Lack of focus and MS - Facebook Question and Answer

Here is another great question (and, hopefully, answer) from Neurologique's open Facebook page.


Question:

Why do some MS people feel so unfocused in the head and what can be done to help this feeling?

Answer:

There are many potential reasons for this:

1. Related to medication side effects.
2. From the MS itself -- fatigue.
3. From the MS itself -- cognitive problems.
4. Something also called "MS brain fog"
5. Depression.
6. Not from MS, but something else.


In terms of how to approach treatment, it is going to depend on the cause. Non-pharmacologically we use meditation (especially mindful meditation), breathing exercises, visual imagery, acupuncture, yoga, tai chi, cooling, etc.

Pharmacologically, we maximize the MS disease modifying drugs and we choose appropriate symptomatic treatments, like medicines for fatigue (Amantidine, Provigil, Nuvigil, B12, Caffeine, Stimulants etc.). At Neurologique we are also looking at an Ayurvedic herb called Ashwagandha for MS -elated fatigue.

Interestingly, there are two medications that I call "NeuroFunctional Enhancers" because they enhance function in people with neurological diagnoses. Thus far the class is made up of:

1) Ampyra (dalfampridine) -- FDA approved for gait dysfunction in MS, but because it helps the nerves work better, it can help in lots of ways.

2) Nuedexta (dextromethorphan + quinidine) -- FDA approved for pseudobulbar affect (regardless of cause), which is, basically, problems with coordinating your emotions and how you display them to others (affect). It has an effect on blocking the effects of glutamate in the brain, and is an NMDA antagonist and Sigma-1 Agonist (scientific mumble jumble)

I hope that this was useful.
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MS with a negative LP (lumbar puncture or spinal tap)

As many of you know, I answer questions for the MS Foundation (MSF) and here is one that we thought would be interesting and useful to you.

Question:

I have 3 spots on my brain the doctor has tested me for MS even had a spinal tap it came up negative. I would like to know if I do have MS but just has not showed up yet sometimes I lose my balance and don't have much strength in my hands.

Answer:

Thank you for the question.

It is true that people with MS may have negative lumbar puncture's (LPs or spinal taps) and someone needs to explain your white spots on the brain, and more importantly, your symptoms. I strongly recommend that you see an MS specialist and that you consider (if not done already):

- Close Cervical spinal cord MRI with and without Gadolinium
- Close Thoracic spinal cord MRI with and without Gadolinium
- Visual Evoked potential (VEP)
- Somatosensory Evoked Potential (SSEP) of the upper and lower extremities
- Brainstem Auditory Evoked Potential/Response (BAEP/R)
- Optical Coherence Tomography (OCT)
- Lab work-up
- Repeat LP in a few years -- ut we don't want to wait that long!

MSF can help you find a neurologist near you ... they always help!!

I know that this means that you will need to be patient.

Thank you,

Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology

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Q&A with Dr. Kantor: Numbness

As many of you may know, I answer questions on multiple sites, including Avvo. I thought that this question and answer would be useful to many of you out there.

Question:

I have been experiencing numbness in my fingertips and toes. What could be causing this?

I have not injured my fingers or toes recently. I have had some numbness in some of my fingertips for awhile, but it seems to be getting more prevalent.

Answer:


I can understand why this is a concerning symptom. There are several possibilities, but remember that online discussions do not replace real life interactions with doctors -- especially neurologists.

The possibilities include that:

1. This is simply a variant of the weird things that we all feel.
2. This is not neurologic.
3. This is caused by a peripheral nerve problem -- like diabetes (diabetic neuropathy).
4. This is caused by a vitamin (like Vitamin B12) deficiency
5. This is caused by a spinal cord problem.
6. This is caused by something going on in the brain.

As you can see, there are a lot of possibilities and your best bet would be to see your primary care physician and then a neurologist.

Please try not to be worried until this is looked into (it may not be worth worrying about).


- Dr. Daniel Kantor, MD
  Medical Director 
  Neurologique 

  info@neurologique.org 
  www.neurologique.org