Ask the Doctor
By Dr. Jack Burks
Can MS Lesions Mimic a Stroke?
Q: I was diagnosed with MS in 2003. I hadn't had a brain MRI since, until about three weeks ago. I was devastated to learn it had progressed significantly, but I am also worried about something else on the radiologist's report. It said "there was evidence of an old-appearing basal ganglia infarct" on the left side.
I have a new neurologist and he tells me that it is a "small stroke" and I should not worry about it - even though it was not on my MRI in 2003. I believe I know when this happened, but I did not see a doctor at that time, thinking it was a bad flare-up of MS. It took over two months to heal.
I am worried; is this common in MS or something else? Should it have been looked into? Will it or something worse happen again?
A: Your questions are very appropriate, but trying to answer them requires considerable speculation on my part. Your brief description and questions raise several more questions. How old are you? Stroke is very uncommon in young adults. Could MS lesions on the MRI be mimicking a "small stroke" in the basal ganglia? (Basal ganglia are structures located deep in the brain, responsible for normal movement.) Do you have risk factors for additional "strokes?" Risk factors include diabetes, heart irregularity, high cholesterol, high triglyceride, hypertension, obesity, and other health conditions. Is your MS getting worse clinically (with more attacks or progressive symptoms), or is the MRI the only thing getting worse? Are you on MS disease-modifying therapies (mentioned earlier)?
What are the next steps? If you have had a stroke, I would recommend you have a stroke prevention and cardiovascular evaluation. As for your MS, new lesions on the MRI in MS patients are worrisome but not unexpected. Brain atrophy or shrinkage is more worrisome, if present.
What can you do to reduce the MS damage? If you are not on an MS disease-modifying therapy, you and your doctor should discuss what options might be appropriate for you. If you are on therapy, discuss the possibility that your therapy may not be optimal. Should this be the case, you may want to consider changing your treatment approach.
Q: I have been diagnosed with primary-progressive MS. There doesn't seem to be very much information on how to treat this form of MS. However, I've read that vitamins C and E may stimulate the immune system. I currently take 500 mg of C and 400 IU of E; if these do stimulate the immune system, should I reduce the amount of C and E that I take each day? What would be the correct dosage? I take the high dosage of C to fight off colds - which has been effective. Also, I read that fish oil may help with MS. Do you have any opinion on this?
A: No specific treatments for primary-progressive MS (PPMS) are approved by the FDA. However, treatments to help the symptoms of MS are available.
Concerning vitamin supplements, while not FDA-approved for MS, many supplements are taken by MS patients. Vitamins are either water soluble (vitamins B and C) or fat soluble (vitamins A, D, E, and K). Fat-soluble vitamins should be taken in moderation since they can accumulate in the body and have toxic effects. The recommended daily allowance for vitamins is available on nutritional websites, or at your doctor's office. However, some MS patients feel that exceeding the daily recommendation may (as you suggest) help with other MS problems or may reduce the chance of getting a cold. Some vitamins are thought to have anti-oxidant effects which may reduce the MS damage. No evidence is available to support the theory that vitamins may worsen MS by stimulating the immune system. Scientific data in these areas are not rigorous.
Vitamin D (the sunshine vitamin) has been shown to reduce the risk of getting MS. Whether or not taking vitamin D reduces the severity of MS is under investigation. Some MS doctors recommend oral vitamin D supplements, especially for MS patients who are not exposed to much sunshine in the winter. The optimal dose has not been established, but 1 to 2 grams per day is common.
Fish oil may be good for general health, but its specific effects for MS have not been demonstrated conclusively. Taking vitamins and fish oil, under a health care professionals' guidance, is common for MS patients. While the proof of benefit for MS specifically is not proven, they are unlikely to be toxic, except for high doses of fat-soluble vitamins. The specific doses for MS patients have not been determined.
Vitamins and fish oil are different from herbal supplements, such as echinacea. Echinacea and some other supplements may increase immune system activity, which might be a stimulus for more MS damage. For additional information, MSAA's monograph, Thinking about Complementary and Alternative Medicine? may be helpful. Written by Thomas M. Stewart, JD, MS, PA-C and Allen C. Bowling, MD, PhD, this publication can assist with finding and evaluating claims about supplements and other complementary and alternative (CAM) therapies. This free monograph may be viewed, downloaded, or ordered by visiting www.mymsaa.org and going to "publications." For individuals without internet access, copies may be ordered by calling MSAA's Helpline at (800) 532-7667.
I also recommend Dr. Bowling's book, Complementary and Alternative Medicine and Multiple Sclerosis, 2nd edition (Demos Medical Publishing, 2007). This book may be borrowed through MSAA's free Lending Library; please see page 48 for ordering information. In addition, MSAA and the National Multiple Sclerosis Society (NMSS) have recently collaborated on a book for PPMS patients, which is expected to be available this fall. MSAA will also be publishing a booklet on PPMS. Please look for more information on these new publications in our next issue of The Motivator.
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Jack Burks, MD, is a neurologist, chief medical officer for MSAA, clinical professor of neurology at the University of Nevada in Reno, Nevada, and member of the Clinical Advisory Committee of the NMSS. He has edited two MS textbooks. Previously, Dr. Burks established the Rocky Mountain MS Center and has served on several Boards of Directors, including the American Society of Neurorehabilitation (past president), the Colorado Neurological Institute, the American Academy of Neurology, and the Consortium of MS Centers. In recent years, he has lectured in more than 30 countries.Back
|Last Updated on Monday, 25 March 2013 11:45|