MS disease modifying Rx
Who should be treated Clinically definite relapsing remitting MSD (RRMS) Some patients with Clinically isolated syndrome (CIS) secondary progressive MS (SPMS) Choice of therapy depends on: age, severity of disease, patient choice, risk of side effects Highest efficacy High to low efficacy is based on limited randomized trials All...
MS Acute Treatment
Multiple Sclerosis review Acute exacerbation IV methylprednisolone: 1000 mg iv daily for 5 days (3 to 7 days) with or without short taper Oral prednisone: 50 mg tab x 20 tab daily for 5 days without taper some previous study suggested iv more effective for optic neuritis ACTH (corticotropin)...
Transverse myelitis
Transvere myelitis = TM Differential diagnosis Compressive myelopathy: needs to be excluded by MRI ADEM: acute disseminated encephalomyelitis Acute demyelination involving brain and spinal cord MS: multiple sclerosis, separated by time and space NMO: neuromyelitis optica usually involves 3 or more vertebral segments Optic neuritis AQP4 Ab positive Poliomyelitis,...
Multiple sclerosis
Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Symptoms are highly variable. A very brief summary is is follow. Types Clinically isolated syndrome Relapsing remitting MS Secondary progressive MS Primary progressive MS Features suggestive of MS Relapses and remissions Onset age 15-50 years...
MS disease modifying treatment
Relapsing remitting multiple sclerosis (RRMS) initial therapy Very active disease: Natalizumab (Tysabri) 300 mg iv q 4 w Natalizumab: Risk of PML, 4 in 1000. check anti JC virus Ab before and at 1 year, then q 6 months or Ocrelizumab (Ocrevus): 300 mg iv, then 300 mg iv...
Tysarbi – PML
Surveillance for PML anti-JCV antibodies: at baseline and after one year PML is rare in the first year baseline brain MRI scan should be obtained prior to initiating therapy For patients who are negative for JCV antibodies at baseline and at one year, check anti-JCV antibody status and index...