MS specialist report

[bairdy]

hi folks
hope you are all feeling ok ?
i got a copy of the report sent to my gp from the MS specialist
its a little long winded but here is what he found on my neuro exam

On examination today he had intermitent tremor of his right leg when seated,
optic discs appeared normal, full range of eye movements with horizontal diplopia to the right( the right eye contributed the false image), no facial weakness, tone normal in the upper limbs,

increased tone in the lower limbs with clonus, power normal in the upper limbs, hip flexion grade 4 bilaterally on formal but appeared satisfactory when heel/shin coordination.
hip abductors and adductors, knee flexors, knee extensors, ankle dorsiflexors,plantar flexors were all grade 5 on the bed, he steps backwards on romberg's test coordination was otherwise normal,
reflexes were 3+ and symetrical in the upper and lower limbs,plantar flexor with jaw jerk, hoffman sign was present more on the left than the right, no crssed adductor responses, joint position, vibration and pin ***** were normal.

i understand from your referal letter that he had previous MR imaging which has been normal. VEP'S were suspicious of an abnormality with aninterocular latency difference,
although both the responces could be within normal range. a lumber puncture was unsuccesfull.in getting access with a needle.

ii would agree that he does appear to have brisk reflexes and clonus,there does seem to be an element of overlay in terms of the tremor and also the apparent hip flexion weakness.

i have repeated his bloods today. i would like to reveiw his ongoing inestigations in particular to look that we have covered all of the causes of a non compressive myelopathy and i am likely to advise that we repeat the lumber puncture although i have explained that this may be non contributory.
and will see him in clinic in four months.

any thoughts guys
has he found anything that helps to confirm MS in the neuro exam
regards bairdy

[bairdy]

hi
yes i am on baclofen 10mg x 3 daily and gabapentin 300mg x 3 daily
i have often wondered if i have spacticty it does make sense cos i do feel like its my muscle tightening and turning and twisting me.i often feel like i have been hit by a truck
regards bairdy

[slightlybroken]

I'm glad your seeing this specialist that is looking for other causes of a non compressive type. When Quix was on the board, she would always say that you should beware of neuros and doctors who say this problem is from this condition, and this problem is from that condition, and by the end of it, you have several diagnosis for several conditions. Especially when some of these symptoms started about the same time.

In my opinion, your exactly right, it's part of the puzzle, and it's just another jigsaw that they have to work with. Maybe why you get so twisted and sore by the end of the day and have weakness is due to severe spasticity. I have the same issue to a lessor extent. I've had spasticity hit me so bad that it has twisted my hip and leg. Spasticity can cause weakness as well and it seems like the more active you are..the worse spasticity will get.

I hope your doctors have you on an antispasmodic like Baclofen or Zanaflex. I think you would benefit from one of these drugs if your not already on 1 of them.

Take Care & I hope you get some answers soon☺

[bairdy]

hi
yes i have scoliosis due to muscle weakness when i get up in the morning im stood straight but by the end of the day im leaning to the left and all twisted and sore !!! but its worse the more active i am during the day .
they used to say all my ptroblems were down to my back issues but now the neuro said they are all seperate . i think all my symptoms and history are all part of the jigsaw.
the ms specialist said he would order more tests and rule out other causes for a non compressive myelopathy. so he might ask for an ssep and thoracic mri just have to wait again
regards bairdy

[slightlybroken]

An SSEP is another type of evoke potentials used to DX MS. SSEP or SomatoSensory Evoked Potential involves electrical stimulus placed on certain points on the limbs, while an EEG picks up how long the wave takes to get to the brain (latency) and how the wave looks. The SSEP is a nonspecific test for MS and can be abnormal in other disease processes, but if it fits with the whole picture (your symptoms, neuro exam, MRI, and other test) it can be used to help confirm MS.

Is your doctors saying that your scoliosis caused muscle weakness, or  that you have scoliosis due to muscle weakness? Do you have a curvature of your back?

If you indeed have scoliosis that is impinging on the cord it could cause many issues at or below the impingement. Scoliosis still would not explain your eye involvement. It looked like from the report that the specialist was still looking for a non compressive myelopathy which would still include MS and other factors for your condition.

[bairdy]

hi
thanks for your reply
yes i do have spinal involvment ?
i have scoliosis due to muscle weakness he says
whats an SSEP ?
regards bairdy

[slightlybroken]

You do have abnormalities on exam that would lead a doctor to believe a neurological problem is occurring. Sounds like this doctor is going to run more test to try to narrow the field down some more. In my opinion, MS is still on the table.

You have horizontal diplopia, increased tone in the lower limbs with clonus, intermitent tremor of his right leg, hoffman sign was present more on the left than the right, VEP'S were suspicious of an abnormality with aninterocular latency difference, hip flexion weakness. I would suspect that you have spinal cord involvement. Have you had an SSEP yet? Sometimes it takes years for lesions to show on MRI in the cord and an SSEP may help pick up on damage.

You also have optic nerve involvement to a certain extent..with eye muscle weakness causing the double vision..that's my guess. I have the same issue with my eyes as well and had to get prisms.

I hope you get some answers soon
Take Care