How is an acute exacerbation of MS managed
Mild-symptoms treatment
Moderate- oral steroids
Severe- admit/IV steroids
How can pyramidal dysfunction be managed in MS ie weakness and spasticity
Physio OT Muscle relaxants Nerve blocks Surgery
What skeletal muscle relaxants are used in MS
Oral Baclofen or tizanidine
IM botulinum toxin
Intrathecal baclofen/phenol
Intrathecal =injection into subarachnoid space of spinal canal
How can sensory symptoms be managed
Anticonvulsant eg gabapentin TCAD eg amitriptyline Tens machine acupuncture lignocaine infusion
How are urinary symptoms managed
Bladder drill
Anti cholinergics eg oxybutynin
Desmopressin
Catheter
What are the first line disease modify ing therapies
Interferon Beta- Avonex, Rebif, Betaseron, Extavia
Glitiramer Acetate (Copaxone
Tecfedira
What are second line disease modifying therapy
Tysabri
Fingolimod
What is third line
mitoxantrone
Describe the modes of each agent and how effective it is for the first line agents?
Interferon B and copazone = injection(SC or IM)
Decrease relapse rate by 1/3
Decrease severity of disability by 50 percent
Tecfedira= oral
50 percent reduction in relapse rate
good for RR ms
When are second line treatments such as tysabri indicated
Highly active RRMS ie
- rapidly evolving severe RRMS
- high disease activity despite active interferon treatment or copaxone
what is associated with tysabri
PML = progressive multi focal leukoencephalopathy
It is a rare and usually fatal viral disease characterized by progressive damage or inflammation of the white matter of the brain at multiple locations
what causes PML
JC virus
What is the risk of developing PML with tysabri
1/385 after two years
When is mitoxanthron indicated
relapsing progressive MS
How is mitoxantrone given and what are its down sides
12 infusions over 2 years Cardiac toxicity (dose related)
