Multiple Sclerosis Vlog: Answering Viewers Questions on MS Attacks

in this video I’ll be answering viewers
questions about MS relapses if you want to better understand MS attacks and how
to treat them then don’t turn away because that learning starts right now Howie thanks for learning about MS with
me Aaron Boster I started this YouTube
channel to help my own MS clinic patients learn between visits and it’s
my hope that through these videos I can help you learn – I adore viewers
questions and comments and in today’s video I’ll be answering selected
questions from viewers specifically related to MS attacks let’s jump in
question number one comes from Cindy who writes with the relapse do you recommend
IV steroids or by mouth Cindy excellent question and as it turns
out both are equally effective the most common way to treat an MS attack is with
a gram of IV solu-medrol that’s a liquid bag of steroids they spike a vein and
they run the drug into your arm most commonly that’s given for 3 to 5 days in
a row but that’s not the only option when treating an attack it’s also
equally as effective and equally as safe and tolerable to take high-dose oral
steroids now they don’t make thousand milligram pills and so you end up taking
a bunch of pills if you’re using prednisone the important take-home here
is that it works just as well and it creates options for people some
of my patients strongly prefer the IV either they find that for them it’s
better tolerated or that for them it seems to work better or the side effects
are more favorable but I have a large group of patients that strongly prefer
the pills they tend to be cheaper you don’t have to go to the infusion center
and there’s certainly upsides to swallowing some pills in the morning as
opposed to an IV at the end of the day it’s all about what works best for you
and I strongly encourage you to talk to your neurologist to figure out what’s
the best option it’s God forbid you need treated for an attack awesome question
and Thanks for writing in our next question comes from Andrea Shoop who
writes do steroids impact the amount of disability after a relapse if not why
give steroids given their side effects also how many
rounds of high-dose steroids are safe in a year or in a lifetime
Andrea outstanding question and thank you for writing in steroids hasten the
recovery of a clinical attack if God forbid you’ve gone blind because of an
attack of optic neuritis and giving you high-dose steroids returns vision that
has major functional benefits and hasting the recovery it makes the world
of sense it’s also my personal belief that steroids can quell active ongoing
inflammation which is literally causing brain damage and spinal cord damage it’s
my belief that steroids make you better faster but also preserve more brain
function and given my druthers I certainly want to treat you with
steroids when we identify an attack now of course you are in charge of you which
means we’re going to have a discussion and at the end of the day if you say nah
I’m not gonna make you do something that you’re not comfortable with your second
set of questions about the safety and frequency of steroids is also very
relevant if you require one or two courses of steroids in a given year I am
very concerned that we do not have good control over your disease and I think
that we have to look critically at the disease modifying therapy and this is a
situation where we’re probably going to want to escalate the dmt you’re asking
more specifically about the safety of suppressing the immune system with
recurrent pulses of steroids giving someone a 5-day course of high-dose
steroids doesn’t have long-term immunosuppressive effects and from a
safety standpoint if we’re doing that once twice three times a year I’m not
terribly concerned about chronic immunosuppression if however we’re
needing to use steroids more frequently than that I do start to become concerned
about chronically suppressing the immune response I’m not aware of a lifetime
concern for too many steroids over giving humans life I do think that as we
use steroids we have to keep in mind it can elevate blood pressure it can
increase the risk of diabetes or problems with sugar it can create
cushingoid problems and it can be rough on the bones and so there’s a lot to
consider weighing the risks and the benefits of treating an attack again
thank you for the awesome question our next question comes from viewer
Julie Jill Raymond who writes why is gestational diabetes a problem with
steroids Julie Jo when you give someone really
high dose steroids it can temporarily interfere with their body’s ability to
process sugar and if you were to take a healthy person who doesn’t have diabetes
and doesn’t have a history of gestational diabetes and give them
high-dose steroids if you check that person sugar you may find that
transiently their sugar levels are elevated in their blood now in someone
with a normal endocrine system that doesn’t really have any long-term
detrimental effects however if that person has a history of diabetes giving
them high-dose steroids can really throw their sugars into whack and when someone
has diabetes we have to partner with their primary care doctor or with their
endocrinologist and use sliding-scale insulin while we’re treating an attack
with steroids sometimes it’s tricky and we actually admit the patient into the
hospital now if you have a history of gestational diabetes that means that
during the time around pregnancy the sugars got out of lack and this is also
a concern when giving that same person steroids years later when we have a
patient who has gestational diabetes or a history of gestational diabetes and
we’re going to give them steroids for an attack again we partner with the primary
care doctor or with an endocrinologist to check their sugars and if we’re
finding that they’re particularly out of whack we can use a sliding scale insulin
it’s all about patient safety and balancing the beneficial effects of
hastening recovery from an attack against the concerns of poor sugar
control in the background of diabetes or gestational diabetes viewer becky barnes
writes in hi dr. foster how often do you see optic neuritis causing permanent
blindness in one eye is that considered a severe relapse Becky
causing blindness and I most certainly qualifies as a severe relapse and in the
acute setting so days two weeks after opting Rytas sometimes we have patients
that have completely lost vision fortunately optic neuritis caused by
multiple sclerosis generally has a return of function I’m not
