Ask the Doctor

Q: I am 55 years old and was diagnosed with MS five years ago. The warmer temperatures in the southeast this winter have caused much perspiration around my head and neck. Since last year, the sweat pours down my head and off the tips of my hair — even when the temperature is 45 degrees outside — and is very embarrassing. I've stopped going out with friends because I start sweating as soon as I get involved with any activity. Can you tell me why this is happening and do you know of any treatment that can help?

A: Sweating is controlled by the autonomic nervous system (ANS). The ANS also controls heart rate and breathing rate. One of the most common symptoms of MS patients are cold, white hands, or the bluish appearance of skin — both related to the ANS. Fortunately, profuse sweating is not commonly caused by MS, therefore, I would look for other causes such as an over-active thyroid. You should ask your physician about other potential causes of excessive sweating. Treatment will depend on the underlying cause. If severe enough, medications or nerve blocks may be tried.

Q: I have had Devic's disease for four years and was wondering what lies ahead in my future.

A: Devic's disease is an inflammatory disease, primarily of the optic nerve (going to the eye), and the spinal cord. It may flare-up only a few times or it may flare-up many times over several years, making it difficult to distinguish from MS. Devic's disease may cause more disability than MS, but there is variability in the disease pattern. More information is available on the Mayo Clinic's website at www.mayoclinic.org/devics-disease/about-devics.html.

The Mayo Clinic has developed a new antibody test which may help differentiate Devic's disease from MS. Treatment options are available if necessary, and recent advances in our knowledge of Devic's disease should lead to even better treatments in the future. Steroids, plasmaphoresis, IV gamma globulin, and anti-cancer drugs are all potential treatments at this time.

Q: My daughter has had MS for six years. She gives herself a weekly injection and hasn't had any flare-ups since her diagnosis, although she has cognitive issues and her balance is not good. Her symptoms don't appear to be getting any worse, and she actually seems to be getting better since her divorce (happier and working part time). She goes annually for checkups at the Cleveland Clinic. I have two questions: (1) does traveling by plane have any negative effects on someone with MS; and (2) do you think that her MS might have stabilized?

A: (1) No data suggest that plane trips have any negative effects on individuals with MS. Most of the people I see who have MS fly whenever needed without any concern for their MS.

(2) Whether or not your daughter's MS has stabilized is a question best asked to her physician. While I'm pleased that she is feeling better, I'm concerned with her having balance and cognitive problems. Are they worse now than a year or two ago? If so, she may be developing the progressive form of MS, which may require a re-evaluation of her medications.

Q: I have been on an MS drug since 1997 and recently noticed that I sometimes get a quarter-sized black and blue spot where I give myself the weekly injection. I've talked to others on the same medication and this happens to them also. What causes this and is there anything I can do to prevent it?

A: I assume your weekly injection is in the muscle (using Avonex). My experience is that it is unusual to have skin reactions with Avonex. I believe that the most common reason for a skin reaction to an interferon is related to medication being on the outside of the needle.

Some patients squirt the medication out of the needle to "get rid of the air bubbles" before injecting. Unfortunately, this allows the medication to coat the outside of the needle, which can irritate the skin. My recommendation is to consult with Avonex's nursing support system to give assistance with the injection technique. The nurse at your doctor's office may also be able to provide this service. To contact the support staff at Biogen (the makers of Avonex), individuals may call (800) 456-2255 or visit www.avonex.com.

Regarding the issue of air bubbles in an injection, I suggest that you ask your doctor or nurse about how you may avoid injecting a large amount of air into an artery when giving an intramuscular injection. And, if you do get medication on the needle, I recommend that you change the needle before injecting. Air bubbles are not a problem with subcutaneous injections (these injections are given just under the skin using tiny needles).

