Premenstrual multiple sclerosis pseudoexacerbations: Role of body temperature and prevention with aspirin.
BACKGROUND
Many women with multiple sclerosis (MS) experience transient neurologic symptom worsening and fatigue in conjunction with the menstrual cycle. Aspirin reduces MS fatigue in some patients.


OBJECTIVE
To describe 3 women with MS who experienced stereotypic, temperature-independent neurologic symptoms and diurnal fatigue in the mid-to-late luteal phase of the menstrual cycle. Aspirin treatment prevented the symptoms.


METHODS
Case series at the Mayo Clinic outpatient MS clinics, Scottsdale, Ariz, and Rochester, Minn.


METHODS
Three women with relapsing-remitting MS.


METHODS
Body temperature measurement, symptom diary, and oral aspirin.


METHODS
Body temperature, Modified Fatigue Impact Scale, and evaluation of neurologic symptoms and signs.


RESULTS
Morning oral body temperature did not differ during symptomatic vs asymptomatic portions of the luteal phase (P = .55). Aspirin (650 mg twice daily) prevented symptoms but did not significantly alter the luteal phase body temperature.


CONCLUSIONS
Aspirin prophylaxis may prevent luteal phase-associated MS pseudoexacerbations. However, the observed relationship between the luteal menstrual phase and MS symptom worsening is not fully explained by thermoregulation, which implicates other hormonal or immunologic mechanisms.
Wingerchuk
Dean M
DM
Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA. wingerchuk.dean@mayo.edu
Rodriguez
Moses
M
D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D001831:Body Temperature; D002940:Circadian Rhythm; D005221:Fatigue / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005498:Follicular Phase; D006801:Humans; D008183:Luteal Phase; D008499:Medical Records; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin