Question: Chronic migraines – I have undergone all possible tests but have not received a concrete or satisfactory answer. Is there reliable information about a direct connection between MS and migraines? I should note that my MS lesions are only in the brain, and I have diagnosed ophthalmic migraines as well.

Answer:
Case series indicate a possible connection between MS brainstem lesions and frequent migraine attacks. One study found that MS lesions in the midbrain increase the risk of migraines fourfold. Today, there are highly effective treatments for shortening the duration of migraine attacks and preventing them, making it possible to significantly reduce the suffering caused by migraines.

Question: Diagnosed in 2012, currently taking Tecfidera, still classified as RRMS. There have been no attacks in recent years, but there is a slow decline manifested mainly by worsening drop foot and increasing difficulty walking. Should I switch to a treatment tailored for secondary progressive MS (SPMS)? What does this mean for my pharmacological and clinical classification in relation to health insurance? I should note that I am JC virus positive.

Answer:
SPMS is characterized by a gradual and slow worsening of neurological symptoms without relapses (which involve rapid worsening followed by improvement).

SPMS can be divided into active and inactive forms:

• Active SPMS: In addition to gradual worsening, there are new lesions on MRI, enlargement of existing lesions, or clinical relapses.
• Inactive SPMS: MRI shows no changes in lesions, and there have been no relapses for years, despite the ongoing gradual worsening.

In cases of active SPMS or rapidly worsening neurological symptoms, switching immunological treatments is recommended, with evidence suggesting that such a change can stabilize the neurological condition.

In cases of inactive SPMS with very slow worsening over many years, the likelihood that switching immunological treatments will bring significant improvement is low. Safety and side effects should also be carefully considered when changing treatments for inactive SPMS.

Currently, there is no sufficient treatment for inactive SPMS, although ongoing research on new medications aims to address this gap. Health insurance typically approves treatment changes for active SPMS but not for inactive SPMS, for the reasons explained above.

Question: Over 20 years ago, I experienced a major attack where my entire left side was paralyzed, including my speech. I now have yearly brain MRIs, which show no new lesions or inflammation. However, I still experience urinary incontinence (requiring self-catheterization), cognitive decline, tingling in the limbs, balance issues/vertigo, severe fatigue, and more. Why do these symptoms persist despite no new or active lesions?

Answer:
In MS and other demyelinating diseases, permanent damage can remain from past attacks, even when the disease shows no current activity. This can be likened to a forest fire: even after the fire has been extinguished and is no longer present, barren patches remain where trees were irreparably damaged. Similarly, neurological damage from previous attacks can cause lingering symptoms, even when there are no new or active lesions.

Question: Is there a medication that can cure the disease’s symptoms, or do current drugs only suppress the disease, as most treatments seem to do?

Answer:
Treatment for persistent symptoms is symptomatic. Medications are available to alleviate fatigue and pain. Vestibular physiotherapy can help with balance difficulties, while cognitive rehabilitation and training can improve cognitive function.

Question: Have there been studies on MS and the likelihood of passing the disease to children? I’ve heard from community members about cases where both a parent and a child have MS. How common is this, and have there been studies on it within the patient population?

Answer:
MS is a multifactorial disease with various contributing factors, some of which are unknown, and there is a genetic component. While most cases do not involve familial transmission, the risk of MS in the offspring of individuals with MS is higher than in the general population.

To provide perspective: According to research, the global risk of MS in the general population is approximately 0.1%. For the child of a person with MS, the risk increases to 1-2%, or 10-20 times higher than the general population. However, this is still a very low absolute risk.