Could Spinal Lesions Be Behind Myasthenia Gravis-Like Symptoms in an MS Patient?
Hello, I’m a 33-year-old female diagnosed with multiple sclerosis, standing at 172 cm and weighing 80 kg. I am currently on kesimpta and do not smoke, though I occasionally use psilocybin mushrooms. Over the past 18 months, I’ve been facing muscle weakness that tends to get better with rest, particularly affecting my arms and neck. It occasionally seems to hinder my swallowing and breathing as well. Numerous evaluations, including blood tests, sfemg, and a CT scan of my thymus, have ruled out myasthenia gravis. My symptoms began after I started taking lithium but showed improvement with IVIG treatment, which led my neurologist to consider a diagnosis of MG. Could the issues I’m experiencing be linked to my spinal lesions? If so, are there any strategies that might provide relief? I appreciate my neurologist's thorough approach and he is currently having me try fampyra, although I have not noticed significant effects. Below, I’ve summarized findings from two MRI reports that highlight my spinal lesions, which differ slightly: **MRI Report 1:** - **C2:** Vague lesion located posterolaterally on the right side. - **C5:** Lesion measuring 16 mm x 8 mm x 4 mm, found centrally. - **C6:** Right lateral lesion measuring 3 mm x 3 mm. - **T2/T3:** Right-sided lesion measuring 11 mm x 5 mm x 5 mm. - **T4/T5:** Minor lesions located centrally and on the right side. - **T6/T7:** Linear anterior lesion present. - **T8/T9:** Central posterior lesion measuring 11 mm x 4 mm x 4 mm. - **T11:** Vague lesion of 8 mm centrally. **MRI Report 2:** - Multiple lesions identified in the cervical and thoracic spine, including lesions in the central cord at C2, a patchy lesion at C3/C4, another within the central cord at C5, and right lateral lesions at C5/C6. Additionally, subtle lesions were observed in the right lateral cord at T1/T2 and at T2/T3, with patchy central cord lesions at T4, bilateral signals at T6, a central lesion at T10/11, and a central/dorsal cord lesion at T11.
Answers (1)
8/8/2025, 12:10:55 PM
OpenHealth AI
Your situation involving muscle weakness with symptoms resembling myasthenia gravis, alongside a diagnosis of multiple sclerosis and spinal lesions, is understandably concerning. While your neurologist has ruled out myasthenia gravis through various evaluations, it’s important to recognize how spinal lesions can contribute to your symptoms, especially given their presence in the cervical and thoracic areas.
Main Points:
- Muscle weakness may be related to spinal lesions associated with MS.
- The issues you experienced while on lithium that improved with IVIG suggest a complex interaction between your underlying conditions and treatments.
- While your neurologist is exploring these connections, there are strategies you can consider for potential relief.
Explanation:
In multiple sclerosis, spinal lesions can affect nerve signals that control muscle function, potentially leading to weakness, especially in specific muscle groups, as you've described. Symptoms like swallowing difficulties and breathing issues can also arise if lesions impact the areas of the spinal cord responsible for these functions. The improvement you noticed with IVIG indicates that your symptoms may respond to treatments targeting inflammation or immune modulation.
Next Steps:
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Symptom Tracking: Keep a detailed journal of your muscle weakness episodes, noting when they occur, their duration, and any associated triggers (like stress, fatigue, or activity level). This can help your neurologist tailor your treatment plan.
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Exercise and Physical Therapy: Engage in a tailored exercise program that includes strength training, flexibility exercises, and activities that promote motor function. A physical therapist specialized in neuromuscular conditions can guide you through this process, which may alleviate some weakness.
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Medication Review: Since you noticed changes with IVIG and are currently on Fampyra, consider discussing with your neurologist the possibility of adjusting or adding treatments, especially if you’ve not experienced significant relief from Fampyra.
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Lifestyle Adjustments: Maintain a balanced diet, adequate hydration, and manage stress through relaxation techniques or light exercises like yoga or tai chi. These can enhance your overall well-being and might improve your symptoms.
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Monitor Medication Effects: Inform your neurologist about your experiences with lithium and any potential side effects. It’s important to evaluate if its usage might be influencing your current symptoms.
As you approach your next appointment, bring up your journal findings and any changes in your condition for a collaborative discussion about further steps. Your proactive approach is key in managing your health effectively. Remember, you're not alone in this journey—stay connected with your healthcare team for ongoing support.
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