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Weird vision on awakening.

Hello fellow MS-ers.

I’m new here and seeking…well, whether anyone else has experienced my latest challenge. I’ll start with a bit of background.

I started with MS in late 2004 and was formally diagnosed with relapsing-remitting MS in 2005. It kicked off with O.N. and 12 months on I had a dose of diplopia. Three months’ wearing of a prism on my specs worked and the diplopia subsided.

In many ways, I’ve been very lucky so far. I’ve had O.N. again on a roughly yearly basis, which affected my left eye. This side has obviously undergone axonal damage, so I’ve the dirty pebble glass effect and weak colour vision. At the last relapse, my right eye was affected but nothing like as badly and it’s back to normal.

As regards treatment, I was injecting Avonex once a week for six years. However, I was suffering flu-like symptoms every time and writing off a whole day to this every week was counterproductive. The consultant and I agreed to suspend treatment and I’ve been taking nothing specific for a year now.

Now for the latest fun and games. For the last two mornings, I’ve woken to a peculiar sight. My bedroom’s colour scheme is magnolia and white - usually. But on waking, I see all the surfaces apparently decorated with small, dark blue polka dots. These don’t move, flash or flicker and - oddly - they are in perspective, it really does look as if the dots are there, painted on every light-coloured surface. After about 20 minutes, the dots will fade to a pale yellow, then they are gone.

I’ve had ‘silent migraines’ before. These involve sparkling zig-zags (scotoma) and last for a similar period. There is no associated headache. I therefore have a strong feeling that the polka dots may be a similar/associated phenomenon.

There’s just one caveat. There’s a great deal going on in my life, as follows…

  • I’m in the middle of a bitter divorce action, which has been going on for over a year - my ex-wife to be left 14 months ago.

  • I’ve just had an orthopaedic operation (trapeziectomy).

  • I’ve been taking pills for the inevitable reactive depression associated with the divorce. This (Mirtazapine) was sedating me far too much, so the dose has been halved, to 7.5mg per day.

  • I have a lot of ‘previous’ for anxiety problems, and occasionally use a small amount of Diazepam.

  • I have failed back surgery syndrome and have been fitted with an implanted neurostimulator (i.e. internal T.E.N.S. machine) which helps a lot.

As you can see, it’s a matter of can open, worms everywhere. As my MS specialist nurse often says, “Don’t always blame the MS”. So, I thought I’d consult the forum. Thank you for reading thus far.

I am sure I read about similar visual symptoms to yours when trying to find out about my own symptom - appearance of rows of multiple copies of a bright image central to my field of view. You will probably find what you have is mentioned as some sort of variety of cerebral polyopia or palinopsia

Thank you Mr bobowen, That’s an interesting notion. However, it doesn’t quite seem to pan out for me since I’m seeing many dots but there is no ‘source dot’ so to speak.9 I’m one of those people who like to know how things work. My enforced dipping of a toe into the murky waters of MS has given me a lot of food for thought. I know, for example, that my retrobulbar optic neuritis lay behind the loss of colour perception and detail in my left eye. The diplopia that followed correlated with the discovery of lesions in my visual cortex. My current ‘polka dot’ perception is binocular so the visual cortex is again the prime suspect.It has to originate there or upstream of the VC. Following your recommendation, I tracked down a condition called ‘Entomopia’, which has an association with seeing things as an insect does with its compound eyes. This again doesn’t quite fit, as multiple images arise of whatever is actually there. One last consideration. ‘Visual snow’ can come with a silent migraine.Given this and the timescale, this is the best match so far.

Did you consider the sub type halucinatory palinopsia. The source image could have been perceived some time prior - possibly days, and has been encoded in visual memory, so it doesn’t have to be present in the scene, and may already have passed out of your short term memory of it. There could conceivably be many instances over a longish period where your eye could have scanned something with the shape of a circular dot, or possibly it was a visual component in a dream as you had just woken up? Just speculating.

Thanks again, mr bobowen,

Your speculation set me to thinking. With he web’s help, I came across something called the ‘Hypnopompic State’, a term coined by Frederic Myers, a renowned psychological researcher of the mid 1800s. We all go through this state while waking and it is characterised by, ‘Depressed frontal lobe function in the first few minutes after waking – known as “sleep inertia” – that causes slowed reaction time and impaired short-term memory. Sleepers often wake confused,’

Apparently, Hypnopompic Hallucinations affect some 6.6% of the general population. Some people ‘see’ geometric, repetitive patterns, while others wake to face people, insects, birds or animals. These visions are all too real.

The outstanding point in my case is that psychoactive medicines, especially those affecting the levels of neurotransmitters (especially serotonin) can trigger hallucinations. Now, given I’ve halved the dose of Mirtazapine, because of over-sedation, I probably have a significantly lessened sedative effect but an increased level of serotonin.

