RISK FACTORS: Living in temperate zone, Northern European descent, Family history of the disease
GENERAL MEASURES
β’ Remissions occur spontaneously and make treatment evaluations difficult
β’ Beta interferon 1a and 1b and glatiramer acetate represent breakthroughs in MS therapy
β’ Emotional support, encouragement
β’ Occupational therapy
β’ Urologic evaluation including any sexual dysfunction problems (impotence common in male patients)
β’ Self-catheterizations for inadequate bladder emptying (indwelling catheter may be necessary in a few patients)
β’ Custodial care, if patient cognitively impaired
β’ Physiotherapy to maintain range of movement and strength and to avoid contractures
ACTIVITY
β’ Maintain activity, avoid overwork and fatigue
β’ Rest during periods of acute relapse
DIET If constipation a problem, high fluid intake, plus a high fiber diet
DRUG(S) OF CHOICE: Drug therapy directed toward relieving symptoms
β’ Methylprednisolone: IV 1,000 mg for 5 days followed by tapered oral prednisone for acute attacks, especially
retrobulbar neuritis (recommended by some clinicians)
β’ Spasticity: baclofen, low dosage to start, 5 mg 1-3 times a day, increase as needed, or diazepam 2-5 mg qhs
β’ Constipation: stool softeners, bulk producing agents, laxative suppositories
β’ Urinary problems: propantheline 7.5 mg every 3-4 hours to start, increase to 15 mg 3-4 times a day plus 15-30 mg at bedtime; or oxybutynin chloride 5 mg 3-4 times a day
β’ Prophylactic antibiotics: for urinary infections
β’ Incoordination or tremors: no ideal therapy; may try beta-blockers (if not contraindicated), primidone, or
clonazepam
β’ Depression and emotional lability: amitriptyline 10-25 mg at bedtime to start, increase as tolerated
β’ Paranoia or mania: haloperidol or lithium
β’ Musculoskeletal pain or discomfort: nonsteroidal antiinflammatories
β’ Hemifacial and dysesthesias: carbamazepine 100-200 mg once or twice a day to start, increase to total daily
dosage of 600-1600 mg 3-4 times a day. Must monitor serum levels.
β’ Immunosuppressive agents (e.g., azathioprine, ACTH [adrenocorticotropic hormone], methylprednisolone,
cyclophosphamide, interferons, cyclosporine) still investigational
ALTERNATIVE DRUGS
β’ Oral steroids: Poor evidence for use alone
β’ Chronic fatigue: amantadine 200-300 mg/day (no specific evidence that this works)
β’ Baclofen 40-80 mg/day in divided doses for reduction of spasticity
β’ Interferon-beta approved for relapsing MS - 0.25 mg SC every other day
β’ Copolymer-1 approved for relapsing MS
PATIENT MONITORING Requires patient follow-up
PREVENTION/AVOIDANCE No known preventive measures. Avoid factors that may precipitate an attack, particularly stress from hot weather.
POSSIBLE COMPLICATIONS
β’ Coma
β’ Delirium
β’ Emotional lability
β’ Nystagmus
β’ Optic nerve atrophy
β’ Paraplegia
β’ Sexual impotence (men)
β’ Urinary tract infections
EXPECTED COURSE/PROGNOSIS
β’ Highly variable and unpredictable. Approximately 70% of patients lead active, productive lives with prolonged
remissions.
β’ May disable the patient by early adulthood or cause death within months of onset
β’ Average duration exceeds 25 years
β’ 30% relapse in one year, 20% in 5-9 years, 10% in 10-30 years