Alcoholism, MS Or What?

[sarah]

My husband, age 36, had an attack last year involving weakness on the right side of his body, loss of speech and mental problems. For the next five months, he had foot drop (right side), vision problems (blur spots), fatigue, pins and needles in the right hand and weakness in the right leg. EEG, MRI (brain, cervical spine), VEP, and blood and urine labwork were normal. Lumbar puncture was normal except oligoclonal bands in the CSF and elevated IgG, IgG index and IgG synthesis. He returned to normal for a few months. However, for the last seven months, he has had: 1) periodic tingling in both hands; 2) periodic shooting pains in arms, neck and head; 3) occasional spasms in arms and legs at night; 4) fatigue regularly; and 5) constant problems with both legs. The leg problems started on the right side in the feet, went up to the knee and then into the hip. It shortly did the same on the left side. Problems include numbness and coldness from toes to navel, tingling in feet, burning in upper legs and stiffness. He has trouble walking, positive Babinski (left foot), and hyper lower reflexes.

My husband told his neurologist about his drinking problem (over 6 drinks a day for 15 plus years) and has cut down to two or three drinks a day since his attack. His neurologist says he has probable MS, alcohol did not cause his MS, but alcohol may make his MS symptoms worse.

Questions: 1) Could my husband's problems be caused by alcohol instead of MS and, if so, what sort of improvement, if any, can he expect if he quits drinking? 2) What additional tests, if any, would be helpful to a diagnosis? 3) Could the oligoclonal bands in his CSF been due to his drinking? 4) Does alcohol make MS symptoms worse? 5) Other than alcohol and MS, any thoughts as to what could be causing his problems?

Your assistance with this is much appreciated.

[CCF Neuro[P] MD, RPS]

Dear Sarah:

Sorry to hear about your husband's problems.  Chronic alcohol use can give a person peripheral neuropathies that can give weakness, numbness, foot drop etc.  However, an EMG would be diagnostic between alcohol effects and the central problem of MS.  With the abnormal CSF study, I would be very surprised to find that alcohol was to blame.  It really sounds very MS-like especially with the clinical history given.  Alcohol would not induce the oligoclonal bands and in IgG synthesis in the CNS.  Yes, alcohol can and does make MS worse.  This is because we think that MS is an autoimmune disease.  Alcohol is an immune suppressor, but it is a greater suppressor of the type or category of the immune system that is at fault with MS.   Therefore, the MS exacerbations would be worse.  In addition, since alcohol suppresses the immune sytem, the patient is more prone to illness.  When a MS patient gets ill, the MS usually gets worse.  So, as you would expect, alcohol predisposes a patient to illness, and the more illness one has, the worse the MS.  

I think that your husband has MS.  I would see a specialist and get a good evaluation baseline.  He would likely benefit from the interferons or copaxone.

Sincerely,

CCF Neuro MD

[CCF Neuro[P] MD, RPS]

Dear Hugh:

There are too many types of diseases to mention.  I would progress with the work up your neurologist is doing and see what may be the etiology of your symptoms.  ALS usually does not present in the way you describe.  MS also does not present as you describe.  If the twitches were from either of these diseases, your physican would have no trouble recognizing them.

Sincerely,

CCF Neuro MD

[Hugh]

Back in July I was driving my car whe all of a sudden, I felt as though I had lost it. My body went numb and I though I was having a stroke. I got out of the car and felt incredibly dizzy and for the rest of the day felt incredibly week and unsteady on my legs. The symptons continued for a couple of days so I went to the doc who told me it was a virus and that a virus could affect you instantaneously. He put me overnight in hospital where I had blood tests, diabetes tests etc and all proved OK. I felt dizzy and light-headed with very weak legs for a couple of weeks and was then referred to an ENT who told me I probably had vestibular neuritis. Over the last few weeks I have suffered from severe fatigue and my legs feel as though they don't belong to me. My fingers and arms don't seem to want to do what I ask of them amd I feel awful and bruising (for not reason) is appearing on my right arm. My doc has now ordered me for an MRI in the next couple of weeks and I am terrified that I have MS or ALS. Of late, I have been suffering from muscle twitches and pins and needles.

Please help! Do you have any idea what the symptons could be indicative of?

[sarah]

Thank you for your prompt and professional response. I have shared it with my husband. As you might expect, he is relieved that he did not cause the problem and understands that he needs to quit to help himself. He has agreed to see a specialist.

[CCF Neuro[P] MD, RPS]

One quick word of wisdom (if I am capable of such a thing?).  We often are prone to make mistakes in life.  As loving spouses, it takes a great deal of love, wisdom, and courage not to place blame and move toward healing.  This is especially true when the mistakes are physically evident.  Your husband needs alot of love and caring, especially now.  Be a good wife, help him and love him.  I know that you know this, and by your posting you seem very caring and wise.  

CCF Neuro MD