Ask the Expert – Temperature Dysregulation

Featuring Marie Namey, RN, MSN, MSCN
Mellen Center for MS Treatments & Research, Cleveland, OH

Question: I find that I am often hot, then cold, then hot again. It seems my internal thermostat is messed up and I am well past menopause. Is this caused by MS and why?

Answer: You are not alone in experiencing these symptoms. We often hear from our patients that they feel hot or cold for “no good reason.”

The medical term is “temperature dysregulation,” meaning that it’s difficult for the body to maintain normal temperatures and results in periods of feeling hot or cold when there has been no change in the actual temperature indoors or outdoors. MS can cause temperature dysregulation. This temperature dysregulation can also make MS patients susceptible to extreme hot or cold.

Some individuals with MS may have impairment of autonomic functions, the functions that are not thought about consciously for the systems to work. Autonomic dysfunction develops when the nerves are damaged. Interestingly in a recent “Patients Like Me” survey, 69% of patients with MS who replied said that their temperature dysregulation is severe or moderately severe.

Also to avoid attributing every symptom to MS you should be checked for other causes of your symptoms such as anemia, thyroid disease, poor circulation, malnutrition, diabetes, or vitamin deficiencies. I always recommend regular health checkups and open dialogue with your MS health care provider and primary care provider.

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Ask the Expert – Cognition

Featuring Randall T. Schapiro, M.D., FAAN
President, The Schapiro MS Advisory Group
Clinical Professor of Neurology (Retired), University of Minnesota

Question: What are some ways to address and treat MS-related cognitive issues?

Answer: Cognitive issues in multiple sclerosis were basically unheard of before 1983.  That was not because they did not exist but because they were not studied.  Subsequently they have been studied extensively and problems with memory, planning, foresight and judgement are clearly present in over sixty percent of those with MS.  It is important to emphasize that everyone with MS is different and all do NOT have cognitive issues.  When evaluating cognition in MS it is extremely important to take into consideration any additional issues of fatigue, depression, and anxiety.  These may falsely lead to a cognitive impairment diagnosis and certainly can contribute to making cognitive impairment appear worse.  There are neuropsychological tests that can objectify cognitive function and are clearly superior to more subjective testing done at the “bedside” or in the office.  Investigators have tried to correlate MRI anatomy with cognitive function with varying degrees of success.  At the present it is very hard to predict cognition by looking at an MRI although clinicians often try to do so.  In my opinion, the best way to manage cognitive problems is to avoid them entirely by prevention with disease modifying medication.  That is one of the reasons we recommend early treatment with these effective medications.  Cognitive rehabilitation through a speech pathologist or neuropsychologist can, at times, be helpful but may be less that satisfying.  Like many symptoms of MS an answer to disability is mobility and remaining mobile and staying active, using your mind is essential.

Question: How can you tell if the “cog fog” is related to MS or other health issues?

Answer: “Cog-fog” is a somewhat slang expression for the feeling that may intermittently layer onto those with MS giving the feeling of increasing cognitive problems.  There is no “officially” accepted physiological explanation for this other than increased fatigue, depression, anxiety.  Medically, accompanying issues such as infection or other medical illnesses e.g. thyroid disease should be explored.  When there is an acute, sudden onset of “cog-fog” or any new symptom, the treating neurologist should be called to review the situation for something that might be contributing to this relapse.

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