Assessment and Diagnostic Tests MRI Rationale: diagnosis of MS is based on the presencce of multile plaques in theCNS observed wit

t 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 Interferon beta1a (Rebif), Interferon beta1b (Betaseron), Interferon beta1a (Avonex{) Dosage/Route/timi ng Subcutaneously Indication Slows accumulation of physical disability and decrease frequency of clinical worsening in patients with relapsing formsof MS -Reduces the rate of relapse in the RR Side effects Considerati on For optimal control of disability, should be started early in the course of disease.

Intramuscularly once a week

Glatiramer acetate(Copaxo ne)

Subcutaneously OD

Flu-like symptoms(ca n be manaed by acetaminophe n and ibuprofen), potential liver damage, fetal abnormalities, depression. Minimal and An option maneageable for those with an RR

IV methylprednisol one

1g OD for 3days via IV, followed by an oral taper of prednisone.

Mitoxantrone (Novantrone)

IV infusion every 3 months

course of MS -decreases the number of plaques noted on MRI and increases te time between relapse. -key agent in treating acute relapse in the RR course -shortens the duration of relapse -reduce the frequency of clinical relapse in patients with secondaryprogressive or worsening relapsingremitting MS.

course; however, it may take 6 months for evidence on an immune response to appear. Mood swings, weight gain and electrolyte imbalances. Seizure, arrhythmias, renal failure, bleeding, abdominal pain, mucositis, fever, Patients may be very closely monitored for side effects, especially cardiac toxicity.

Symptom management Symptom Spasticity Drug Baclofen (Lioresal), a GABA agonist Benzodiazepin (Valium), Trianidine (Zanaflex), Dantrolene(Dantrium) Fatigue Ataxia Amantadine (Symmetrel), pemoline (Cylert), fluoxetine (Prozac) Beta-adrenergic blockers (Inderal), antiseizure agents (Neurontin), benzodiazepin (Klonopin) Anticholinergic agents, alpha-adrenergic blockers, antispasmodic agents Ascorbic Acid (VITamin C) -medication of choice -administered orally or by intrathecal injection for severe spasticity Patients with disabling spasms and contractures may require nerve blocks or surgical intervention.

-ataxia is a chronic problem most resistant to treatment

Bladder and Bowel Problems Urinary Tract Infection

-to acidify urine, making

bacterial growth less likely. Antibiotics