telling you that it’s 100% but most of the time patients regain function I’ll
share with you that in my experience optic neuritis early on in the disease
course tends to have a better long-term prognosis for regain of vision as
compared to optic neuritis which occurs later in a given person’s disease I also
want to point out that optic neuritis caused by MS tends to fare better as
compared to optic neuritis from a cousin of MS neuro myelitis opteka nmo optic
neuritis tends to be much more severe with much poor recovery nonetheless in
both cases we can aggressively treat optic neuritis attacks by using
high-dose IV steroids or oral steroids or when necessary using plasmapheresis
great question Becky thanks for asking our next question comes from viewer
Marilyn alone who writes can an abscessed tooth cause the same Ms
relapse symptoms that a UTI can cause I’ve been feeling pretty punky and
hopefully now that my tooth extraction is done I’ll be bouncing back Marilyn
you bring up a most excellent point a discussion about a pseudo relapse pseudo
is the Greek word for similar to but at 8 and a pseudo relapse is when MS
symptoms manifest or come back out in the setting of an infection the most
common example of an infection which could trigger a pseudo relapse is a
urinary tract infection and you are absolutely right that another infection
such as an abscess tooth can also cause a pseudo attack in the setting of a UTI
when we treat the urinary tract infection we expect the neurological
symptoms to subsequently go away and I would expect the exact same thing in a
pseudo attack caused by an abscess tooth excellent question our next question
comes from one of my most cherished viewers Britta Roth who writes good
afternoon Aaron my question is is there a combination between infections like
the flu and flare-ups relapses and the answer is yes during the winter months
when we see more flu we see an increased risk of attacks
it’s rather tricky because a flu could trigger a
pseudo attack where you have an infection which raises your core body
temperature and causes old neurological symptoms to kind of come back out and
visit you and when the infection goes away and the core body temperature drops
back down those symptoms go away that’s a pseudo attack but a flu can
also trigger an MS attack and cause new neurological symptoms to manifest and so
obviously the importance of seeing your MS provider having a proper neurological
examination and being tested for infection is key to success
britta as always it’s wonderful to hear from you and thank you for the awesome
question our next question comes from Jennifer Cruikshank who writes I am
scheduled for rotator cuff surgery on Friday can surgery cause a relapse
are there any precautions I should take Jennifer it is possible that the trauma
of surgery might trigger an attack but we have to keep in mind a couple key
things you’re not multiple sclerosis you’re a human being who happens to have
multiple sclerosis you also based on your question happen to have a rotator
cuff tear and we have to weigh the risk benefit of having your shoulder fixed so
you can use your arm against the slight possibility of an attack it’s generally
my opinion that it is worthwhile to proceed with the surgery when it’s
necessary if God forbid it were to trigger an attack after healing we can
certainly treat it using high-dose steroids again it goes back to the
risk-benefit and sometimes life is a little too generous I hope that your
rotator cuff surgery went well and I certainly hope that it didn’t trigger
any MS symptoms if you’re watching this video
share in the comments how things are going I hope they’re going well our next
few questions have to deal with attacks and the MRI Paul Zakhar writes in
question how common is it to have a clinical attack without MRI evidence and
the answer is it’s pretty common if someone comes to my clinic and has
manifested new neurological symptoms and I can see
symptoms on an examination I don’t feel I need an MRI if I were to get an MRI
that didn’t show spots I don’t care they still have an attack they’ve still
manifested symptoms and I can still see them on exam if I see that they have a
new spot on their MRI it doesn’t change what I’m about to do which is to treat
the attack the MRI is not a perfect measure it doesn’t capture all the
pathology of MS and there’s lots of different reasons why that’s the case
suffice to say we’re treating the human being not the MRI and if someone
manifests a clinical attack and has findings on exam I don’t think the MRI
is even necessary to be ordered and if it was ordered and doesn’t show new
spots I still think we need to treat the attack great question Paul thank you
Nicola asks almost the opposite question do you treat active MRI lesions without
clinical presentation my answer is yes I do
when I see an MRI that shows a newly enhancing lesion meaning it lights up
after giving contrast that means the same thing to me as if that person
manifested a clinical attack either one of them in my opinion is considered new
disease activity and either one of them deserve steroids to quell inflammation I
have an entire video on this topic and I’ll throw a link up above in case you
want to hear more about that we’ll wrap up these viewers questions with one more
question related to the MRI this questions by Carey at M who writes
finally got an MRI no new lesions since February of 2015 but some older ones are
larger is this breakthrough by my way of thinking yes it is if you have a
clinical attack I call that activity and if you’re on a medicine and you have a
clinical attack I call that breakthrough activity I apply the same logic when
looking at the MRI if you have a new MRI that shows a new spot
I call that activity and if you are on a disease modifying therapy in the MRI
shows a new spot I call that breakthrough disease activity to me
seeing an old MRI spot that’s gotten larger is another sign of act
and if you have a new MRI spot that got larger despite taking a
disease-modifying therapy that’s breakthrough disease activity in my
clinic that’s grounds for a discussion on escalating or changing therapy thank
you for asking that awesome question if you’d like to learn more about the MRI
and multiple sclerosis check out this playlist right there YouTube thinks that
you would adore this video right there and if you haven’t yet subscribed to my
channel please consider doing so just click the circle with my head in it go
ahead click my head my name is Aaron boster and thank you for learning about
a mess with me until my next video or livestream
take care

