Questions and Answers With Doctor Nitin Sethi, Neurologist

Doctor Sethi has graciously agreed to answer some questions posed by readers and here they are:  

1.   This first question comes from  Franklin Catholic 

Is it possible to have MS and also have an abnormal nerve conduction test?

Dear Franklin,

That is an interesting question you ask. Classically multiple sclerosis is defined as a demyelinating disease of the central nervous system (CNS). The CNS includes the brain and the spinal cord. So in multiple sclerosis the pathology lies in the brain and spinal cord (meaning that the lesions or plaques as we refer to them lie in the white matter of the brain and/or the spinal cord).

Multiple sclerosis does not involve the peripheral nervous system (PNS). The peripheral nervous system consists of the nerves which carry the impulses to the muscles. So in multiple sclerosis typically the nerve conduction studies are normal (nerve conduction studies determine the conduction in peripheral nerves which are unaffected in multiple sclerosis).

Of course there is always the possibility that one may have two diseases. Let me explain with the aid of a simple example. Let us assume that you have MS but also have a pinched nerve in your neck. Well in this case the nerve conduction study in the upper limb may be abnormal.

2. The following question was asked by an anonymous caregiver:

I am a caregiver to a loved one with MS.  It is the remitting type and so of course there are good days and not so good days.  I have often wondered if there are triggers to the bad days.  I have read about heat and so we know to watch out for the real hot days and try to plan accordingly.  Sometimes other things seem to trigger onsets, certain foods, stress, and so forth.  Is this just our imagination or would you agree that such things do trigger episodes and if so, what would you recommend we watch out for in planning our days?

Dear Anonymous,

Thank you for writing in. Taking care of a loved one with MS is indeed challenging and demanding. My patient's care-givers never fail to inspire me. They bring their loved ones to see me, act as their advocates and their love and devotion is apparent. Care giver stress and burn out is common especially when  confronting a chronic and debilitating condition such as MS.

Now to your question. The relapsing remitting form of MS (RRMS) is characterized by acute episodes of MS exacerbation, which then remit over time. At times no neurological deficit is left behind and the patient returns to baseline. Things remain fine till another attack strikes!!!.

We now know that there are certain factors which may worsen pre-existing neurological symptoms in patients with MS. Uhthoff's phenomena is the name given to the worsening of neurological symptoms in patients with MS usually when their body temperature rises (as when they have fever) or when the ambient temperature goes up ( such as when they are in a hot environment, after a hot shower etc). Infact many times patients come to the ER thinking they are having an acute MS exacerbation (such as increased weakness, increased blurring of vision, they feel more unsteady), only to find they have a fever due to a urinary tract infection or a pneumonia. We treat the infection and lo and behold they are back to their baseline with respect to their MS symptomatology. Hence exacerbations like the above are actually not true exacerbation rather we refer to them as pseudo-exacerbation.