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 patient's 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 demyelination 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 disease-modifying therapies including B-interferons in the treatment of MS? (See Multiple Sclerosis-treatment pgs. 8-10 on this website).