Q: Two readers ask about visual problems

(1) My sister has secondary-progressive MS and has been experiencing double vision for the past year. Her optometrist disagrees that she has double vision and would not prescribe prism glasses. My sister says that her vision is "jumping all around." The neurologist says she has bilateral intranuclear opthalmoplegia (INO) and there is nothing she can do. Do you know of any treatment that can help?

(2) My husband has MS and is experiencing a profound visual problem called "oscillopsia," causing chaotic eye movements and bouncing vision. His neurologist prescribed valium and suggested he see a neuro-ophthalmologist; do you have any recommendations?

A: I recommend that both patients see a neuro-ophthalmologist who specializes in MS. These are difficult issues and require the highest level of MS and ophthalmology expertise. Sometimes people are able to adapt to this "bouncing vision" after several months and the symptom may improve.

Q: My neurologist has told me that hearing is not affected by MS, however, my hearing specialist tells me that my hearing problems are associated with MS and cannot be treated. Can you tell me who is correct?

A: Hearing problems are unusual with MS, however, they can occur. I look for other causes first, before I attribute hearing loss to MS. If hearing problems arise as part of an attack with MS, they could potentially improve with high doses of steroids. When a hearing problem cannot be treated, please note that there are many devices available, such as hearing aids and special phones with increased volume, to help individuals cope with hearing impairment.

Q: My neurologist wants to give me Botox injections to treat weakness in my leg. Is this a commonly used treatment for weakness?

A: Botox injections may be used to treat muscle stiffness (also referred to as "spasticity"), but not for weakness. In fact, one potential side effect of Botox is weakness. I recommend that you discuss this possibility with your doctor before getting any Botox injections.

Leg stiffness often requires large doses of Botox and the stiffness will return after several months. Therefore, repeated injections may be needed over time. For selected patients, Botox can be very effective, but many insurance companies do not pay for this expensive treatment.

No specific medications are available to treat weakness. I refer MS patients with weakness to a physical therapist (PT) for evaluation and strengthening exercises to help the affected muscles. The surrounding muscles, which may not be affected by the weakness, are also helped through such exercise, and may be able to take over the affected muscles. Please note that leg weakness is associated with an increased risk of falling. A PT can address this issue and possibly recommend an assistive device, such as a cane.

Clinical Trials Resource Center Now on MSAA Website

MSAA's new Clinical Trials Resource Center may be found at www.msaa.com and is presented in partnership with Thomson CenterWatch. Through the Clinical Trials Resource Center, website visitors may learn more about clinical research and new medical therapies for treating multiple sclerosis. Topics available include:

• Clinical Research (and the clinical trials process)
• Listing of Multiple Sclerosis Trials
• Listing of Studies from the National Library of Medicine
• Email Notification Service
• FDA Drug Approvals
• Neurology Research Centers
• CenterWatch Research Headlines
• New Medical Therapies (NMT) Trial Results
• Patient Bookstore

Please also visit www.msaa.com for information on all of MSAA's programs and services, including regional events and activities in your area. Copies of MSAA publications are available on the site, as well as news updates and other important and useful information for the MS community.

Jack Burks, MD, is a neurologist who specializes in MS. He is vice president & chief medical officer for MSAA, as well as president of the Multiple Sclerosis Alliance. Additionally, Dr. Burks is a clinical professor of medicine in neurology at the University of Nevada School of Medicine in Reno, Nevada, and a member of the Medical Advisory Board of the National MS Society. He has edited two textbooks on MS, and in the 1970s, Dr. Burks established the Rocky Mountain MS Center in Colorado, one of the nation's first comprehensive MS centers.

To Submit Questions to Ask the Doctor®

Many of these questions were submitted by readers. If you have a question that you would like to ask, please submit your question to:

MSAA
Questions for Ask the Doctor
Attn: Andrea Borkowski
706 Haddonfield Road
Cherry Hill, New Jersey 08002

Readers may also send in questions via email to aborkowski@msaa.com. Please be sure to write "Ask the Doctor" in the subject line.

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