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The
neurologist made a diagnosis of multiple sclerosis based on the
MRI, Evoked Potential, and CSF protein results. The
diagnosis was made 12 years after Janet's initial symptoms.
Instructor's
Note: Multiple
Sclerosis is a very difficult disease to diagnose. Plaques
are usually not evident for many years, and in some cases may
never be seen. Physicians often make a "probable
diagnosis" of MS based on the patients symptoms.
Janet
was put on a high dose of prednisone, a steroid used to reduce
inflammation, thus reducing plaque formation. A home health
nurse administered SOLU-MEDROL (methylprednisolone) by I.V.
This drug is a synthetic steroid that suppresses acute and
chronic inflammation.
Janet
was relatively symptom free for the next 8 years. Another
exacerbation (attack) at this point left Janet unable to move
without the use of a wheelchair or walker. This attack
lasted several weeks. During this time, a home health care
nurse visited Janet daily performing many services including
helping her bathe, massaging muscles and administering
medications. At this point, her physician recommended
changing her medication to
Avonex,
a beta interferon. The doctor explained that this
medication could slow the progression of demylination by up to
40%. The Avonex was administered once a week by injection by
the home health nurse. Although Janet's motor skills
improved after the attack, she did not fully recover. Janet
can walk, but does so with a stiff and awkward gait. She has
severe muscle tremors but is still able to function quite
normally. Her hope is that the new interferon medications
will slow the exacerbations so that she can maintain the level of
activity she now enjoys.
19.
How do steroids differ from B-interferons in the treatment of
MS? (See Multiple
Sclerosis-treatment).
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