MS? Physical or Mental?

[KimB]

Hi.  First let me say what a great service you provide!

I am a 38yr old female. My symptoms began about 6 months ago with intermittent tingling in my right limbs.  I had several episodes which lasted anywhere from several hours to several days.  3 months ago I had another such "attack" but this time it's never really gone away.  It's better -- good days, bad days -- but still there.  Also the tingling gradually changed to more of a buzzing/vibrating type feeling.  And then the buzzing gave way to weakness/heaviness and I really don't have much tingling anymore.  The left side started in several weeks ago as well (also started as tingling progressing to weakness) but it is still markedly worse on the right side.  If I work on the computer too long, fingers get achy and right arm feels heavy.  If I walk long distances, my right leg begins to feel heavy and weaker.  I also have occasional quick muscle twitches anywhere and everywhere and some cramping in right leg but not enough that I would label them as significant symptoms.

All tests have been normal (Lyme, ANA, Vit B, thyroid, Heavy metals, brain/cspine MRIs, EPs, and right leg EMG and Nerve conduction).  Actually, there was a "slight abnormality" on the right foot but he said it wasn't enough deviation to be concerned about.  (But I have noticed, from the 2 internists and 2 neurologists I've seen, that the right foot reflex seems less active than others.)  So the end diagnosis from 2 neurologists is anxiety and then come back in several months if symptoms persist or worsen.  For 2 months I've been on Remeron at night and Xanax (as needed for anxiety) thru the day.  Haven't taken Xanax too much because I don't "feel" anxious.

I should also note that I don't feel that my life is particularly stressful right now and in past times when it was, I was presented with headaches and IBS.  Have none of that now.

My questions are:
1. Can this truly be mental and not physical?
2. I've had non-stop insomnia since the birth of my daughter 2 years ago.  Since Remeron, my sleep has been great though!  Could any of my symptoms be related to sleep deprivation of the past?
3. I suffered terrible post-partum depression for 6 months for which I never sought help.  Thought I'd worked through it on my own.  Could this be related?
4. What can a psychiatrist do for me?
5. Would I need to take Xanax more consistently to see results?  If this is a brain chemistry thing, how long before seeing results?
5. Are there additional neurologic tests I should have at this point or is "wait and see" the best approach for now?  How long should I wait this out before I get concerned?
6. Approximately how long is the waiting list to get into your clinic?  I'd really rather not leave the sunny south for Cleveland in the winter, you know!!!  :-)

Sorry about the length of this.  Once again, I thank you...

Kim

[CCF Neuro[P] MD, RPS]

Dear Betty:

It is difficult to say without examining your husband and seeing the MRI films.  But, MS is a waxing and waning type of illness (hence the name multiple in multiple sclerosis).  One event would, at this point exclude MS.  The fact that his spinal cord had other areas of hyperintensity along the cord would turn me away from the diagnosis of transverse myelitis.  I would lean toward ADEM, acute demyelinating encephalomyelitis.  This is a post infectious demyelinating disease.  But, again, without seeing the films or examining your husband I cannot tell you for certain.  A transverse myelitis is more limited to one area of the spine and not in many places.  However, this could just be a large area of demyelination, I can't tell.

Sincerely,

CCF Neuro MD

[Betty]

My husband had a strange attack a year ago, which affected his legs and feet. He appeared to be dragging his feet, and he had weird sensory sensations where he felt as if his skin was damp, and he could not bear his clothing to touch his skin. This sensation spread up his body and he had a kind of band of discomfort round his middle, with numbness, and tingling in his hands and arms. Just at the time all of this started he had a flu like illness.
Over the last year most of these symptoms have either disappeared or improved considerably, but they have taken a long time to receed. He still seems to be a bit stiff.
He has had a huge range of tests, all of the blood tests were normal, but the MRI scan did show up some sort of inflammation in his spinal cord just about the neck region. The MRI also showed some other problem further down his spinal cord, but the consultatnt feels that this is not necessary an inflammation but may have been an artefact caused by the scanner.
He is unsure as to whether my husband has transverse myelitis or MS.
How could he be certain which of these conditions it is. Please help, because at the momoent we feel very concerned.

