Thank you for this video, Dr Beaber. I was "out" for 2 days last week that began with abdominal issues but included several other symptoms reminiscent of past MS relapses before I began feeling better. REST to RESET is sometimes all it takes
Thank-you so much for creating this video. I had a pseudo relapse last December that I thought was a MS attack. Prior to it happening, I was under a lot of stress due in both my work and personal life.
Great video and such helpful info for patients and families to better understand whats happening to us as patients. Interestingly, I have this issue with my vision and balance when I am hot, tired, emotional, sick etc but also, if I fast more than 18-20 hours. I have been intermittent fasting for 8 years and my optic neuritis was 1.5 years ago. Ever since the flare, I have to keep my fasting windows to 16-18 hours. Just another example of a "stress" on the body that it can't handle I guess.
Thank you for these videos. I was diagnosed 18 years ago and so much has changed since then. I appreciate being able to educate myself about the latest in treatment strategies.
Hi Dr Brandon, yes this video was extremely interesting and very helpful. Interestingly I used to be able tell if I was coming down with an illness such as a mild cold before it actually happened, because my MS symptoms (diagnosed with MS at the time prior to NMO) would get significantly worse. Several years ago, I'm pretty sure I did a video on this. I'm familiar with the 1000mg Methylprednisolone by IV over 3 days, I've had this several times over the years. At first, it worked really well, my symptoms would calm right down, I would then plateau for several months and feel really great, my pain would reduce and mobility would improve. But then, the slippery slope of returning symptoms, worsening pain and increased weakness would be back. The Methylprednisolone no longer seems to have the same effect, I'm lucky if I feel better for a week or two afterwards now. I'm on Prednisolone as part of my treatment plan, currently on 25mg daily but I really don't like taking it because of the side effects. I feel it is severely effecting my vision, I've had extremely good vision all my life (soon to be 50 eek), but now my distance vision is terrible. The weird thing is, when I first awake in the morning, I can see perfectly normal, really sharp vision, but then an hour or two after taking my medication my vision deteriorates. I've tried tapering the Prednisolone slowly dropping by 5mg weekly, but I can't get past 15mg because my mobility and pain worsen SO MUCH I can't cope with it. So, the choice for me is vision or, slightly improved pain and mobility.. not a good choice I'm sure you'll agree. Goodness me, I seemed to have composed a small essay. Well, thanks for listening, I'm really enjoying your videos and as you know you always get a 👍from me. All the best - Neil (UK)
Excellent explanation Dr Beabs. #sharingiscaring This is such a difficult topic to get others to understand. People get scared as soon as they feel symptoms return, when in fact- it comes with the territory (IMO). When I am fatigued/ sick/ dehydrated- my symptoms act up- I know once I’m over my triggers- I’ll feel better.
Once again, you have delivered an extremely needed insight into a topic us PwMS deal with. Thank you, Dr. Beaber. I've dealt with pseudo-exacerbations especially in my first year on Ocrevus (2019-20). Gradually, I learned to recognize what was happening. I am one of the patients who try to evade steroids like the devil - they give me energy (yay) but make me very bloated and lose sleep over a week or more (nay).
Rare over the years. I had an episode in my 20s, went to Doctor s and explained about tightness around the chest but no other significant symptoms. Even though I said my left leg was uncomfortable and a slight weakness in my left hand. Had a chest x-ray and that was it. So over the years functioned ok until I hit 49 and wow what a relapse, weakness left side, Ms hug, loss of feeling in hands and that horrible thing that happens when you bend your head forward that feels like an electric shock. I made some recovery but still have problems with my hands and still have tingling when I bend my head. So I do believe it lies in waiting for you when you are at your weakest.
I had the weird zappies when I look forward as well it's so weird I hit 44 and had a flare from hell that's when I got finally diagnosed so I feel your pain it's very frustrating to know that I could have been on dmts and probably kept more of my faculties
How did you know this was exactly what I needed I think I have gastroenteritis right now because it seems like I have a 24-hour flu and yesterday when it was at its worse I was experiencing some MS symptoms and I was concerned about having another flare up but now I know it's probably just part of the pseudo exasperation thank you so much my sister's been trying to take me to the ER and I don't want to go LOL
This video was very informative. I dislike receiving steroids so I avoid them for the most part. However, like you suggested, the pseudo exacerbation isn’t tolerated well and I give in and undergo treatment. So far I haven’t regretted turning down steroid treatment. If I can be patient and tolerate the symptoms I much prefer to wait it out. Steroids are a double edged sword - they make you feel better sooner, but you don’t know what long term effects are laying in wait.
awsome video i deal wiht these often actually a lot of my new symptoms have been during pesudo exsaterbations do to exsaternal stresses like my mental health or infections or even one time when i did shooms just to put that out there for people who use micro dosing with ms that episode made my face sag for 6 month even after i was sober and i had no new lisons and was the first time i started getting trigerminal neralgia but as you said i already had lisons in the area common for these symptoms i just never delt with them till that moment this issue has been one of the hardest part to accept about ms as they really do feel like real ones and you have to learn how to cope .... awesome video
Thank you. Nice review. I wish professionals would stop using "pseudo" to describe this phenomenon. There is nothing "pseudo" about it. I've called it fatigue exacerbation with my patients and it makes it much easier for them to understand -- they already know that UTI's, colds, etc. cause fatigue. (I'm a psychologist who also has MS.) The explanation of why MS is more susceptible to fatigue exacerbations as compared to other neurological diseases is helpful. It's a particularly nice review of steroid use and dangers. I wish professionals would talk more about energy management plans, something that need to be individualized for each person with MS, as a way to respond to this phenomenon. This can be developed with a knowledgeable psychologist, physical therapist, occupational therapist, nurse, or even with a MS support group.
