The “MS hug”
The lay term, “MS hug,” may be used by people with MS to describe dysesthetic sensory symptoms. Wingerchuk and colleagues4 at the Mayo Clinic, Arizona, evaluated the charts of 116 patients with MS (71% female, 76% with relapsing disease) who reported the MS hug. The investigators defined the MS hug as a “unilateral or bilateral segmental constricting (squeezing, band-like, or girdle-like) sensation involving the thorax, abdomen, or both that was associated with objective evidence of a neuroanatomically appropriate current or prior spinal cord lesion and not attributable to another cause.”
Although 116 patients reported the MS hug, only 46 (41%) had symptoms and pathophysiology that met the study definition. In these patients, symptoms occurred during cord relapse evolution (41%), more than 3 months post-relapse or during the progressive phase (39%), or during early recovery (20%). Of the remaining 70 patients who complained of an MS hug, 27 (39%) had other types of neuropathic pain.
Six patients (9%) with symptoms suggestive of the MS hug had serious causes not related to MS that required immediate intervention. These included three patients with herpes zoster and one patient each with cholecystitis, myocardial infarction, and pulmonary embolism. Other non-MS causes of the MS hug included musculoskeletal discomfort, gastroesophageal reflux disease, anxiety, and bowel symptoms. Eleven patients (16%) had no clear etiology. The authors caution that the term MS hug may accurately describe spinal cord symptoms in people with MS but may also indicate unrelated medical problems that may be serious and require immediate treatment.
Although many somatic symptoms in people with MS may be related to their underlying disease, some symptoms may reflect different pathology. This study emphasizes the importance of investigating all symptoms in people with MS in order to detect and treat potentially serious comorbidities.
Virtual reality therapy
People with MS may suffer chronic symptoms such as depression, fatigue, and pain, which may respond only partially to conventional treatment. In an ongoing study, Shaw and colleagues5 explored the use of virtual reality in an attempt to alleviate symptoms. Treatment consisted of eight 35-minute sessions with an HTC Vive headset. Patients were randomized to either passive (viewing) or interactive (moving). Patients were monitored by a technician for safety. The Positive and Negative Affect Schedule (PANAS) and Patient Reported Outcomes Measurement Information System (PROMIS) scales were administered prior to and following virtual reality treatment to assess response. Data available thus far for eight patients indicated that all experienced an improved positive affect and reduced negative affect. The authors concluded that virtual reality is a promising tool for symptomatic treatment of patients with MS and other chronic neurologic conditions.
While there have been many advances in the treatment of the inflammatory component of MS, comprehensive patient management demands symptom improvement as well. This study suggests that virtual reality therapy may become a helpful modality.
This brief sample of advances in MS presented at the 2019 American Academy of Neurology meeting includes the effect of disease-modifying agents on fetal outcome, diminished risk of PML via extended natalizumab dosing, the potential of NFL as an MS activity biomarker, the diverse etiologies that underlie the “MS hug,” and the potential for virtual reality therapy to alleviate affective symptoms in people with MS. Many more presentations at the meeting demonstrated progress in the understanding and treatment of MS.
About the author
Andrew Wilner, MD, is a neurologist who blogs at www.andrewwilner.com/blog. His latest book is The Locum Life: A Physician’s Guide to Locum Tenens.
1. Ahmed SF, Almuteri ML, Al-Hashel J, Alroughani R. Pregnancy outcome in multiple sclerosis patients exposed to disease modifying therapies. Presented at: American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA. Abstract P4.2-100.
2. Ryerson LZ, Foley J, Chang I, et al. Reduced risk of progressive multifocal leukoencephalopathy (PML) associated with natalizumab extended interval dosing (EID): updated analysis of the TOUCH Prescribing Program database. Presented at: American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA. Abstract S26.006.
3. Uher T, Schaedelin S, Benova B, et al. Monitoring of subclinical disease activity by serum neurofilament light chain levels in multiple sclerosis. Presented at: American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA. Abstract S37.005.
4. Wingerchuk D, Sanchez CV, Carter J. The “MS hug”: definition, characteristics, course, and misattribution risk. Presented at: American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA. Abstract P5.2-111.
5. Shaw M, Palmeri M, Krupp L, Charvet L. Acute and lasting benefits of a virtual reality in multiple sclerosis. Presented at: American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA. Abstract P1.7-010.