Multiple sclerosis Flashcards
Treatment for fatigue
Amantadine
Modafenil if sleepy
Hyperbaric oygen
Diagnosis of MS
At least 2 epsidoes suggestive of demyelination
Dissemination in time and place
McDonald criteria
Obv look at MRI and CSF etc
Evoked responses in MS
Delay in visual evoked response
Treatment for exacerbation of MS
Steroids
Spasticity treatment options
Passmedicine –> baclofen (gabapentin)
Education Physiotherapy Oral medication - baclofen,tizanidine I.M. Botulinum toxin Nerve blocks Intrathecal baclofen / phenol Surgery
What is tizanadine?
A muscle relaxant
Treatment for sensory symptoms
anti convulsant eg. gabapentin anti depressant eg. amitriptyline tens machine Acupuncture Lignocaine infusion
Treatment for urinary tract dysfunction
Anticholinergics e.g oxybutynin
Desmopressin
Catheter
First line disease modifying therapy
Interferon beta
Copaxone
Tecfidera
Second line disease modifying therapy
Tysabri
Fingolimod
Third line disease modifying therapy
Mitoxantrone
Effect of interferon beta/copaxone
Reduce relapses by 1/3rd
Decreases severity of relapse by 50%
How do you adminster beta interferon/copaxone
Injectable - SC / IM
First line for relapsing remitting MS
Tecfidera
-44% reduction in relapse rate
How is tecfidera administered?
Orally
Treatment for:
Patients with rapidly evolving severe relapsing remitting multiple sclerosis
Patients with high disease activity despite treatment with a interferon
Tysabri
Role of alpha4beta1 integrins in MS
Allow T cells to cross the BBB
How does tysabri work?
Acts against the receptor that allows immune cells to cross the BBB
Whats the weird thing you have to be really careful with when using tysabri?
JC virus
can cause PML - estimated risk 1/385 after 2 years
What can JC virus cause?
PML (progressive multifocal leucoencephalopathy)
How does fingolimod work?
S1P modulator
When can you use mitoxantrone?
For relapsing progressive MS
How many infusions of mitoxantrone can you receive?
12 over 2 years
-cardiac toxicity dose related