I’m no biochemist, nor am I a psychiatrist. However, I’ve as MSc in psychology and a lot of experience of/with psychotropic drugs. This leads me to believe that my vision experience is a withdrawal effect. This is more likely since hallucinations are in fact a rare side effect of Mirtazapine use.

It’ll be interesting to see if the issue disappears as my brain chemistry stabilizes.

Hiya I’m just under the process of a diagnosis but I also this morning woke up with my right eye having a vastly different contrast to by left eye, I was almost just seeing black it’s gone now but it was really noticeable this morning.

Hiya I’m just going through the process of a diagnosis. But I also this morning woke up with my right eye having a vastly different contrast to the left it was almost completely black but only lasted about 5 minutes?

ON once a year, with (already!) permanent damage to your vision doesn’t sound like ‘very lucky so far’ to me.

In my own case, the vision problems are the ones that have freaked me out more than the rest put together. Well, almost. But what I mean is that, in your shoes, I would be fighting tooth and nail to preserve my remaining vision, throwing everything in the medicine chest at the problem. You say that your right eye returns to normal. Well, good, but sometimes recovery that feels total isn’t really - there can be damage done, and that accumulation of damage all takes its toll over time. You haven’t got any spare eyes. I really would suggest thinking again about how you can limit the damage with another DMD.

Sorry - nothing to offer on the blue spots front. I am sorry that you are having such a rotten time.

Alison

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Having read through some other responses now, and seeing that your MS has developed a taste for your visual cortex as well as your optic nerves, I feel even more strongly that you should consider what else can be done to increase your protection against future damage.

Alison

Hi Pat,

This seems to correlate with the hypnopompic state - my spots on surfaces thing lasts about the same length of time.

My experience of optic neuritis (referred to as ‘a harbinger of MS’ by the consultant) might actually offer you a little reassurance. I was in Scotland (near Gretna Green), with my new wife on honeymoon, in our camper van. On the second day after the wedding, I was about to change a bulb at the back of the van. Suddenly, all I could see with my left eye was steam…but it didn’t go away.

After the O.N. had ‘developed’, I was (and have been) left with poor detail resolution and bad colour vision in the left eye. Yes, the contrast perception is lessened but there has been no blackening at all, ever. The nearest description I have is this. You know that knobbly glass they used to put in toilet windows and back doors - it’s called figured glass. Imagine looking through this glass when it’s very grimy. However, I’ve satisfied the DVLA by passing every visual field test they’ve asked for, and so I can still drive.

Hope this helps.

Thanks Alison,

I say I’ve been very lucky so far because I’ve had no motor problems at all with my MS. This is just as well because my irreparable slipped disc means I must use a walking stick permanently. I know there are no guarantees but statistically, suffering with sensory MS makes the likelihood of also developing motor MS less likely.

I appreciate what you’re saying about the use of another DMT, which remains an option to me. However, with Avonex, the story went like this…

  • Inject myself every Saturday night, around midnight.

  • Be completely unable to get to sleep sooner that 7am at best.

  • Wake up with flu-like symptoms and put up with them for the first few days of the following week.

  • Repeat every week.

I had long discussions with my consultant and my coming off Avonex was a joint decision. The snag is that the available DMTs are not especially effective in real terms. For example, like Avonex, Dimethyl fumarate (Tecifdera) is classified in the ‘good’ section of effectiveness, as in…

Relapses dropped by: 53%

Disability getting worse was slowed down by: 38%

These are figures from this website’s data.

The consultant and I agreed that writing off one full day per week and undergoing a ramped recovery for a further two days or so made little sense. And the suggested lessening of this profile over time simply didn’t happen. So now (orthopaedic operation aside) I can continue with my hobbies of archery and target rifle shooting on three evenings a week. In case you’re wondering how I can use a bow with a temporarily unusable thumb, I thought ahead and built a crossbow!

Bearing in mind that I can go back on a DMT if my relapses become more frequent, sever or strike elsewhere, what I’m doing now suits me at the moment.

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Sorry if I was sounding shrill. My excuse is that MS vision stuff gives me the heebie-jeebies on my own account and that my MS has never played nicely.

Alison

[quote=“alison100”]

Sorry if I was sounding shrill. My excuse is that MS vision stuff gives me the heebie-jeebies on my own account and that my MS has never played nicely.

Alison

[/quote] You weren’t sounding anything other than concerned so no apology is needed. In fact, I agree - MS can be an intimidating bedfellow. In my experience, attitude makes a huge difference. There really are worse things. I won’t go into detail but having worked in a medical school put many things into perspective for me.

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Just a little update to begin with. The spotty walls thing has gone away completely, even though I’m down to less than half my previous dose of Mirtazapine. I’ve also taken on board the advice offered by Alison100 (see above). I called my MS specialist nurse and asked if I could be considered for tecfidera. This is on the basis of hopefully preventing further damage to the neurons that handle my eyesight. A new prescription may be refused as I am lacking the required number of relapses. However, my consultant is a helpful individual. Will keep you posted.