Diagnosis help

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Diagnosis help

Postby ttt1 » Mon Dec 07, 2009 3:58 pm

I was diagnosed with MS 10 days ago.

Symptoms: double vision 6 weeks ago, optic neuritis 11 days ago, both improved since, not totally gone. I also experienced some ~ slurred speech 2 y. ago, untreated Lyme disease 9 y. ago.

My medical testing results so far:
[translated from another language, by myself]
Code: Select all
1. sample: Liquor
Treponema pallidum, antibodies VDRL-RPR: nonreactive
Treponema pallidum, antibodies TPHA: negative
2. sample: Serum
Treponema pallidum, antibodies VDRL-RPR: nonreactive
Treponema pallidum, antibodies TPHA: negative
intrath. synthesis IgG 20,59% [H]
intrath. synthesis IgA 0
intrath. synthesis IgM 0
S-Glucosys 4,2 mmol/L (normal 3,6-6,1)
Lc-Albumin (immunoc.) 343
Lc-IgG 67,70 mg/L
Lc-IgA  4,86 mg/L
Lc-IgM  0,53 mg/L
Quotient Alb (10E3) 6,86
Qalb ref. value 6,2
Quotient IgG (10E3) 6,39
Q lim(IgG) 5,07
Quotient IgA (10E3) 1,78
Q lim(IgA) 3,35
Quotient IgM (10E3) 0,40
Q lim (IgM) 1,56
S-Albumin (immuno) 50 g/L (ref 35-52)

1. Sample: Serum
Lyme borelliosis - immunoflourescent test without absorbtion
IFT - IgM: negative
IFT - IgG: 1:64
( [border?] titer was 1:256 )
2. Sample: Liquor
Lyme borelliosis - immunoflourescent test without absorbtion
IFT - IgM: negative
IFT - IgG: negative
( [border?] titer was 1:16 )
(test) (result) (units) (orientative ref. value)
S-IgG 10,60 g/L ( 6.90 - 14.00 )
S-IgA 2,73 g/L   ( 0.70 - 4.10 )
S-IgM 1,32 g/L   ( 0.30 - 2.40 )
1. sample: Liquor

Tick-borne meningoencephalitis: negative
Mumps: negative
Herpes simplex 1+2: negative
Enteroviruses: negative
Polioviruses (pool): negative
Varicella zoster: negative
2. sample: Blood (for serologic research)

Tick-borne meningoencephalitis: 1:20
Mumps: negative
Herpes simplex 1+2: negative
Enteroviruses: negative
Polioviruses (pool): negative
Varicella zoster: 1:20
Test results of cerebrospinal liquor and serum for oligoclonal bands
Liquor: positive
Serum: negative
MRI: demyelinating lesions
Numerous T2 hyperintensive oval lesions, largest one is 2.6 x 2.3cm (1.02" by 0.90"), numerous lesions in corpus callosum and beside it, some are also on T1 hypointense. Contrast medium colorized ring visible in mentioned largest lesion, as well in lesion next to
occipital horn of the left lateral ventricle. Numerous lesions in pons and medulla oblongata - mostly right side.
( I believe most of my lesions are in right hemisphere, and I usually sleep on right side of my head - are such results common ? )
Motoric tests were fine, slight tremor on the right in finger-nose test, reflexes slightly better on left side.
Euphasic, no meningeal signs.
( blood test before Medrol was ok, low lymphocytes % [L] 19.7 (ref 20-50), lymphocytes num. 1.1 [ref 0.8-5] )

I received 3 Solu-Medrol (methylprednisolone) infusions [10,9,8] days ago.
local lab blood test, taken 5 days after last Medrol infusion:

S-Uric acid (ref 150-480)  328   µmol/L
S-Fe        (ref 10.7-28.6)  27.9  µmol/L
S-Calcium   (ref 2.1-2.6)  2.4   mmol/L
S-Magnesium (ref 0.7-1.10) 0.95  mmol/L
S-Ferritin  (ref 30-400)   113.9
S-Cortisol  (ref am 171-536, pm 64-327) 560.9 [H] ( 11:27:09 am, almost pm )
still waiting for Vitamin D3 (25-OH tnx jimmylegs), EBV-EBNA-1, et al

Lower S-Uric acid levels are more common in MS, according to http://en.wikipedia.org/wiki/Uric_acid, but Methylprednisolone increases Uric acid levels, as well does B-12 - which I took daily 4 previous days, not sure how much effect these might have had.
Any ideas how long should I have waited before taking that test, or how long before any blood test should one have stopped taking any pills ...

