MS tx Flashcards
(43 cards)
Multiple sclerosis
Diagnostic criteria of MS
-dissmination in Time and space
-REQUIRES at least 2 demyelination-related episodes separated by time and space
-use MRI and CSF testing
dissemination in Time (DIT)
-time between evidence of new lesions in subsequent MRIs (30 days)
-damage that has happened more than once
Dissemination in Space (DIS)
-need for >1T2 lesion appearing in at least 2 of 4 MS-typical CNS regions:
-corticol, periventricular, infratenorial, spinal cord
-damage that is in more than one place
Types of MS
-clinically isolated Syndrome (CIS)
-Relapsing Remitting (RRMS)
-Secondary Progressive (SPSM)
-Primary Progressive (PPMS)
-Progressive Relapsing (PRMS)
Clinically isolated syndrome (CIS)
-first demyelinating event involving:
-optic nerve
-cerebrum
-cerebellum
-brainstem
-spinal cord
-most will develop MS in 20 years
Relapsing Remitting MS (RRMS)
-85%
-relapses w complete or partial remission between
-most become progressive over time
-white 30 year old women
Secondary Progressive MS (SPMS)
-80% of RRMS
-fewer relapses
-continuing disability
Primary Progressive MS (PPMS)
-10-15%
-progressive from onset
-minor improvements or periods of stability
-more common in pt dx in later years >50yo
Progressive Relapsing MS (PRMS)
-least common
-5%
-steadily worsening
-later, clear, acute relapses
-may be some recovery but no remission between relapses
Disease modifying drug therapy is focused on:
-RRMS type of MS
-one exception for PPMS
-based on current drug target of inflammation vs neurodegeneration
Expanded Disability Status Scale (EDSS)
-assess severity of MS
-0-10
-10 is death, 5 is cane
-mostly based on ability to get around
-pt presenting w RRMS progresses to 4 within 7 years of dx
-score of 4: able to walk w/o aid or rest but has severe disability (one big disability or a bunch of small disabilities
Goals of MS tx
-start early, reduce relapses to stall neurodegeneration
-tx acute relapses for better remission
-begin DMDs at CIS stage if possible (target inflammation)
-improve QOL: fatigue, gait, pain
Treatment of acute attacks
- high-dose corticosteroid
-most pt will be inpatient (IV)
-methylprednisolone, ACTH, prednisone
Methylprednisolone
-500-1000mg IV qd for 3-7 days
-w or w/o: oral taper over 1-3 weeks
-GIVE TO PT W OPTIC NEURITIS
ACTH
-or plasma exchange
-$$$
Prednisone
-if outpatient
-oral 1250mg qod x 5 doses
-no need to taper
Oral MS meds
-Cladribine (Mavenclad)
-fumarates
-ginolimod
-ozanimod
-ponesimod
-siponimod
-teriflunomide
Injectable MS meds
-IFN-B1a/b*
-PegIFN-B1a*
-Glatiramer acetate*
-Ofatumumab (Kesimpta)
Infusion MS meds
-Alemtuzumab*
-Mitoxantrone
-Natalizumab*
-Ocrelizumab*
-Ublituximab-xiiy
Progressive Multifocal Leukoencephalopathy
-rare side effect caused by reactivation of dormant JCV
-cause myelin producing cells to break down
-looks similar to MS relapse
-50-80% of abults have JCV aBs and are at risk
-50% mortality
-pt MUST BE TESTED FOR JCV ANTIBODIES
MS Vaccines
-inactivated vax preferred
-live not recommended bc weakened immune response
-alemtuzumab - no live vax
-varicella vax in pt w no chx pox especially if starting an immunosuppressant (fingolimod, almetuzumab)
dimethyl, diroximel, monomethyl fumarate
-capsule should NOT be opened/chewed/crushed
-monitor LFTs and CBC (neutropenia
-associated w PML
-can cause flushing = take aspirin 30 min before dose
