Ins and outs of Multiple Sclerosis - Treatment options in acute setting

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Unfortunately, multiple sclerosis (MS) has no cure. We try to treat acute MS attacks and reduce the progression of the disease. Sometimes patients with mild symptoms may not need any treatment at all.



General measures:

Patients education and counselling (very important aspect of the management plan).

Physiotherapy

Walking aids and orthoses

Visual aids

Occupational therapy



Management strategies to treat acute attacks:

a. Intravenous methylprednisolone.

Dose: 1 gm/24 hr intravenous/oral for three days shortens relapses. We need to be very cautious about using steroids in long term. High dose steroid in an acute setting on short term basis is indicated but care should be taken when using steroid for longer period. Use wisely and sparingly (maximum twice a year in high dose).

Some well known side effects of steroids are:



Gastrointestinal

Peptic ulceration

Pancreatitis

Candidiasis

Esophageal ulceration



Musculoskeletal

Osteoporosis

Myopathy

Fractures

Growth retardation



Endocrine

Cushing's syndrome

Adrenal suppression

High blood sugar, which can trigger or worsen diabetes



Eye

Cataract

Glaucoma

Papilloedema


Steroid induced cataract

Cardiovascular system

Fluid retention, causing swelling in your lower legs

Increased blood pressure



Central Nervous System

Depression

Psychosis

Aggravated epilepsy



Immune system

Increased susceptibility to opportunistic infections (along with increased severity), eg chicken pox. Steroids can also cause fever and increase white cell count.



Physicians should explain the side effects of steroids in terms that patients fully understand. If steroid is going to be used in long term, there should be plans to prevent osteoporosis. Remember, risks of steroids are mostly long term. So doctors should be judgmental about explaining each side effects. Using excessive steroids is bad and life-threatening. But explaining every side effects all at once may result in patient being very well informed, but frightened and even dead!

It is worth mentioning that, steroid shortens the duration of acute relapse and hastens patient's recovery, but it does not affect the long term course of the disease.



b. Plasma exchange (for patients who are not responding to steroids)

In this procedure, blood is removed from your body and blood cells are separated from your plasma. Plasma is removed and blood cells are mixed with a replacement solution and returned to your body.





About the Author

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Author: Dr Rezahaider

I am a physician by profession. I dream to work on medicine in the near future. I have completed my residency three years back. Now, I am planning to obtain MRCP. This is very hard exam and surely, I am always scared of it. I have also decided to do my specialization on cardiology. Before medical school, I never thought that our heart could be so complex! So pray for me. I usually don't have enough time to write due to my studies. But whenever I get time I love to write. I write on medical related issues. I try to make it simple for you.

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