on this? Are the MRI results conclusive evidence when combined with these symptoms.

[CCF Neuro[P] MD, RPS]

Dear Barb:

Sorry to hear about your problems.  Whether your symptoms are MS or not is difficult to say.  The MRI lesions may or may not be MS lesions.  Alot depends on where they are, what they look like on T2, and the age of the lesions.  Did you have a normal CSF study?  I think that if the neurological exam give some indication of MS, the MRI lesions are suggestive of multiple lesions of different ages in the usual areas, and the abnormal CSF study, then you have MS.  But, we know that there are some forms of MS that don't follow the usual.  Time will tell.  I would stay in contact with your neurologist.

Sincerely,

CCF Neuro MD

[[e-mail]]

i am 33 yrs, old aand just dx with ms
i also was dx with epilepsy when i was 11
yrs old.was put on meds to treat the
seizures but they didn't to do the job
90% of my seizures happen only around
the time of my monthly cycle,i don't seem
to have any seizures any other time.
i also had a period of time for about
7years were i had no seizures,i was taking birth control pills.i have 3 kids
gave birth to two of my children with no
problems,my third child was born almost
2yrsago,and that is when my life changed
it just seem to get worse the seizures
started aagain went through all the test
the mri showed lesions the lumbar punct,
confirmed ms,now i'm on avonex,dilantin
2kinds,depakote,lamictal,xanax,zoloft
i would like to know what to do about the
seizures the meds don't seem to be doing the job correctly.i keep telling the neuro that it has to do with hormonal
problems he says he don't think so.i have
seen probably 11 neuro so far.i'm not
sure that i'm happy with this one either
i am tired of going through test and all
the meds to end up right were i started
from.if you or any of your collegues have
any input or know of a doctor in michigan
that could help me.i need it for me and m three childen 9,8 & 21 months.i can't live in fear anymore.please help me any-
way possible thank you.
michele,from livonia, michigan.

[CCF Neuro[P] MD, RPS]

Dear Michele:

There is very good neurologists at the University of Michigan that should be able to help you.  A Jonathan Edwards trained here at the Cleveland Clinic before going to Univ. Michigan.  You might see if you can see him for your seizure control.

CCF Neuro MD

[debby]

I started with severe dizzy spells Oct. of 98, they lasted till around march of 99.  These spells left me with severe balance, concentration, and memory problems along with constant fatique.  I started working out with a trainer who worked with me on getting my stablizing muscles strengthed. This seemed to have made a big difference for about 9 months then I started getting these light headed spells, overall aching, lots of earaches, just generally feeling run down.  I haven't seen a doctor this time since the first onset  the doctors could find no cause.  Who should I be seeing to find out whats wrong?  And is it true that maybe they never will find out what causes this?  HELP me and my family are tired of me being to tired to join in on all the fun life has for me.  I'm 46 and I also live in Michigan, I live in the Huron Township area.  If anyone has any ideas, or who can help please let me know.  Thanks for your time.