I'd love to see a video on the notorious "crap gap" that people have between Kesimpta and Ocrevus. Does it cause new symptoms, is it from disease progression, is it just pseudo exacerbations?
Great video! I understand that even if a lesion is remyelinated it still appears abnormal on MRI (same white spot like before) and can be seen on autopsy only. But what does it mean when lesion shrink or disappear over time in terms of remyelination, is it good thing actually?
Really interesting video Dr Beaber, completely explains why I had reoccurrence of optic neuritis after I went through my first does of Ocrevus as I was ill at the same time as well, so I think it was just like you are describing in this video!
Very good timing. My neurologist and i were just speaking about an attack I had which would have been deemed a pseudo vs. a flare up covid caused for me recently. But I have had prednisone multiple times, all of which have never help the optic neuritis or the nystagmus in my eyes
Out of every Neurologist I have spoken to or followed, you seem to have the most knowledge and honest regarding MS. I just came back from having my MS HSCT treatment at Clinica Ruiz Mexico. It was amazing!! I would like to discuss my results with you! How can I contact you? I have no problem paying you for a 15 to 30 min. phone consultation. The Kaiser clinic was no help trying to contact you.
Thanks for the video. I was prescribed intravenous Steroids on a monthly basis for close to a year. I believe the Steroids contributed to my osteoporosis. I can experience neurological systems - like numbness, tingling, weakness and debilitating fatigue - after eating nightshades and certain baked sweets. My reactions can be instaneous suggesting a breach of the blood brain barrier causing an inflammatory response in my CNS. The symptoms can last for 1 to 6 hours. My lesions are in my spine. My MRI's are stable. Would you consider these symptoms exacerbations ? I had these reactions for decades. Whatever they are these foods are stressing my body and should be avoided. Thanks.
Very interesting I had just recovered from a respiratory infection and it caused my optic neuritis to flare up which is typical but when my left side of my face and mouth/chin went numb and I was having a hard time eating I for sure thought I was relapsing my Dr admitted me started the roids and to my surprise my MRI was stable!!! My Dr was like I dunno why your face went numb. I even had to work with the speech therapist and eat soft food to avoid choking. After the steroids my numbness calmed down and after a couple days it resolved but now I’m wondering if it was an “old” symptom like you mentioned…I’m still super confused.
Thank you for the info and the work you put in. May I ask, what is your opinion on MS cases (such as mine) that never acts out despite 20+ lesions. No heat intolerance, no pseudo attacks, no fatigue, no trouble walking for miles. Is that normal? Should I look into other possibilities even though I met all the McDonald criteria 10 years ago. Thank you if you respond!
I can't comment on your specific situation, but many people with MS have minimal symptoms. There is a lot of remyelination in the central nervous system, and lesions which are T2 bright but normal on T1 sequences tend to be associated with less axonal damage and less disability. I may do a video on so called "benign" multiple sclerosis at some point.
@@DrBrandonBeaber thank you so much for clarifying, doctor! Here's to hoping it's one of the benign cases. Time will tell. Thank you so much for the answer once again.
I never heard anybody talk about sodium intake in the context of MS, I recently stumbled upon an observational study with MS Patients from 2015 titled "Sodium intake is associated with increased disease activity in multiple sclerosis" in the JNNP suggesting a 2.75-fold exacerbation rate for patients with higher sodium intake. Based on this study and your experience, would you advise your patients to try to limit their sodium intake?
Yes. There is some preclinical evidence to suggest that a high salt diet may promote an inflammatory response. For instance, high salt intake has been linked to elevated monocyte (a type of white blood cell) activity and elevated proinflammatory cytokines such as IL-6 and IL-23 On 4/25/2013, three papers were published in nature with the following 3 findings a) Sodium regulates, TH17 cells, a subset of t helper cells implicated in the pathogenesis of multiple sclerosis b) Sodium upregulates serum glucocorticoid kinase 1 (SGK1) gene expression which enhances TH17 differentiation in vitro and in vivo c) High sodium levels worsen experimental autoimmune encephalomyelitis, an animal model of multiple sclerosis. In an Argentinian study, high sodium intake was correlated with higher relapse rate and higher MRI lesion accumulation in multiple sclerosis pubmed.ncbi.nlm.nih.gov/25168393/
In regards to treating UTI infections, is there a particular kind of antibiotic that you recommend, or conversely, a class of antibiotic you avoid prescribing? I know that Cipro is a popular powerful antibiotic for treating UTIs, but my MS neuro doesn't prescribe it in the setting of MS for some reason.
For UTIs associated with neurological diseases, it is generally advised to check a urine culture for antibiotic sensitivities. Cipro is a perfectly legitimate antibiotic, though it is somewhat broad spectrum and can cause more diarrhea than narrow spectrum antibiotics such as macrobid.
love your videos! two things. 1) the messy office is killing my OCD 😂 2) could a remedial massage cause a mini flare up of existing symptoms? eg I had a massage a week ago and noticed almost immediately tingling and pins and needles in hands and arms - my current symptoms which match the above had been getting better and then post massage they felt like it got back to how it was months ago. no virus /infection that I was aware of.
Life is still good even though I have MS. Suicide is not the answer for an MS diagnosis. With the development of good MS treatments life is good. Also, I believe in a higher power who wants what is best for me. MS is just a part of what He thinks will make me the person I need to be.
