MULTIPLE SCLEROSIS-MANAGEMENT

SUMMARY

1. The treatment of acute exacerbations is high-dose corticosteroids. Do not do strenuous exercises during an acute flare.

2. Glucocorticoids may shorten the duration of exacerbations but do not alter the natural history of MS: IV methylprednisolone, 1g/day for 3-7 days, followed by a rapid prednisone taper.

3. 2012 Cochrane review showed no dif­ference in outcomes when comparing oral vs. IV steroids for relapses.

4. Parenteral corticosteroids are the treatment for optic neuritis.

5. Interferon and glatiramer (Copaxone®, a synthetic amino acid polymer) reduce relapses by 30%, while natalizumab (Tysabri; monoclonal antibody against the cell adhesion molecule α4-integrin) reduces relapses by 60%.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].