Dr. Ronit Galili Mosberg – Senior neurologist, MS specialist, Herzliya Medical Center – Board Member of the Advisory Medical Council in the Israeli Multiple Sclerosis Society
Question: Shingles vaccine.
Answer: This vaccine prevents the outbreak of the virus that causes a blistering disease (resulting in skin blisters), which leads to pain and, in some cases, prolonged pain even after the blisters have healed.
This virus, responsible for chickenpox, remains dormant in the body, in cells located near the spinal cord. When the immune system is weakened, the virus may reactivate and cause clinical symptoms.
The recommended vaccine is called Shingrix, administered in two doses, several months apart. The vaccine is generally given to individuals aged 50 and older. It is included in the national healthcare basket for those aged 65 and older or younger individuals with immunosuppression.
Consult your treating neurologist regarding receiving the vaccine, as some multiple sclerosis treatments may require avoiding the vaccine or administering it before starting drug therapy.
Question: Medical cannabis treatment.
Answer: A specialist neurologist can prescribe medical cannabis for multiple sclerosis patients who, in the neurologist’s clinical judgment, meet the criteria for this treatment.
Question: Impact of “new” medications.
Answer: The fact that a medication is “newer” does not necessarily mean it will be more effective for a specific patient than an “older” medication. The response is individual.
Regarding the timing of starting drug treatment, the approach is to begin treatment relatively early in the disease course rather than waiting for later stages, when there is often already irreversible clinical damage. Studies have demonstrated greater effectiveness when treatment is initiated in the early stages of the disease.
Question: Chronic fatigue.
Answer: I am not sure what “Magat” refers to that you drink.
Cipralex is an antidepressant with a stimulating effect and is not an addictive medication.
There are medications available to improve fatigue in multiple sclerosis patients, such as Modafinil or Armodafinil, which are effective. A prescription is required.
It is advisable to check your vitamin B12 levels and thyroid function, as deficiencies or hormonal imbalances in these areas can also cause or contribute to fatigue, a common symptom among multiple sclerosis patients.
Question: What are the treatments for multiple sclerosis?
Answer: Multiple sclerosis is a chronic disease. Some patients experience prolonged remission, meaning they have no symptoms for years, although disease activity may still be visible on an MRI of the brain or spinal cord.
Performing MRI exams depends on the recommendation of the treating neurologist. The exam is crucial for diagnosing the disease. Subsequently, follow-up MRIs are conducted, for example, during drug therapy, to assess whether the disease is inactive in addition to clinical evaluations.
Question: Connection between multiple sclerosis and migraines.
Answer: Indeed, studies have found a link between multiple sclerosis and migraines, with migraines being more common among multiple sclerosis patients.
Question: Secondary progressive multiple sclerosis (SPMS).
Answer: When there is a change in the course of the disease, it is worth considering a change in drug therapy. Schedule an appointment with your treating neurologist to discuss therapeutic options tailored to your clinical condition, taking into account your JC virus positivity.
From the perspective of health insurance services, it is recommended to receive rehabilitation treatments, such as physical therapy and the fitting of walking aids, if needed, due to increasing difficulty in walking.
Question: Neurological symptoms when brain MRI shows no changes.
Answer: In your case, some symptoms, such as urinary dysfunction and tingling in the limbs, are likely caused by lesions in the spinal cord, which is also involved in the disease (the spinal cord is part of the central nervous system, along with the brain).
Therefore, spinal MRI scans (cervical and thoracic) are an important part of imaging follow-ups, in addition to brain MRI.
Severe fatigue is a common symptom of the disease and may also occur in its early stages.
Additional points:
- There are various treatments to alleviate the symptoms of MS, including medications to regulate bladder activity, reduce fatigue, and ease tingling in the limbs. These medications do not cure the problems but improve symptoms as long as they are taken.
- Regarding genetic predisposition: MS is more common among family members of patients. Genetic testing is not available, as multiple genes are involved in the disease. While the likelihood of MS is higher among relatives, most patients do not have a family history. When a parent has MS, the child’s risk of developing the disease is approximately 2%.
Question: Preventing memory decline.
Answer: First, it is important to diagnose cognitive impairments. These may include additional issues such as difficulties in language function or disorientation alongside memory problems.
To slow memory decline:
- Maintain regular physical activity.
- Engage in mental stimulation, such as reading or solving puzzles.
- Participate in social activities.
Ensure proper sleep hygiene and adequate levels of essential vitamins (e.g., B12, D).
Cognitive complaints in MS patients may sometimes result from or be worsened by depression and fatigue. Addressing these symptoms can improve cognitive concerns.
Question: Gastrointestinal issues.
Answer: Gastrointestinal disturbances can be a manifestation of MS.
Consult a dietitian about dietary adjustments, such as increasing fiber intake, to improve bowel movements.
Seek advice from your treating neurologist and, if necessary, a gastroenterologist regarding medications that may help with gastrointestinal symptoms.
Remember that not all issues are necessarily related to MS. For example, conditions like stomach ulcers or Helicobacter pylori infections can also occur. MS patients should undergo routine screenings, such as stool tests for occult blood and colonoscopies, similar to the general population.
Question: Hyperbaric oxygen therapy for multiple sclerosis (MS).
Answer: There is no known evidence to suggest that hyperbaric oxygen therapy is beneficial for progressive MS.
Regarding myelin regeneration: The body has some ability to regenerate myelin, particularly in the early stages of the disease. This is evident in attacks from which patients recover completely and in dynamic brain lesions that disappear. However, the ability for self-repair diminishes as the disease progresses.
Some medications, such as Teriflunomide, have demonstrated potential myelin repair capabilities in laboratory studies.
Scientists and pharmaceutical companies are working to develop therapies that can effectively regenerate myelin as a treatment for MS.
The decision to continue or change medications depends on clinical status and imaging follow-up results.
Question: Leg edema in non-ambulatory patients.
Answer: Leg edema is caused by several factors, including reduced or absent leg movement.
Walking activates muscles, facilitating the return of blood from the legs to the heart through the venous system. In non-ambulatory individuals, venous return is impaired, leading to blood pooling in the legs and causing swelling.
To prevent leg edema:
- Move the legs actively or passively as much as possible.
- Elevate the legs while lying down.
Edema is often more pronounced in the weaker leg.
Medications like Fampridine in combination with Aubagio may help. Fampridine has been clinically shown to improve walking speed and stability. It has relatively few side effects, and its effectiveness can be assessed within one to two weeks.
Question: Numbness and body stiffness.
Answer: There are medications available to alleviate numbness in different body parts and reduce stiffness or spasticity. Consult your treating physician for recommendations.
Question: Lower back pain before menstruation.
Answer: Non-steroidal anti-inflammatory drugs (NSAIDs), such as Naproxen, can help alleviate the pain. These medications should be taken after meals and not on an empty stomach.
Question: Various complaints related to MS.
Answer: Many MS symptoms can be managed through tailored medications and lifestyle adjustments. For example, taking midday rests to reduce fatigue or scheduling activities during the most productive hours of the day.
Functional impairments caused by the disease can affect mood and self-esteem. It may also be challenging to avoid comparing oneself to peers without the condition.
I recommend consulting a medical psychologist to develop better coping strategies. If you are experiencing symptoms of depression, antidepressant treatments may also be helpful.
