Neurology Long Case 2

Question 1

How would you manage Babak’s Multiple Sclerosis?

Answer 1

• Supportive care
		○ Treat spasticity - baclofen
		○ Bladder urgency - amitriptyline
		○ Facial spasm - carbamazepine
		○ Intention tremor - propanolol
		○ Pressure care
		○ Falls prevention
		○ Home layout optimisation
	• Pharmacological
		○ Natalizumab
			§ PML Risk
			§ JCV antibody test
		○ Fingolimod
			§ Lymphopaenia
			§ First-dose bradycardia
		○ Teriflunomide
		○ Alemtuzumab
			§ CD52 antibody
			§ Autoimmune disease
	• Flares
		○ Steroids
		○PLEX or IVIg