Betty

[CCF Neuro[P] MD, RPS]

Dear April:

Serazone would not mask the symptoms of MS.  It should only act on your mental state and not your motor system or sensory system, would not change the picture of the MRI or CSF findings.

Sincerely,

CCF Neuro MD

[april]

Dear CCF Neuro MD,

Could you tell me why a Neurologist might use Serazone first?  I have heard that this would only mask the symptoms of MS and thus be written off to depression?  Could you give me some insight to this.  I appreciate your help.

Thank You,
April

[CCF Neuro[P] MD, RPS]

Dear Melissia:

I do not know of any neurologist using a red cell mobility test to diagnose MS.  The diagnosis of MS is clinical and based on physical exam and history or relapsing and remitting symptoms.

CCF Neuro MD

[Melissa]

I have been reading up on MS since my mother was told that she may have MS.  Someone mentioned in an earlier posting a "red cell mobility test."  I didn't see any follow up to that question and I was wondering if you know what that is and is it helpful in determining MS?

Thank you in advance and congratulations in providing sucha great service to everyone!

[CCF Neuro[P] MD, RPS]

Dear Shari:

If you truely have muscle weakness and also muscle twitching, I think you should see a neurologist.  Most of the time, it is something benign, but these two in combination can be the harbinger of something bad.  I would bet that it is nothing, but get checked out and make sure.

Sincerely,

CCF Neuro MD

[Shari]

I was amazed to hear Kim's posting because I have nearly the same symptoms.  I've been having a lot of weakness in my right arm and leg.  I can still do my regular activities - tennis, jogging, etc.  I'm a 31 year old female, and I've been extremely scared that my symptoms are related to some terrible disease.  The weakness in my arm and leg gets better and worse at times.  I've also had weakness in my jaw with chewing lately. I have also had muscle twitching and fatigue.  I never had any of this until I had my son 2 1/2 years ago.  I also had an epidural.  I went to my dr. about the weakness and twitching and he put me on Wellbutrin (an antidepressant) and ibuprophen (possible inflammation in my shoulder and hip) which hasn't helped at all. Should I go to a neurologist?

[CCF Neuro[P] MD, RPS]

Dear Rachel:

Sorry, I thought you were making a comment.  No, there is no data to indicate that bipolar disorder (genetic) and MS (polygenetic and environmental) have any relationship.  Many people with MS have psychological problems and many suffer depression.  However, a link has never been made.  The families with bipolar disorders have no more incidence of MS than the general population.  Twin studies do not show that bipolar and MS are linked (therefore not genetically tied together).  If you have MS, the pill will in NO way have any effect on whether you develop MS.  The hormonal shifts might change your immune status, but that would be minor.  The data on pregnancy is individual.  Some women get better when they are pregnant, and some women get worse, and some women are not effected either way when they get pregnant and have MS.  

Sincerely,

CCF Neuro MD

[Rachel]

Hello, is the neuro listening? I did not get a response from the doc regarding a possible connection between bipolar disorder and MS? Because both bipolar and MS are rare, and I have the incredible bad misfortune of probably having both at the age of 29, I cannot help but wonder if there is aan underlying mechanism which is responsible for both. I know that, in my case, it was not the MS that caused the depression. I never had MS symptoms until last year whereas I have battled depression on and off since age 15.  Also, I have noticed that every time I am on the verge of menstruating and during the first couple days of my cycle, the numbness and tenderness in my feet worsens temporarily and then subsides as my cycle winds down.  Have other women noticed this worsening at the time of their cycle. I am on the birth control pill to combat very painful menses (strong possibility of endometriosis) and I am hoping the pill may help balance me out and reduce my susceptibility to MS. I have heard that when women are pregnant, they are unliikey to suffer from an MS flare. So, maybe women with MS should be on the pill. I feel strongly that a hormonal imbalance impacts heavily on the course of MS.

[CCF Neuro[P] MD, RPS]

thanks for your comments.

