Multiple Sclerosis Flashcards
What should any patient with transient worsening of neurologic symptoms be screened for?
Uhthoff phenomenon, a transient worsening of baseline neurologic symptoms in the setting of hot weather, physical exertion, or fever. This worsening occurs because of a temporary reduction in neuronal electrical conductance at higher temperatures, which causes magnification of symptoms from previously demyelinated pathways. Any patient with a suspected relapse should be screened for causes of Uhthoff phenomenon masquerading as a relapse (or “pseudorelapse”) to avoid unnecessary treatment. Patients often need reassurance and counseling that such events are not indicative of new inflammatory damage.
how do you diagnose MS
The McDonald criteria for diagnosing multiple sclerosis require symptoms of central nervous system demyelination separated in space and time from a series of clinical relapses or progression, signs on physical examination, distribution of lesions on MRI, and (if necessary) the presence of CSF-unique oligoclonal bands.
MS Patients have which vitamin deficiency
patients with MS have a three- to sixfold increased risk of reduced bone mineral density, most likely from a combination of reduced physical activity, repeated use of glucocorticoids, and vitamin D deficiency. Vitamin D deficiency is common in MS patients, and reduced serum levels of vitamin D are predictive of MS development and future accumulation of lesions on MRI. A randomized trial of vitamin D supplementation added to interferon beta treatment resulted in reduced accumulation of lesions seen on MRI compared with placebo. Vitamin D supplementation is now recommended for all patients, although the ideal dosing regimen and serum 25-hydroxyvitamin D level are still being investigated.
What HCM recommendations are there for MS patients
Current multiple sclerosis (MS) treatment guidelines recommend vaccination against influenza and maintenance of standard immunizations; smoking cessation also is advised because of the threefold risk of conversion from relapsing-remitting MS to secondary progressive MS and faster rates of disability accumulation in cigarette smokers.
How do you treat MS relapses
The standard treatment for MS relapses is high-dose glucocorticoids, typically intravenous methylprednisolone; frequent or prolonged glucocorticoid treatment should be avoided to minimize the risks associated with long-term glucocorticoid use.
What is the first line treatment for MS
What about for those with liver disease
What about those who have failed treatment?
Interferon beta preparations or glatiramer acetate are considered first-line agents for relapsing-remitting multiple sclerosis, given their favorable risk profiles; glatiramer acetate is preferred in patients with liver disease.
Liver dysfunction is a potential adverse effect of fingolimod, the interferon beta preparations, and natalizumab. Therefore, none of these drugs would be the best choice for this patient. Additionally, natalizumab is recommended for patients who have not responded to previous disease-modifying therapy. Because this patient has not yet been treated for his MS, use of natalizumab as a first-line agent would be inappropriate.
What is a known In patients with multiple sclerosis who take fingolimod as a disease-modifying therapy, regular ophthalmic examinations are necessary because of the increased risk of macular edema with this medication.
This patient should now have regular ophthalmologic examinations. Fingolimod is a once-daily pill that results in sequestration of activated lymphocytes in lymph nodes. Fingolimod reduces
In patients with multiple sclerosis who take fingolimod as a disease-modifying therapy, regular ophthalmic examinations are necessary because of the increased risk of macular edema with this medication.
This patient should now have regular ophthalmologic examinations. Fingolimod is a once-daily pill that results in sequestration of activated lymphocytes in lymph nodes.
What is the only treatment for Primary Progressive MS
Ocrelizumab is the only available therapy for primary progressive multiple sclerosis (MS), and mitoxantrone is the only FDA-approved therapy for secondary progressive MS; given the lack of benefit of other MS therapies in these disease subtypes, using agents other than ocrelizumab and mitoxantrone in patients with progressive forms of MS not only increases cost but burdens patients with unnecessary risk.
What is the name of the drug used for patients who dont respond to first line treatment and why is it reserved
Natalizumab is a highly effective treatment in multiple sclerosis that causes a two-thirds reduction in relapse rates, slowing of disability progression by approximately 40%, and a reduction in MRI activity of approximately 90% compared with placebo; it is typically limited to use as a second-line agent because of the risk of progressive multifocal leukoencephalopathy.
How do you treat cognitive dysfunction in multiple sclerosis.
Cognitive dysfunction occurs in at least 50% of patients with multiple sclerosis (MS). The most common deficits involve short-term memory, processing speed, and executive function. Cognitive disability has a significant effect on the employability of patients with MS and can reduce their overall quality of life. To this point, however, no pharmaceutical agent has been shown to improve these symptoms in patients with MS. In contrast, cognitive rehabilitation approaches, such as the development of accommodative strategies and training with challenging cognitive tasks, have shown this benefit
What are the three key core phenotypes
The three core phenotypes of multiple sclerosis can be modified by the presence of activity (clinical relapse or new/enlarging MRI lesion); primary and secondary progressive multiple sclerosis can be further modified as “progressive” if there is ongoing accumulation of neurologic deficits independent of clinical relapses.
