Neurological tests are entertaining.
In brief, neuro checkups sometimes border on the gloomy, darkly lit twilight zone of your existence, especially when you get up close and personal with the MRI scans of your central nervous system – your brain and spinal cord. Both are the cause of what makes you the multiple sclerosis patient, including the bits and pieces you don’t admire and cannot hide from.
The nervous system is divided into two parts: the central nervous system and the peripheral nervous system, but there is a distinction between the CNS and PNS. The term peripheral nervous system applies to any part of the nervous system that lies outside of the brain and spinal cord. The CNS is separate from the peripheral nervous system, although the two systems are interconnected.
But, before I lose myself in neuroscience, a field so vast, I must get back on track.
Some time ago I saw a multitude of young, already practising physicians passing by my neurology station as they were undertaking clinical exams to obtain a higher qualification. As I continued to be flabbergasted by their knowledge each and every time, one thing stood out.
I was called middle-aged.
Let that sink in.
Let that sink in a little deeper.
Now, I could be absolved for looking dreadfully fatigued and slightly wobbly on my legs. I’m also neuropathically challenged in hidden corners of my body as well as talking gibberish when the batteries are near dead… this is life with multiple sclerosis after all. But, while I never hold anyone’s age as a disqualifying factor against people’s worth and the significance they bring to my life, I did kind of try to raise my eyebrows.
Emphasis on ‘try’.
Now, therein lies the issue.
Since ladies don’t usually disclose their age, let me phrase it this way: “I’m only such-and-such an age, give or take twelve months or so.” Nevertheless, thinking either eyebrow exercises or my age would rule the rest of the consult, I was holding on to my breath, and was ready to get in gear fast should the latter be a fact.
No wrinkles? At all?!
Just like I could be forgiven for looking ill, anyone could be forgiven for not finding any lines running from left to right on my forehead when keeping my eyebrows raised. But, thanks to a run in with some form of facial palsy over the last decade and a half, caused by MS or not, my forehead cannot wrinkle itself into a pickle. In peripheral seventh nerve palsy, the lesion of the nerve is usually located at the level of the geniculate ganglion (located in the facial canal) and therefore outside the central nervous system. Peripheral facial palsy, however, can also result from a central lesion at the level of the ipsilateral facial nucleus or facial nerve at the pons.
So, Willeke-Maya being Willeke-Maya, using Occam’s razor is always the first go-to to work out where it all went wrong, or in this case, where it all went right depending on where you stand on the L’Oréal brand of anti-ageing cream.
Occam being Occam by and of itself, dictates that the best explanation to a query is the simplest answer, and therefore I might just be damn lucky in the genes department. Leaving OR out of the simplest of equations, when you’re looking for a medical reason to my lack of fine lines, trigeminal neuralgia might be high on the list of culprits. After all, my life with MS began with facial issues like electric-shock-like punching, crushing, piercing, burning and other forms of nerve pain shooting up and down my fifth cranial nerve.
Trigeminal neuralgia was my first symptom before my MS diagnosis months later. Overwhelming fatigue and unexplainable neuropathic pain on my left side soon followed the arrival of facial pain.
Suddenly, its pattern became all too clear.
“In short, on a frosty morning – and after another week of maddening pain around my upper cheek, eye and ear and eating painkillers for lunch – the sixth batch of antibiotics to heal a “bad ear infection“ had been proven as fruitless as a dead apple tree once more. That Monday, I was on my way to work when it went pear-shaped yet again. My favourite seat on the bus didn’t provide any warmth, as the cold emanating from its freezing window to my left inexplicably began puncturing my face. Repeated, excruciating blasts lasting a from a few seconds to two minutes perforated my left ear, eye, the area around my eye and a small spot behind my ear, just like it had when sitting next to a cold window on a train a week before.
An epiphany flashed through my mind, a penny just dropped said that this was much more than a longlasting ear infection, which it never was. I had enough of misdiagnoses, missing work, buses, trains, cold air, talking, eating and everything that involved touching my face kept on punishing me with unwarranted, excruciating bouts of pain that were unlike anything I had ever felt before. So, I was done with it. I was in need of a proper diagnosis by someone preferably more in tune with modern medicine. For six months, I ran from one specialist to another who could not place my facial pain symptoms inside their own distinct field of medicine.
The route of my bus drove past my local hospital. I jumped off, went to Accidents & Emergency and said that something was seriously wrong with me and that I would not leave until I knew what it was.
In the end, there were only 200 days between my first symptoms and eventual diagnosis. Had I taken the train instead, I might have languished in pain for much longer.
Getting on a bus? The best decision I ever made.”
The second thing which is for sure, somewhere down the line, a crackpot facial defect was gradually being forged around my 31st birthday, allowing it to freelance in the Botox department without ever accepting any botulinum toxin injections. Ergo, I consider it one giant pain in the proverbial bum because it doesn’t give any guarantees as what my countenance can expect later in life, not that I lie awake at night counting hairlines and eyelashes.
Also, taking into account how expensive Botox is, I should be happy, really. Having no frown or lines that depict my age, and hopefully never needing any real Botox on account of an out of whack central nervous system free of charge… I can live with that.
As for the origins of facial palsy in MS:
“Peripheral demyelination in MS patients is rarely described and most of the authors believe that the motor disease observed in MS is related to the lesion in brain, pons, and medulla more than a peripheral involvement. More studies are needed to evaluate the prevalence of peripheral versus central involvement in MS-related facial palsy.”
(DeJong’s The Neurological Examination, 7th edition by William W. Campbell, Professor Emeritus, Department of Neurology, Uniformed Services University, Bethesda, Maryland, copyright 2013)
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