Multiple Sclerosis Centers of Excellence
Managing - Frequently Asked Questions
To ask a question send an email to: MSCentersofExcellence@va.gov.
- I am a 70% service connected compensated veteran with MS - Honorably discharged 1986 - 1990 RA. Does the VA have a program for providing Service connected veterans with help in either acquiring or financing motorized or non motorized wheelchairs. My ability to walk is getting progressively worse and my endurance is down to about an hour.
- If I have MS, what is the risk that my children will have MS?
- Should I get a flu shot if I have MS and I am on an injectable therapy?
- Can MS cause heart trouble and what kind of heart trouble can be related to MS?
- What are interferon-beta neutralizing antibodies and do they matter?
- Why is the first attack of MS severe for some people and mild for others? Does the severity of the first attack predict the future?
1. I am a 70% service connected compensated veteran with MS - Honorably discharged 1986 - 1990 RA. Does the VA have a program for providing Service connected veterans with help in either acquiring or financing motorized or non motorized wheelchairs. My ability to walk is getting progressively worse and my endurance is down to about an hour.
Service connected veterans for MS or other disorders that result in mobility issues who need a wheelchair are issued one that meets their needs. The VA does provide medically necessary equipment like motorized wheelchairs, scooters and other aids to help with mobility for eligible veterans with MS. In some cases, fatigue may be a severe enough impairment to warrant power mobility (scooters or motorized wheelchairs). A veteran who would like to be evaluated for scooters or other power mobility equipment should have their VA primary care provider send a consult to their facility’s wheelchair clinic, physical or occupational therapy units to consider the best mobility device for your life needs. In addition to medical equipment, the physical therapist and/or occupational therapist can also help you develop strategies that will help you conserve your energy. For more information click on the following website articles: Life Issues: Is it time for Wheels? Life Issues: Transporting a Scooter or Power Wheelchair
The risk to the general population, with no one else in the family with MS is 0.1%. The risk to a child of a mother with MS is 3-4%. The risk to an identical twin of someone with MS is 31%.
According to a recent study published in the Achives of Neurology (2003), and one published in Neurology (2001), the flu vaccine (injectable) is not associated with an increased risk of an MS exacerbation. However, Dr. Dennis Bourdette, Professor of Neurology at Oregon Health & Science University has stated that nasal spray flu vaccine should not be given to persons with MS. He recommends the injectable flu vaccine over the nasal spray for patients with MS.
The risk of heart problems also called cardiovascular disease is not due to MS directly impacting the cardiovascular system, but more likely through elevation of the cardiac specific risk factors. Epidemiologic studies report that people with MS have a higher rate of mortality from cardiovascular disease than the general population. Cardiac specific risk factors can be divided into two types: 1) nonchangeable (example: family history of heart disease) and 2) changeable (example: stop smoking). In the general population there are some nonchangeable risk factors that can increase the likelihood of people experiencing heart disease. Some of these factors include: people over 65 years of age, being male, family history of heart disease, and race. Some racial groups have a higher likelihood than others to experience heart disease they are African American, Mexican American, Native Indian, Native Hawaiian, and some Asian American groups. There are some risk factors that are associated with an increase in heart disease that can be changed or modified. Factors that are changeable include: hypertension, tobacco smoke, elevated cholesterol, physical inactivity, obesity and being overweight and diabetes. Individuals with MS may have difficulty getting enough activity due to mobility problems and fatigue. While all people need to work on the changeable risk factors, if people with MS have one or more of the nonmodifiable risk factors, it is important that they pay close attention to their medical needs. With any symptoms suggesting heart disease, patients should see their provider for further testing and diagnosis. If there are risks factors that are changeable it is important that you share them with your VA providers. They could help you with changing or modifying those factors to decrease your risk of heart disease. They might help you with developing an exercise program to reduce body fat and set up a time with a nutritionist to make dietary changes that could keep lipids and your body mass index within a normal range. If you smoke there are numerous smoking cessation programs within the VA that are available to help you quit. There are also medications and rehabilitation strategies to lower high blood pressure and to help with diabetes. The VA also supports other programs like stress reduction and alcohol abuse that are also changeable factors that are associated with heart disease.
Neutralizing antibodies (NAB) to interferon-beta occur in some patients receiving human recombinant inteferon-beta. NAB are detected in patients by demonstrating that a serum sample can block in vitro a biologic effect of interferon-beta, such as inhibition of viral infection or induction of MX protein. NAB bind to interferon-beta and interfer with its ability to bind to the Type I inferferon receptor. There are commercially available tests to detect NAB. NAB are given a titer and typically titers > 20 are considered significant. The three formulations of interferon-beta differ in the prevalence of induction of NAB. Avonex induces significant NAB titers in 2-5% of patients; Rebif induces NAB in 15-25% of patients; Betaseron induces NAB in ~30% of patients. NAB typically appear 6-18 months after therapy is started. They may disappear after continued therapy but frequently do not, particularly if the titer is >100. NAB induced by one interferon-beta product cross react with the other products. It remains uncertain whether or not there is any clinical significance to the development of NAB. Some physicians believe that the preponderance of evidence indicates that patients with persistent NAB with titers >20 do not derive any benefit from continued interferon treatment and recommend switching these patients to glatiramer acetate. Other physicians do not believe this and do not worry about the risk of inducing NAB or check for them.
6. Why is the first attack of MS severe for some people and mild for others? Does the severity of the first attack predict the future?
We do not know why the first attack can be severe for some people and mild for others, in fact we really do not know why any attack is severe or mild. It partly depends on where in the brain, spinal cord or nerves to the eyes the attack occurs and how much damage occurs. But why these vary between people and even between attacks in the same person is unknown. When looking at lots of people with MS, the type and severity of the first attack is one thing that seems to help predict the course MS will follow. People whose first attack is just sensory symptoms (numbness and tingling) or optic neuritis tend on average to have a milder form of MS than people who have weakness or imbalance with their first attack. However, this applies only to large groups of people and there are lots of exceptions. So it is very difficult to predict how severe an individual's MS is going to be based just on how severe or mild the first attack is.ã ã ã