CCF Neuro MD

[comment to Racheal]

I was just reading all of these posts and yours about the connection between ms and bi-polar was interesting to me.  I am cerrently going through the tests for ms based on several symptoms and repeated episodes of problems (I'm 29).  My mother has bi-polar I believe (we don't talk anymore) and I went to 5 neurologists in a year before I could get one to take me serious.  Anyway, a couple of them had suggested that I may have bi-polar, and I always figured they were just saying that because I told them about my mother.  Now I wonder about the connection too or can bi-polar mimic ms like other things do?  I doubt that bi-polar is the cause of this terrible tailbone pain I keep experiencing that my Naprelan is not helping with.  Well, just wanted to comment on your posting. Best wishes to you, and have a nice holiday.  Heather

[CCF Neuro[P] MD, RPS]

Dear Randy J. Beesaw:

Sorry to hear about your problems.  I would tell you to see a neurologist and get a work-up for your muscle fasciculations.  Since you describe no real muscle weakness or cramping it is likely not a worrisome disease.  But, it is affecting you and you need someone to examine you and tell you that you do not have MS or ALS (which would be very unlikely).

Sincerely,

CCF Neuro MD

[randy j. besaw]

over a year ago i noticed a twitch in my left thumb.that lasted a couple of months.then a finger on my right hand started twitching,then i started getting them everywhere.i now have them in my hamstrings and feet.i never had any weakness,but after 11 months i started to get a weird feeling in my right foot.this comes and goes.i don't know if it's weakness because i can still
walk and run on my toes and heels.lately i've been feeling a dull
ache in my upper back near my neck.this causes my hand to feel weird,then it goes away.the feeling in my foot has lasted over 2 months and has not gotten worse.i feel that their is some inflammation in my upper back near my neck.what could this be.i
fear als but the slight weakness feeling i get goes to different ares of my body.please help me.

[Kimmy]

Rachael, I have ms and I'm concerned about having bi-polar disorder... I have a friend who is dianosed w/ bi-polar and my symptoms are somewhat simular to his. From teen years on (I'm 31) I have insomnia off and on, periods of extra energy, moody moody moody!!!,depression at other times, suicidal ideation (I really don't want or plan to kill myself!!!) I just have intrusive thoughts of suicide when stress builds up too much. I have strained relationships because I always expect too much from people yet I expect to be understood at all times. Really crapy way to be but I can't seem to get it together. I don't move alot or change jobs  (same work for 13 years, same home for 10). Sexual impulses increase with alcohol only. If there is a link between the 2 I'd like to know as well...I KNOW OF 2 PEOPLE WITH BOTH. I would lie a pin map of where ms patients live, I'm convinced there is an outside cause to this disease. My neurologist thinks so too...he has had a large increase in number of patients this year (253 total new cases). This is a staggering number if you consider in the USA there are supposedly only 250,000 of us at any one time. Well my thoughts and prayers are with you. Good luck.

[CCF Neuro[P] MD, RPS]

Dear Kim:

It is difficult to tell you that your old moldly basement office is the culprit or not.  On thing is for certain, clean out your basement and have someone check out if there is mold (fungus) growing in the carpet or walls.  Certainly, mold can cause respiratory problems and respiratory problems can lead to CNS problems.  If you or your husband are immunodeficient, then the mold might cause a direct CNS problem.  As far as a direct CNS effect, it would remote but possible.  I am sure that there is a web site for this on the internet as there are sites for most everything these days.  I would start with the EPA (government site) and then there is a neurotoxicology department at the University of Oregon Health Center in Portland that you should be able to get information from.

Sincerely,

CCF Neuro MD

[kim]

I just read an article about toxic household molds and how they can affect our health including CNS symptoms?  If "DYNAMITE Doc" is still around, what can you tell me about this?  Would these be long-term damaging symptoms or symptoms that would wane after the mold problem is resolved?  And would anything show up on neurologic tests with a mold-induced CNS problem?

When I first read this, I kind of blew it off however my symptoms have gotten better in the last several weeks coincidental with having NOT been in my office in the basement.  Also my husband often comes down with very bad sinus irritations with a croupy cough and other gross stuff I won't go into.  They never seem to be linked to the illnesses our family is passing around.  He came down with another such episode last week coincidental with spending a lot of time in our basement.  (Our basement has flooded numerous times and contains carpet which the EPA website says is haven for molds.)