16 thoughts on “Multiple Sclerosis Vlog: Answering Viewers Questions on MS Attacks

  1. Hi Dr. Boster! Thanks for another great video! Question: high-efficacy DMTs (like alemtuzumab) make relapses less frequent, but do they also make relapses less severe? or easier to recover from? Thanks so much! 🙂

  2. Hey there Dr. B…..just a quick question….how likely is it that I have RR vs a more progressive form of MS. I am 51 yrs old, and was diagnosed 3 1/2 yrs ago…..I have never had a relapse… thanks!

  3. When I was diagnosed, I was given a round of solomnodrol or whatever it's called. The good effect disappeared as soon as the iv was out. Continuing with Ocravus seems to be doing it right. Does that define my ms as PPMS? Does it matter? Thanks from Jerusalem!

  4. I was recently diagnosed but had symptoms for a while ms is taking over my regular life I'm always mad or depressed my vision acts up I forget things and I constantly fall .

  5. I love my clinic, but the head doctor will not allow steroids for any worsening symptoms unless there's evidence on the MRI! Too many side effects, outweigh the benefits… they say.

  6. Awesome video again! ❤️ I have an MRI question; what causes a lesion in the brain to take on a ‘bullseye’ or ‘hoop’ shape, similar to a ring enhancing lesion but without contrast?

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