Treatment of MS

Question 1

Reduce relapse duration

Answer 1

corticosteroids - limited to 3x per year, severe, high doasge

plasma exchange if unresponsive

Question 2

reduce relapse frequency (old)

Answer 2

interferon/glatrimer

Question 3

reduce relapse frequency, new oral therapy - reduce trafficking of wbc

Answer 3

fingolimod (sphingosine-1-phosphate)

Question 4

reduce relapse frequency, new oral therapy - anti inflam and reduce ox stress

Answer 4

dimethylfumarate - monitor for lymphopenia

Question 5

reduce relapse frequency, new oral therapy - anti inflam and immunosuppression

Answer 5

tertriflunomide - teratogenicity and hepatotoxic

Question 6

monoclonal Ab against integrin 4

Answer 6

reduce wbc trafficking - natalizumab

complications: PML and rebound relapse if withdrawn

Question 7

monoclonal Ab against CD52

Answer 7

ateluzumab (camPATH)

can cause other autoimmune disorders eg thyroid, ITP, infection

Question 8

neuroprotective

Answer 8

lamotrigine trial

Question 9

cellular

Answer 9

haemopoietic transplant

Question 10

treatment of spasticity (6)

Answer 10

passive stretching
intrathecal baclofen
benzodiazapine
cannbis
botox
surgical ablation of nerve roots

Question 11

treatment of bladder symptoms (5)

Answer 11

suprapubic catheter
self catheterisation
botox
antimuscarinics
desmopressin (nocturia)