Multiple Sclerosis Flashcards
What is multiple Sclerosis?
Chronic autoimmune disease, demyelinating the central nervous system
What can MS be present through?
Relapsing or Progressive or BOTH!!
How many times does active MS present ( in the past 2 years despite treatment with beta…)
2 relapses in the past 2 year despite treatment with interferon beta
What are the 5 symptoms and how are they managed?
- Spasticity(continuous stiffness and spasms): using baclofen(treats muscle spasticity, relaxes muscles), diazepam, tizanidine and dantrolene (direct acting muscle relaxant)
- Relapses: Methylprednisolone
- Oscillopsia(objects moving)- Gabapentin
- Mood alteration: Amitriptyline
- Fatigue: Amantadine (antidyskinetics meds)and fampridine
Increasing baclofen dose
If we want to increases the dose of baclofen, this needs to be done slowly as its associated with 2 major sideeffects: Sedation and hypotonia(low muscle tone and low muscle strength) - We want to avoid side effects coming on hard
What is relapsing-remitting?
the most common pattern of the disease - characterised by periods of exaggeration of symptoms followed by unpredictable stability(remission)
What is Active MS?( number of relapses and years?)
Active = 2 relapses in the past 2 year despite treatment with interferon beta
What is highly active MS?
unchanged/increased relapse rate or by ongoing severe relapses compared to previous years
AIMS OF MS Treatment?
modify the course of disease and manage symptoms in order to improve quality of life- aim to reduce frequency of relapses
What is involved in drug treatment?
Shared decision making between patient and their clinician.
What is low vitamin believed to be?
believed to be a risk factor for developing MS - Some patients given Vit D to help with this.
What can be given to relapsing MS/progressive - relapsing MS?( outside the box by specialists?)
Under specialists: Disease- modifying drugs such as anti-lymphocyte monoclonal antibodies, anti metabolites,immunomodulators,immunostimmulants and interferons may be used for the treatment
How symptoms are managed?
Other than episodes of Nero dysfunction other chronic and cognitive symptoms create more of a disability -
Smoking increases the progression, therefore smoking cessation should be encouraged:
Spasticity can be exacerbated by….. and treated using??
Can be aggravated by infection, bladder and bowel dysfunction, poor posture,(continuous stiffness and spasms): using baclofen first line (treats muscle spasticity, relaxes muscles), if not tolerated, Gabapentin (unlicensed use) diazepam, tizanidine and dantrolene (direct acting muscle relaxant) - A 4 week Cannabis extract trial can be offered as adjunctive treatment- should be initiated by a specialist
Relapses
See specialist+ Corticosteroid recommended - Methylprednisolone oral, IV methylprednisole an alternative to consider if oral fails or not tolerated - or if hospitalisation is required
