MS Mx in afya

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Treatment in multiple sclerosis is focused at reducing the frequency and duration of relapses. There is no cure.

''Acute relapse''
High dose steroids (e.g. IV methylprednisolone) may be given for 3-5 days to shorten the length of an acute relapse. It should be noted that steroids shorten the duration of a relapse and do not alter the degree of recovery (i.e. whether a patient returns to baseline function)

''Disease modifying drugs''
Beta-interferon has been shown to reduce the relapse rate by up to 30%. Certain criteria have to be met before it is used:
    relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided
    secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)
    reduces number of relapses and MRI changes, however doesn't reduce overall disability

Other drugs used in the management of multiple sclerosis include:
    glatiramer acetate: immunomodulating drug - acts as an 'immune decoy'
    natalizumab: a recombinant monoclonal antibody that antagonises Alpha-4 Beta-1-integrin found on the surface of leucocytes, thus inhibiting migration of leucocytes across the endothelium across the blood-brain barrier
    fingolimod: sphingosine 1-phosphate receptor modulator, prevents lymphocytes from leaving lymph nodes. An oral formulation is available

''Some specific problems''
''Spasticity''
    baclofen and gabapentin are first-line. Other options include diazepam, dantrolene and tizanidine
    physiotherapy is important
    cannabis and botox are undergoing evalulation
''Bladder dysfunction''
    may take the form of urgency, incontinence, overflow etc
    guidelines stress the importance of getting an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients
    if significant residual volume → intermittent self-catheterisation
    if no significant residual volume → anticholinergics may improve urinary frequency

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