Symptom + Relapse Management Flashcards
An MS relapse is classified as…
New/worsening symptoms, lasting 24+ hours; can be separated from previous relapse by 30+ days
No evidence of other causes
For relapses that require treatment, this may be given…
High dose corticosteroids
Anti-inflammatory
Not all relapses are treated
Fatigue from MS can be caused by…
Primary - caused by MS (more energy needed due to damaged CNS)
Secondary - depression, pain, muscle spasms, sleep disturbances
Non-pharmacological options that could be trialed to help with fatigue include…
OT/PT
Sleep hygiene
Avoiding excess heat
Adequate exercise and diet
Pharmacological options that could be trialed for fatigue include…
3
Amantadine
Modafinil
Methylphenidate
Evidence is…not great
Amantadine, modafinil and methylphenidate share similar AE which is…
Insomnia - sleep disturbances
Could worsen fatigue
Non-pharmacological options that could be trialed to help with gait include…
OT/PT
Bracing or walking aids
Exercise
This could be trialed to help with gait, but…
Fampridine - effect is very minimal and can cause UTI, insomnia, headache, dizziness
Non-pharmacological options that could help with spasticity include…
Exercise, stretching
Pharmacological options that could be tried for spasticity include…
Baclofen
Gabapentin
Botulinum toxins
Common AE among pharmacological spasticity options include…
Drowsiness, GI issues/nausea
Majority of symptomatology management in MS would be treated…
Exactly the same as regular population
Ex: bladder + bowel dysfunction, pain, depression, etc.
This may be tried as add-on treatment for spasticity and pain in MS…
Cannabis
Lack of evidence for any other MS symptoms, but anecdotal benefit
Potential AE’s with cannabis may include…
Dizziness
Blurred vision
Tachycardia
Falls
Fatigue,
Long term cognition effects
Patient already likely dealing with this
Challenges with using cannabis include…
Unknown dosage/ratio
Type of cannabinoid to use
Varying quality/quantity if street cannabis
Finding cannabis “naive” patients
