The Authors Respond

We recently reported elevated body temperature and its association to fatigue in persons with relapsing-remitting multiple sclerosis (RRMS). The response by Mooney cites our article in support of a link between body temperature and environmental temperature that we actually did not investigate. In fact, we are currently most interested in investigating endogenous factors we believe to be related to body temperature elevations in persons with RRMS. Specifically, we are investigating a novel hypothesis of body temperature as a biomarker of inflammatory events in the brains of people with RRMS. Evidence reveals that only about 10% of new lesions are accompanied by a clinically evident exacerbation, ^,  which means that a great amount of disease activity is taking place in the brains of people with RRMS in the absence of sensorimotor symptoms. The deleterious impact of this clinically silent inflammation is highlighted in an article by Zivadinov et al, who showed that regular corticosteroid use was much more effective than corticosteroid administered only during clinical relapses in preventing brain atrophy and physical disability over time in persons with RRMS. These findings suggest that clinically silent inflammation was being effectively treated by consistent administration of corticosteroids, which underscores the critical importance of developing an effective method for monitoring MS disease activity. Confirmation of our hypothesis holds the potential of identifying body temperature as a novel and easily obtained biomarker of clinically silent inflammation that would put disease monitoring in the hands of MS patients themselves for the very first time. This holds important and immediate implications for treatment, while also pointing to physiological mechanisms underlying MS fatigue.