Treatment 💊

Question 1

How to treat MG?

Answer 1

1. Pyridostigmine (or neostigmine (anticholinesterase )
2. steroids +/- Azathioprine
   (cyclosporine and cyclophosphamide are alternatives to Azathioprine)
3. plasmapheresis or intravenous immunoglobulin (for sever cases)
4. Thymectomy
5. Mycophenolate is new alternative to steroids with less side effects

Question 2

How to treat ELS?

Answer 2

1. Tumor resection
2. (3-4 diaminopyridine or guandine) and acetylcholinesterase inhibitors can be added.
3. corticosteroids and azathioprine can be given

Question 3

How to treat?

Answer 3

1. plasmapheresis or IV immunoglobulin
2. Glucocorticoids are NOT effective
3. monitor vital capacity for respiratory support
4. Aggressive physical ttt

Question 4

What is the treatment of ALS?

Answer 4

1. Riluzole is the only ttt to slow the progression ( by ⬇️ Glutamate release)
2. balcofan, tizanidine for spasticity
   death usually occurs from 3-5 years

Question 5

What is the treatment of MS?

Answer 5

it depends on the course so

• Relapsing-remitting: interferon B1a, B1b ,Glatiramer acetate
• secondary progressive; B1b , mitoxantrone
• primary progressive; no approved treatment

Also it depends on the symptoms;

• Spasticity; baclofen, Tizanidine & Diazepam
• pain due to neuralgia & dysesthesias ; Carbamazepine,gabapentin, phenytoin,pregabalin, tricyclics antidepressant
• bladder hyperactivity; oxybutynin
• urinary retention ; bethanecol
• fatigue; Amantadine or fluoxetine
• eractile dysfunction; sildanafil acetate