Is there is anything to this?  If so do you know where I might find more info on it?  And how hard would it be to determine if my neurologic problems stem from air quality?

Thanks,
Kim

[CCF Neuro[P] MD, RPS]

thanks for the comment.

CCF Neuro MD

[C Jenkins]

Ah!  "Puritanism" haunts us still.  Breastfeeding was taboo in the 60's.  Ross Laboratories flourished though.  They nursed themselves on "Similac" along with stockholders.  Yeah, hormones have scads of power.  Women first fo through puberty, experience "starting" (ooh, we can't wait), then go through all the hassels and highlights of womanhood... only to end up hot-flashing our way into "puberty in reverse" and are ever-so-glad when our kids take their kids home after a weekend visit.  But menopause doesn't mean it makes us love them any less.  It means we have to stay tongue-tied and calm when it comes down to how they are raising our grandkids!  Talk about nervous disorder!  I just had to say all that.  Sorry about that, Kim.  Humor is good medicine.

C Jenkins

[CCF Neuro[P] MD, RPS]

Dear Maureen McL:

Congradulations for the duration of your breastfeeding, it does take effort to persist in our society.  I actually published a paper concerning the levels of good cytokines in breast milk a few years ago.  Your children are very lucky.  One can only note that continued breast feeding helps mothers loose weight (gained for this reason during pregnancy and also nutritional benefits for the fetus), loose and somewhat modest birth control, but you are correct the stimuli are to tickle the pituitary gland to produce prolactin for lactation.

Sincerely,

CCF Neuro MD

[Maureen McL]

RE. Breastfeeding and Neuro problems:

My problems also began when weaning my daughter at around 10 mos.  (By the way World Health Organization says average duration of breastfeeding is 2 years - we are just not used to seeing older babies nurse in our culture.  I'm poking fun now at CCF - neuro because I know he actually loves kids and supports breastfeeding!  I nursed all three of mine for almost a year and they are extremely healthy.  No tubes in their ears, no allergies, etc.) I feel the hormonal swing associated with the weaning factored into the triggering of my syndrome. The power of hormones!

[Rachel]

Hello all. I would like to know if research has been conducted to investigate a possible connection between bipolar disorder and multiple sclerosis.  I am a 29 yr. old female who has suffered from recurring clinical depression since about age 15.  I had one manic episode at age 21.  Last year, at age 28, I experienced a neurological attack involving sudden onset numbness and tingling in the feet spreading up to waist level over the course of several weeks.  My lumbar puncture revealed elevated IgG and elevated myelin basic protein as well as two oligoclonal bands. Initially, I was told my spinal and brain MRIs were normal, but I took the films to an MS specialist who told me he detected a small lesion near the 7th thoraccic vertebra.   He told me the truth no one else would--I have a 90% chance of going on to develop RR multiple sclerosis and a 10% chance that I just endured transverse myelitis which does not recur.  I have not been officially diagnosed nor will any doctor prescribe Avonex or the other cutting edge drugs for MS.  I find this incredibly frustrating. I have had to struggle and dig for information.  I have met several people who have both an affective disorder such as bipolar or depression and concurrent MS.  Now it is happening to me.  So, I wonder how many people out there have both conditions. Could there be a common underlying mechanism which causes a nervous system imbalance? Could chronic use of antidepressant medication be a factor in the subsequent emergence of Multiple Sclerosis? Thanks to all who respond. I am determined to stop this disease!
Rachel

[kim]

Right, right...  "Dynamite Doc!"  It was midnight when I wrote it so what can I say?  Funny thing is I woke up this morning thinking, "Did I write dynamite or dynamic?"  Duhhh!  I'm not going to blame my cognitive problems on whatever ails me though becuase this sort of thing, unfortunately, has been with me for too long!  :-)

[C Jenkins 2 Kim]

Exercise and good posture make for a staturesque woman.  I hope things get better for you.  Shop til you drop if you have to.  And... he is the "Dynamite Doc", isn't he?  Always there.  Always reading.  Always giving the best advice he can.  I don't believe there is one of us who would have it any other way.  Would we?  Have a good one! - C Jenkins