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Assessment and Diagnostic Tests
MRI
Rationale: diagnosis of MS is based on the presencce of multile
plaques in
theCNS observed wit MRI.
Electrophoresis of CSF
Rationale: identifies the presence of oligoclonal banding
(several band of
immunoglobulin G, bonded together indicating, indicating an
immune system
abnormality.).
Urodynamic Studies
Rationale: identifies underlying bladder dysfunction
Nueropsychological Testing
Rationale: indicated to assess cognitive impairment.
Sexual History
Rationale: identify changes in sexual function
Medical Management
The goals of treatment are to delay the progression of the
disease, manage chronic
symptoms, and treat acute exacerbations.
Pharmacologic Therapy
Disease-modifying Therapies
Name of Drug Dosage/Route/timing
Indication Side effects Consideration
Interferon beta-1a(Rebif),Interferon beta-1b (Betaseron),
Interferon beta-1a (Avonex{)
Subcutaneously
Intramuscularlyonce a week
Slowsaccumulationof physicaldisability anddecreasefrequency
ofclinicalworsening inpatients withrelapsingformsof MS
Flu-likesymptoms(can be manaedbyacetaminophen
andibuprofen),potential liverdamage,
fetalabnormalities,depression.
For optimalcontrol ofdisability,should bestartedearly in
thecourse ofdisease.
Glatirameracetate(Copaxone)
SubcutaneouslyOD
-Reduces therate of relapsein the RR
Minimal andmaneageable
An optionfor thosewith an RR
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course of MS-decreases thenumber ofplaques notedon MRI
andincreases te
time betweenrelapse.
course;however, itmay take 6months forevidence onan immune
response toappear.
IVmethylprednisolone
1g OD for 3daysvia IV, followed byan oral taper
ofprednisone.
-key agent intreating acuterelapse in theRR course-shortens
theduration ofrelapse
Mood swings,weight gainandelectrolyteimbalances.
Mitoxantrone(Novantrone)
IV infusion every 3months
-reduce thefrequency ofclinical relapsein
patientswithsecondary-progressive orworseningrelapsing-remitting
MS.
Seizure,arrhythmias,renal
failure,bleeding,abdominalpain,mucositis,fever,
Patientsmay bevery closelymonitoredfor
sideeffects,especiallycardiactoxicity.
Symptom management
Symptom DrugSpasticity Baclofen (Lioresal), a
GABA agonist-medication of choice-administered orally or
byintrathecal injection forsevere spasticity
Benzodiazepin (Valium),Trianidine
(Zanaflex),Dantrolene(Dantrium)
Patients with disablingspasms and contracturesmay require nerve
blocksor surgical intervention.
Fatigue Amantadine (Symmetrel),pemoline (Cylert),
fluoxetine (Prozac)Ataxia Beta-adrenergic blockers(Inderal),
antiseizureagents (Neurontin),benzodiazepin (Klonopin)
-ataxia is a chronicproblem most resistant totreatment
Bladder and BowelProblems
Anticholinergic agents,alpha-adrenergic blockers,antispasmodic
agents
Urinary Tract Infection Ascorbic Acid (VITamin C) -to acidify
urine, making
