3 oligoclonal bands, is it MS?

[prabhu]

I got covid in July, and experienced numbness after day 2 of Covid (started with my left arm which resolved in one day, but then my right half of body, chest down, was numb for about 18 days). Covid symptoms were flu-like and resolved in a week. Incidentally, the numbness started the day I I took paxlovid for the covid, a few hours after. My neurologist ordered MRI of brain and spine, and they found a single lesion in the spine (which he said is trasnverse myelitis and the reason for my numbness). Bbrain MRI was normal. The doctor said that TM was most likely due to the covid infection but asked to get lumbar puncture to rule out MS. The test came back yesterday and says 3 oligocolonal bands and none in serum. All other tests seem to be normal so far. Vitamin B12 levels were 500 when I tested in July, and then 200 when I tested again a month later.

Am I looking at an MS diagnosis? I'm a 43-year-old male from India. Been living in the US since 97.

Thanks

[NHE]

Vitamin B12 levels were 500 when I tested in July, and then 200 when I tested again a month later.

Welcome to ThisIsMS. A vitamin B12 level of 200 pg/mL is deficient. Low B12 puts you at risk for subacute combined degeneration which causes demyelination of the spinal cord. B12 deficiency can mimic MS. Low B12 can increase levels of the toxic amino acid homocysteine. Homocysteine is both cardio and neuro toxic. It can cause brain lesions in white matter seen on MRI.

I recommend reading the book ‘Could It be B12, an Epidemic of Misdiagnoses’ by Sally Pacholok https://www.amazon.com/Could-Be-B12-Epi ... 884995691/

Many people do B12 shots, but sublingual Supplements are just as effective. I use the following B12 supplement by Superior Source. The tablets are small and dissolve in a minute. https://iherb.co/4ANYW5M I was B12 and folate deficient and these brought my levels back up to normal. They also corrected my irregular heartbeat by bringing my high levels of homocysteine back to the normal range.

[prabhu]

Thanks.

Can low b12 levels cause 3 oligoclonal bands?

They tested for Homocysteine which is normal (13), they also tested METHYLMALONIC ACID which is also normal (0.15). Does the rule out B12 as a possible cause?

[NHE]

Can low b12 levels cause 3 oligoclonal bands?

B12 deficiency can cause lesions on the spinal cord. This is called subacute combined degeneration. It typically affects the cervical spinal cord. When I was B12 deficient, I had a 7 cm lesion on my cervical spinal cord. In theory, the demyelination process could activate the immune system due to the damage and increase your CSF IgG levels. See the video in the following post.
viewtopic.php?p=237383#p237383

They tested for Homocysteine which is normal (13).

Sally Pacholok's book cites a range for homocysteine of 4-12 micromolar. A value of 13 is a little high. One medical group in my area specifies a range of less than 9 micromolar due to its cardiotoxicity.

Does the rule out B12 as a possible cause?

No. Your B12 is too low and homocysteine is too high. I would try some of the B12 supplement I linked to and see how yow you do. My low B12 was caused by a folate deficiency from drinking too much green tea. Folate is used to regenerate (remethylate) spent B12 back to the active form.

[prabhu]

Thanks so much for your response.

Two things I want to mention--I currently don't have any symptoms. So if I took b12 supplements, how should I determine if there is improvement, or if b12 was the cause of the CSF positive result? Should I repeat the lumbar puncture?

Also, the timing of this...I got the numbing episode during covid infection, on day 2 specifically. I've been reading that Covid can have some neurological consequences but not able to figure if it could have an effect on the CSF bands. Do you think covid has anything to do with any of this, given the timing of it?

It's been emotionally draining since yesterday thinking this is likely to be MS

[NHE]

Two things I want to mention--I currently don't have any symptoms.

I thought you mentioned that you had numbness symptoms. If that's the case, then I wouldn't anticipate that they go away immediately.

So if I took b12 supplements, how should I determine if there is improvement, or if b12 was the cause of the CSF positive result?

When I was B12 deficient, taking B12 made me feel like the sun had just burnt off the fog in my brain.

Should I repeat the lumbar puncture?

I've only had one spinal tap. I got a severe spinal headache afterwards. After a week, I had to go back to the hospital to get a blood patch to stop the spinal fluid leak. It's not a procedure I would wish to repeat. If you were to take the B12 , then it would be reasonable to get your blood tests done again after a few months.

Also, the timing of this...I got the numbing episode during covid infection, on day 2 specifically. I've been reading that Covid can have some neurological consequences but not able to figure if it could have an effect on the CSF bands. Do you think covid has anything to do with any of this, given the timing of it?

Yes, I've read that covid can have neurological effects. I would resist getting an MS diagnosis. Any problem you get after that will be viewed through MS tinted glasses.

By the way, have you had an MRI? If so, then what were the results?

[prabhu]

Yes…MRI showed a single lesion in spine. Brain mri was normal. I had numbness which started during covid but went away after 18 days.

[NHE]

Yes…MRI showed a single lesion in spine. Brain mri was normal. I had numbness which started during covid but went away after 18 days.

If I were you, then I would take the B12 & methylfolate for 2-3 months and then get your bloodwork repeated. Note, you should do a wash-out before the test. It's best to wait a week before retesting. I took daily B12 for several years after my deficiency as it still increased my energy levels. Now I take it just once per week.

B12 deficiency can be quite disabling. It can put you in a wheelchair on a permanent basis.

viewtopic.php?p=241646#p241646

By the way, I would ask to get your folate levels checked prior to taking any supplements. Repeat the folate test when you get retested following the B12/methylfolate.