The diagnosis of MS can be very difficult at times. It is still a “clinical diagnosis,” meaning there is no specific diagnostic test you can take. Rather, your doctor looks at your MRI and spinal fluid results in conjunction with a clinical history and exam to see if the results are compatible with a diagnosis of MS. MS can be present even with a normal MRI and spinal fluid test although it’s uncommon to have a completely normal MRI. Sometimes the MRI of the brain may be normal, but the MRI of the spinal cord may be abnormal and consistent with MS, so this also needs to be considered. Also, the symptoms typically associated with MS can occur with other problems in the brain or even blood. Other diagnoses may need to be considered if your MRI is normal. There are no specific over-the-counter treatments that are recommended for multiple sclerosis patients who suffer from pain or allergy and sinus problems. Every patient is individual and may respond differently to different medications. There also is no specific list of medications to avoid. It is not a common phenomenon that patients with MS have problems with sensitivities to antibiotics and over-the-counter medications. More importantly, if your mother has been diagnosed with relapsing-remitting multiple sclerosis, she should be getting appropriate care for her condition. Potential therapies would include interferons and/or Copaxone (glatiramer). There is no specific scientific evidence that diet changes or vitamins impact the long-term course of multiple sclerosis. Q3. I went to the neurologist with pain going down my right arm with slight numbness. The pain was constant and moved to my chest, back and left arm. I also have strange twitches or spasms down my legs, arms and back. The MRI showed 12 lesions in my brain and some on my spine. However, the lumbar puncture only showed two white blood cells and a normal IgG count. But I have the oligoclonal bands. The doctor doesn’t want to put me on the disease-modifying drugs and won’t conclusively say that I have MS. He wants to wait and see if I have more symptoms. How long is too long to wait to be put on the meds? Would the meds do me harm being on them and finding out it was something else? The most important task is always making the correct diagnosis, and it sounds like you and your doctor are moving in that direction. The symptoms you describe could certainly be seen in multiple sclerosis, although these symptoms alone are not diagnostic, as a number of other neurological disorders could lead to similar symptoms. An accurate and definitive diagnosis is guided by a composite of the symptoms you offer in your history, signs on neurological examination, findings on brain and spinal cord MRI, and findings in the spinal fluid. We are helped in this by a set of criteria, called the McDonald criteria, and these guidelines are revised every few years. These criteria incorporate the clinical information as well as the MRI and spinal fluid findings. In your case, the presence of abnormalities or “lesions” on the MRI and oligoclonal bands in the spinal fluid is certainly suggestive of multiple sclerosis. However, the size, location and shape of the MRI abnormalities are also extremely important as many “white spots” can be seen that are not typical of MS and can even be seen in completely normal individuals! Once a firm diagnosis is established, we would recommend treatment with one of the disease-modifying drugs at the earliest possible time in an effort to reduce new symptoms or “flares,” to prevent the development of new abnormalities on the MRI, and to reduce the chance of any progression of disability. However, we would never encourage initiation of treatment until a definite diagnosis of multiple sclerosis has been established. Sometimes this does require a period of observation or follow-up MRI studies, and that would certainly be more appropriate than starting medication prematurely! Another opinion can also be very helpful in sorting out a diagnostic challenge. Q4. What do you know about Chantix with regard to multiple sclerosis? It’s used to help you quit smoking. I’ve heard you can develop MS after taking this drug. I’ve also heard that people develop MS symptoms or their existing MS symptoms get much worse while taking this drug. There is no evidence that using Chantix (varenicline) for smoking cessation results in the development of multiple sclerosis or worsens MS or its symptoms. However, there is evidence that smoking cigarettes may have a role in the development of multiple sclerosis and that actively smoking exaggerates many MS symptoms. In addition, there is some evidence that smoking may accelerate the transition from relapsing MS to secondary progressive MS. Although there is certainly controversy on these points, there is enough available data for us to advise our patients not to start smoking and, if they already smoke, to quit. Chantix is one of several strategies available to help with smoking cessation, and it would certainly be worth discussing this and other options with your primary care doctor and your neurologist. Q5. My sister was diagnosed 19 years ago with MS. I have MS as well. She hasn’t had a symptom in eight years (and before that had been symptom-free for four years), and she has never taken any medication for her MS either. The doctor has asked her for an MRI but she sees no use in this since she has no symptoms, and it appears her MS is benign. Is there any benefit for her to have an MRI since it appears her MS is benign? The fact that your sister has had almost no symptoms over the last 12 years doesn’t necessarily mean that her multiple sclerosis is benign. The diagnosis of “benign MS” can only be made at the end of someone’s life, when it can be seen in retrospect that MS did not cause gradual progressive problems or significant neurologic disability. There can be progressive gradual changes of MS detectable on an MRI, even though the person may not be having clinical symptoms. If an MRI shows either active inflammatory changes following intravenous contrast with gadolinium or if there is a progressive accumulation of more “white matter plaques” compared to prior MRI images, then there will likely be clinical symptoms eventually. Thus, the advantage of having an MRI, even when symptoms are stable, is that the clinical situation may be just the tip of the iceberg. The MRI can be a guide as to whether or not there are any anatomical changes in the brain that may cause clinical, cognitive or physical problems in the future. Then appropriate treatment decisions can be made based on the MRI changes, whether acute or chronic. Learn more in the Everyday Health Multiple Sclerosis Center.
