Q&A 97: Chemobrain?

The chemotherapy you had for your ovarian cancer (cisplatin and taxol) are neurotoxic and are likely to have contributed to your worsening function.

Case

I am a 62-year-old. I was diagnosed with MS in 2005. I had saddle-type hypesthesia/dysesthesia. In the ensuing months, symptoms escalated with optic neuritis, Llhermitte’s sign and hypesthesia of the right sole. Brain MRI had some non-enhancing lesions, which in the next few months were accompanied by more than a few lesions in the cervical and thoracic spinal cord. After a few grams of prednisolone, I was placed on interferon and continued it very religiously for the next 16 years, despite moderately severe flu-like symptoms. My symptoms subsided, and no new ones appeared, apart from a few more falls, and increasing difficulty, an uncertainty when descending stairs. All MRIs during this period did not show new lesions; the existing ones were non-enhancing.

In 2021, I was diagnosed with high-grade serous ovarian adenocarcinoma Stage III-IV and underwent chemotherapy with Cisplatin and Taxol and surgery. Since May 2022, I have been on niraparib.

During this time, I was not as diligent with interferon, which I stopped in March 2023 after a Neurology Professor here said that I was probably already in a secondary progressive stage and any new Medication would result in immunosuppression, contrary to the effort to contain the cancer.

This communication is because I have had a significant decline in function, namely walking, stair climbing, descending and balance during these two years off interferon. This makes me very anxious, I am not sure that the decision to stop it was the right one, and am at a loss for how to deal with the functional worsening.

For the past 7 years, I have been moderately exercising, and I haven’t smoked for the past 21 years,

And my medications are vitamin D, propafenone, low-dose bisoprolol and tamsulosin for neurogenic bladder. I don't drink alcohol, and my BMI is 26.5 kg/m2.

I have been using a cane for the past year, I have had falls for over 6 years, and my sleep is less than optimal, with premature awakening. Muscle stiffness stays with me almost until sundown every day.

What is your opinion? Do you agree with the interpretation of the disease pattern? Is there something I could do that I am missing?

Thank you for your time and attention

NOTE: General Substack newsletters and the microsite are free; only Q&A sessions are restricted to paying subscribers. I can't run and maintain the MS-Selfie microsite, so I must pay people to help me do the work. If people want to ask medical questions unrelated to the Newsletters or Podcasts, they either need to become paying subscribers or email (ms-selfie@giovannoni.net) to request a complimentary subscription.

Prof G’s answers

Q: What is your opinion? Do you agree with the interpretation of the disease pattern? Is there something I could do that I am missing?