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ASK THE DOCTOR

Dr. David Gelber is Medical Director of the Central Illinois Multiple Sclerosis Clinic and Director of Rehabilitation at Memorial Medical Center in Springfield, Illinois, and is also Director of the Springfield MDA Clinic. Address your questions to the group facilitator, or submit them on our website.

QUESTION: Are there any other steroids or drugs that help with exacerbations of MS?

DR. GELBER: Steroids in any form seem to be of benefit in treating exacerbations. However, studies have not determined which steroid is bet o which for (i.e. oral, IV, etc.) is most effective. For very severe exacerbations, chemotherapeutic agents such as cyclophosphamide or mitoxantrone may be considered. Data on other interventions such as intravenous immunoglobulin and plasmapheresis are scant.

QUESTION: Is massage beneficial for patients with MS?

DR. GELBER: Massage can be of help, especially for patients with muscle cramps and spasms.

QUESTION: Can Aricept help people with MS?

DR. GELBER: Aricept is a drug used to help improve memory in patients with Alzheimer disease. This, and other similar drugs are currently being studied in MS patients to see if they improve cognition (memory). At present, there is no available data to know whether these agents are effective. I have several patients on Aricept but it is too early to know in these individuals whether it has made a difference.

QUESTION: What causes neuralgia in MS patients?

DR. GELBER: An MS plaque that irritates a cranial nerve or spinal nerve root can cause neuralgia. This is a sharp stabbing or burning, radiating pain that can affect the face, trunk, or limbs. It is best treated with anticonvulsant medications such as gabapentin (Neurontin) or carbamazepine (Tegretol), or the antidepressants such as amitriptyline (Elavil).

QUESTION: I have always heard that MS is not hereditary, but I know several people who have parents or siblings with MS. Another person told me that they now think there might be different kinds of MS that runs in those families that have multiple members with the disease. So is MS hereditary in some families more than others, or is there a definite percentage assigned to the risk of acquiring MS?

DR. GELBER: There is thought to be a genetic component to MS, probably related to the way we “inherit” our immune system. This is similar to other autoimmune disorders, which tend to “run in families.” The risk of developing MS in the population is 1 in 1000. However, if a first-degree relative (parent, sibling) has the disease, the risk is increased to 1 in 100. Therefore, if one has a close family member with MS, they have a 10 times higher risk of developing the disease compared to someone who has no affected family members. There is currently ongoing research looking at specific genetic factors that may play a role in the development of MS; to date, these have not been specifically identified.

Note: The opinions expressed in the Ask the Doctor column are solely those of Dr. David Gelber, based on his education, training, experience, and expertise, and may or may not represent the opinions of the National Multiple Sclerosis Society. If you have any questions regarding any issues raised in the Ask the Doctor column, please contact your primary care physician or neurologist.