Even if my Lyme borelliosis result, IFT - IgG: 1:64, is interpreted as negative, and result is not to be doubted - online.wsj.., anyone know of some other bacterial tests I should take ?
One can get similar symptons, as well similar lesions, afaik, as Bartonella, Brucella canine, ... although I don't remember any fever..
How long did it take you to get your MS diagnosis, how definite MS would you think I am ?

My next doctor visit is in two days, any suggestions which questions should I ask, additional tests I should take ?
No evoked potentials testing was done [yet?].
I'd prefer not get treated with wrong drugs.

Tnx for any reply
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Postby jimmylegs » Mon Dec 07, 2009 7:52 pm

ttt1, a few years ago i added the uric acid and ms info to the wikipedia uric acid page.

at the time i couldn't get it onto the main MS wikipedia entry because someone else kept deleting it. as an alternative i stuck the info on the uric acid page. there, we see updates from time to time but no edit wars per se.

your UA level does look to be right in the 'healthy control' zone. however, it took me ages to get mine there. for years i took tons of vitamin b12 attaining levels as high as the mid 600s, but with no effect whatever on uric acid. i had to take zinc to get my UA level anywhere above 194.

now when it comes to methylprednisolone, there i can't help you. i don't know if that drug has the kind of impact that could take you to a uric acid of 328, if you started, hypothetically, down on the ms average of around 194.

as far as i can tell, 1-2 weeks should be a decent washout period for vitamins. i don't know about the methylprednisolone but the docs should be able to tell you, or maybe someone else on here who is familiar with the pharma route :)

i see you're waiting for the D3 test, that's great.. anything in the works for testing zinc?

keep us posted how things develop, keep well

PS FYI your magnesium looks good :) when i had trouble i was at .84, and i've seen in the research minimum .91.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Postby jimmylegs » Tue Dec 08, 2009 4:44 am

hi i looked into the methylpred thing

High-dose Methylprednisolone Therapy in Multiple Sclerosis Increases Serum Uric Acid Levels
Gordana Toncev, Biljana Milicic, Slavco Toncev, Goran Samardzic
Clinical Chemistry and Laboratory Medicine. Volume 40, Issue 5, Pages 505-508

Uric acid, which is the final product of purine nucleoside metabolism, is a strong peroxynitrite scavenger. Several studies report on lower serum uric acid levels in multiple sclerosis. In this study, we investigated serum uric acid levels before and after high-dose methylprednisolone treatment (intravenous 1 g/day/5 days) in multiple sclerosis patients. Blood samples from 25 definite multiple sclerosis patients (11 male and 14 female) before and after methylprednisolone treatment (days 0, 6 and 30) and from 20 healthy donors (9 male and 11 female) were analyzed. Serum uric acid levels were measured using a quantitative enzymatic assay (Elitech diagnostics, Sees, France) according to the manufacturer's protocol, and the results were standardized using a commercial uric acid standard solution. We observed significantly increased serum uric acid levels 1 day after the termination of the therapy (day 6). These differences were sustained for 30 days after starting treatment (during remission period). Mean serum uric acid levels were significantly higher in the control group. These results suggest that increasing the uric acid concentration may represent one of the possible mechanisms of action of methylprednisolone in multiple sclerosis.

this table will probably be a disaster but i don't have time to code it out.
salient points follow the table info.

Table 2
Serum Uric Acid Levels (umol/l) EDSS
Groups n Mean Range Mean Range
MS patients 25
Day 0 175 125-247 4.08 2-7
Day 6 208 175-260 2.88 1-6
Day 30 219 200-250 2.56 1-5

Controls 20 292 210-395

salient stuff:
25 ms patients, 20 controls

ms start mean UA 175, EDSS 2-7 (top ms patient UA value = 247 which is remission level)

ms end mean UA 219, EDSS 1-5 (you need average 230 to be in the remission neck of the woods)

control mean UA 292

so, ttt1, it looks like yes the MP (depending how much you took) probably muddied your (hoped-for) baseline UA numbers. i still don't know about washout period requirements.

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