Low lymphocyte count and MS

[glenntaj]

Just wondering--has anyone (medical professionals included) heard of lymphocyte levels being depressed during MS, particularly during exacerbations/acute attacks? I have been suffering from painful peripheral neuropathy for almost 3 months (started in right foot 4/12--went from tingling to burning in four hours--was in hands by 4/16, and whole body by 4/22--think sun poisoning over whole skin surface). Only other symptoms were occasional dizziness when rising from seated/prone position and intermittent crampy feeling in backs of legs. First neurologist put me on Neurontin, which damped pain down some (though we had to increase dosage twice to 1200 mg/day) and thought situation acute enough to check me into hospital for brain spine MRI, lumbar puncture, chest x-ray, extensive blood/urine analysis, etc. Only things that have come out "abnormal" so far:

--Brain MRI says "small irregularity at collosal/septal interface--this can be seen with early MS and follow-up is advised in six months if clinical symptoms persist"

--T4/T8 lymphocyte panel shows low CD4+ count (360), low CD8+ count (109),and low absolute lymphocyte total (838)-this was obtained at 7 AM 6/14, fasting state.

Now I know I am HIV-negative (and was tested again during this, just to make sure; also, have no high risk behaviors for that at all--married 21 years, no drugs, etc.) I know there are other conditions which can lower lymphocyte count, but I seem to be testing out of most of them, as well as most other peripheral neuropathy causes (I have had normal/negative tests for glucose level/tolerance, hepatitis A, B, C; lyme, west nile, hypothyroidism, B12 deficiency. ANA, Hu antibody, heavy metals, monoclonal antibodies, HLTV I and II, immunoglobulin profiles, rheumatoid factor, angiotensin, C-reactive protein, anti DNA-antibodies, C3/C4 levels, hemoglobin A1C, even evoked potentials. Is it possible that I am experiencing early signs of MS, and that the two results above are part of that? Or are other explanations more plausible? (I've seen some anecdotal web evidence that MS attacks/exacerbations can result in lower serum lymphocyte levels--theory is that they're breaching the blood/brain barrier and are in lower levels in the blood then--but would like to get input. Thanks.)

[CCF-Neuro-M.D.-CS]

The MRI findings can be seen in MS, but also in other disorders such as small vessel ischemic disease or migraine. The low lymphoyte counts are not characteristic of MS. I could find no medical literature suggesting low lymphocytes in MS. Therefore, I would think more about a systemic disorder. If you have not been evaluated by a Hematologist/Oncologist this may be benefical.

Regarding the painful symptoms you are describing, these may be related to a small fiber peripheral neuropathy (these are the nerve fibers which carry pain). Special testing to evaluate these disorders can be completed, but typically only at an academic center.

Your case is very complex, and unfortunately without actually seeing you and reviewing the tests, these are the thoughts which come to mind. Again obtaining a second opinion at a large academic center may be benefical at this time.

[glenntaj]

Thank you for the reply.

I have had a CBC and lymphoctye panel done again, and am awaiting the results to see if they are consistent--I recognize that WBC/lymphoctye counts vary widely, sometimes even over the course of a day.  I also have scheduled a hematological/oncological consult.

I also wanted to post the following, form Med Friendly's Dominic Carone:

  
Hi Glenn: As you correctly stated, lymphocytes (specifically, T-lymphocytes) can cross the blood brain barrier in MS. This process is called lymphocyte infiltration. The lymphocytes are believed to cause much of the damage (through an inflammatory process) to the myelin sheath (the fatty covering around nerves) of the brain and spinal cord that occurs in MS. If lymphocytes migrate to the brain, there would be less of them in the blood.

     The lymphocytes are attracted to the blood brain barrier by special sticky molecules in one of the layers on the blood brain barrier. These sticky molecules stick to the lymphocytes that are passing though the blood. There are some medications (such as monoclonal antibodies; for example, Natalizumab) that are designed to decrease lymphocyte infiltration. They do this by preventing the lymphocytes from sticking to the sticky molecules in the blood brain barrier.

Please keep us updated.

    Anyway, here are some references for you. You can get them at a local medical school library or order them there if they do not have the journals.

Migration of multiple sclerosis lymphocytes through brain endothelium. Prat A, Biernacki K, Lavoie JF, Poirier J, Duquette P, Antel JP.Archives of Neurology 2002 Mar;59(3):391-7.fficeffice" />

Hohlfeld R. Biotechnological agents for the immunotherapy of multiple sclerosis: Principles, problems and perspectives. Brain. 1997;120:865-916.

Maloy KJ, Powrie F. Regulatory T cells in the control of immune pathology. Nat Immunol. 2001;2:816-822.

Martin R, Sturzebecher CS, McFarland HF. Immunotherapy of multiple sclerosis: Where are we? Where should we go? Nat Immunol. 2001;2:785-788.

Rieckmann P, Smith KJ. Multiple sclerosis: more than inflammation and demyelination. Trends Neurosci. 2001;24:435-437.

Steinman L. Multiple sclerosis: a two-stage disease. Nat Immunol. 2001;2:762-764.