when to seek medical attention for worsening leg symptoms?

Dear Dr.,

I am 23 (F); diagnosed with MS in June.  Presentation was with transverse myeltis (2 thoracic lesions + multiple brain) in Nov.03.  Leg problems from the incomplete TM had partially resolved, but my right leg has been getting 'heavier' and more incoordinated since late Jan05, along with more pronounced L hand clumsiness.  In December04, I had a follow-up MRI (brain + thoracic); one prominent new finding was a new big lesion in the L cerebellar peduncle, and another in 'semi oval centrum'.  R leg had pendular reflex, and pronounced L hand disdiadochokinesis.

Both legs feel much 'heavier' and the right one especially drags quite a bit now and turns outwards when I walk. I am also unusually tired, although I don't know if this is a cause or effect of the physical effort from the R leg incoordination and loss of balance. I am not an anxious person, and I tend not to go see a Dr. unless something is very obviously wrong.  I guess my questions are:  

1) for patients with MS, is there a defined point at which you would consider symptoms as 'new' and in need of reporting, vs simply exacerbation of old ones?  When do you recommend your patients to see a doctor about their symptoms?  

2) what is the significance of a big spot on the L cerebellar peduncle and another in Semi oval centrum in terms of related functions?

I cannot see an MS specialist or a neuro before mid-June (waiting list!), so I am getting a bit confused as to when I should see a dr., given there is very limited that can be done even if there is a problem.  Thanks for your advice

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

1) an 'attack' of MS is usually complete by 1 month, so another symptoms after this time period and the previous symptoms had resolved could be termed a new attack. Also, a new symptom in a different part of the brain or spinal cord could be termed a new 'attack'
Over time residual symptoms can persist, which can be made worse with fatigue, illness etc (that is a worsening of an existing neurological deficit), and are not necessarily new MS lesions.

this is presuming a diagnosis of Relapsing Remitting MS where the pattern is, at least initially of discrete attack with normal function in between
there is also a Primary Progressive form of MS, where neurological deficits are more likely to persist, and may get worse slowly over time. I cannot tell what type of MS you have over the internet, but you could bring this up with your doctors
this would have implications as to what is a new MS attack or worsening of an existing MS lesion

2) a lesion in the left cerebellar peduncle can cause clumsiness on the left side of the body, and more rarely some jerky eye movements or left sided weakness. A problem in the centrum semiovale could cause weakness or sensory symptoms on the opposite side of the body.

The waiting list is fairly long! If you are in the Cleveland area anytime, you could always arrange an appointment at the Cleveland Clinic Mellen Center for Multiple Sclerosis. Which type of MS you have could be clarified and treatment to reduce attacks could be initiated.

Good luck

[aliaat]

Thought I should add that I don't think there is weakness in any of the legs per se, it feels to me like the incoordination is more from the hips.  Sort of like R leg is s separate entity with a mind of its own!  

If anyone's had this with spinal injuries, any suggestions for dealing with it other than stretching and keeping active? Has anyone had vertigo with MS? I'm not taking any meds right now.