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MS and Shingles: What MS Patients Should Know

MS and Shingles: What MS Patients Should Know

What is Shingles?

About one in every three Americans will have shingles in their lifetime. Shingles is a painful array of blisters that follow the distribution of a single nerve root on the skin (usually the torso) and are usually one-sided.  The blisters usually resolve entirely in two to four weeks. The blisters often are preceded by a few days of pain, itching, or tingling, where the blisters will form. Some also experience fever, headache, and chills. While most people only develop shingles once in their lives, it can occur more than once.

Shingles are caused by the Chickenpox virus (the Varicella-zoster virus). When someone recovers from having chickenpox, it doesn’t mean the chicken pox virus has left the body.  Instead, the virus “goes to sleep” (becomes dormant) in one of the nerve roots and remains there for the rest of one’s life.  Years after having chicken pox, the virus becomes reactivated as shingles in the nerve root where it is “sleeping.”

Possible Complications from Shingles

Before the chickenpox vaccine was available for children, more than 99% of the population born before 1980 had chickenpox.  All individuals are at risk of developing shingles. The risk of developing shingles and possible complications increases as the population ages.

Just under 20% of people who develop shingles suffer from severe nerve pain that can last months or years after the blisters have cleared. This severe nerve pain is called Post-Herpetic Neuralgia. While Shingles isn’t life-threatening, there are other potential complications, such as vision loss, hearing loss, pneumonia, and inflammation of the brain (called encephalitis).

Treatment of Shingles

The shingles vaccine, called Shingrix, successfully prevents shingles in most people. Further, if shingles does occur, antiviral medications can shorten the course of shingles including Acyclovir, Valacyclovir, and Famciclovir. Additionally, other non-opioid medications can help minimize the pain.

MS and Shingles: Results of a Recent Study

A recent study presented at a meeting of the Consortium of Multiple Sclerosis Centers has shown that patients with Multiple Sclerosis (MS) are much more at risk of developing herpes zoster infections than people who have normal immune systems. This can lead to significant additional suffering in MS patients. Herpes zoster infections are known as shingles. The greater the immunosuppression in an MS patient from some medications used to treat MS, the greater the incidence of shingles.

This study studied the response of MS patients related to their medications. Here is the breakdown of the results:

  • 55% had no to low immunosuppression related to their medications (Natalizumab, fumarates, glatiramer acetate, interferon beta, teriflunomide, azathioprine, methotrexate, or mycophenolate mofetil).
  • 35% had moderate immunosuppression related to their medications. And
  • 10% had high immunosuppression related to their medications (fingolimod, Siponimod, Ozanimod, Ponesimod, and Cladibrine).

The study lumped all medications into categories of the degree of immunosuppression, making it impossible to know the risk of shingles from any individual MS therapy.

Shingles Incidence in MS Population

The incidence of shingles in the MS population was 13.8 per 1000 people per year compared with 5.6 cases per 1,000 immunocompetent patients. Younger MS patients were more than three times more likely to develop shingles than those with normal immune systems.  The gap narrows with the ages of the patients studied.

Accordingly, most clinicians who treat MS patients believe MS patients must receive the Shingrix vaccination and contact their physicians for anti-viral therapy as soon as they suspect they have a case of shingles. Additionally, the CDC recommendations for the timing of the dosing for MS patients on immunosuppressants are different than for the immunocompetent general population.

Meanwhile, Take a Proactive Role in Monitoring MS

Taking a proactive role in healthcare is critical to monitoring and managing the disease between doctors’ appointments.  BeCare MS Link can help. Our app can monitor for changes in neurologic function for MS patients. As a result, patients and their clinicians can help guide the best therapy for them.

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