CASE PRESENTATION ON MULTIPLE SCLEROSIS

AYESHA FAREED PHARM D 5TH YR

ROLL NO: 07SVCP

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CHIEF COMPLAINT: A 36YOF c/o pain and tingling in fingers of left hand which progressed to arm and neck Blurred vision- right eye since 15 days

SUBJECTIVE:

PMH: HTN 

FAMILY HISTORY: Nil

SOCIAL HISTORY: Nil

ALLERGIES: NKDA

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OBJECTIVE:

Physical examination: General appearance:Height: 165cm Weight: 65 kg BMI: 23.8 Kg/m²

Vital signs:Pulse: 78 beats/minRR: 20 breaths/minBP: 100/70mmHgTemp: 98.2o F

HEAD TO TOE EXAMINATION:EXT: weaknessEYE: blurred vision (right eye)

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Laboratory investigations:

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TEST VALUE REFERENCE

Albumin 3.4* 3.5-5.5 g/dl

Urea 27 20-40 mg/dl

Sr. creatinine 0.8 0.6-1.6 mg/dl

TLC 11.7* 4-11000cells/mm

Platelets 2.6 1.5-4.5lakh/mcLHb 14.3 13-18 g/dlPCV 42 40-54%

MEDICATION RECONCILIATION:

• T. ESLO (amlodipine) 5mg PO OD (HTN)• T. PANTEL (pantoprazole) 40mg PO OD

Diagnostic test: MRI: revealed acute demyelinating optic neuritis

CSF analysis (oligoclonal bands) done- reports awaited

DIAGNOSIS: Rt optic neuritis- Multiple sclerosis

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BRANDNAME

GENERIC NAME

DOSE ROUTE

FREQ

INDICATION DAY

Inj. SOLUMEDROL

methylprednisolone

1g in 200 NS over 2 hrs

IV OD Optic neuritis D1

T. PANTODAC pantoprazole 40 mg PO OD APD D1

T. REMYLIN- D

α-lipoic acid, pyridoxine, methylcobalamine, vitamin- D

1 tab PO OD Neuropathy D1

T. DOLO paracetamol 650 mg

PO OD Headache STATD2

T. STAMLO amlodipine 5 mg PO OD hypertension D3

T. OMNACORTIL

prednisolone 40 mg PO OD MS D3

T. GABAPEN gabapentin 300 mg

PO HS Neuropathy D3

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ASESSMENT:A 36 YOM c/o pain and tingling in fingers of left hand

which progressed to arm and neck and blurred vision in right eye since 15 days

MRI was done which revealed optic neuritis

MULTIPLE SCLEROSIS: Inj. SOLUMEDROL (methylprednisolone) 1g in 200

ml NS over 2 hrs was given as pulse therapy

Intravenous methylprednisolone has been shown to shorten the duration of acute exacerbations, and it may delay repeat attacks for up to 2 years after optic neuritis

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T.GABAPEN (gabapentin) 300mg PO HST. OMNACORTIL (prednisolone) 40 mg

PO OD T. REMYLIN- D 1tab PO OD

HTN:T.S.NUMLO (amlodipine) 5 mg PO OD

APD:T. PANTODAC (pantoprazole) 40 mg PO

OD

PLAN

Goals:

To decrease mortality and long term disabilityTo reduce ongoing neurologic injuryTo prevent progression of the diseaseTo control relapsesTo manage the signs and symptoms

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Disease monitoring parameters

Monitor Blood pressureCBCThyroid profileLipid profileLiver enzymes

Drug monitoring parameters

Prednisolone: Blood pressure; blood glucose, electrolytes, intraocular pressure 

Amlodipine: BP, HR, signs of edemaGabapentin: depression, behavioural changes, suicidal

thoughts 10

Patient counselling Multiple sclerosis is a disease that causes vision problems,

numbness and tingling, muscle weakness, and other problems. It happens when the body’s infection-fighting system attacks and damages nerve cells and their connections in the brain and spinal cord

DIET: Have a diet low in saturated fats and supplemented by Omega-

3 (from fatty fishes, cod-liver oil, or flaxseed oil) and Omega-6 (fatty acids from sunflower or safflower seed oil and possibly evening primrose oil)

Eliminate sugar (fructose) from your diet. Keep a daily fructose intake of not more than 25 gms

Eliminate pasteurized milk and dairy Eat plenty of raw food- fruits and vegetables Optimize your vitamin- D levels by getting regular sunlight

exposure 11

DISCHARGE MEDICATIONS: T. S.NUMLO (amlodipine) 5 mg 1 tab orally once daily

(HTN) T. PAN (pantoprazole) 40 mg 1 tab orally once daily

(APD) T. REMYLIN- D 1 tab orally once daily (neuropathy) T. GABAPEN (gabapentin) 300 mg 1 tab orally once

daily after dinner (neuropathy) T. OMNACORTIL ( prednisolone) 40 mg 1 tab orally once daily for 1 week then 20 mg 1 tab orally once daily for 1 week then 10 mg 1 tab orally once daily for 1 week and stop

FOLLOW UP: Review with CSF reports in neuro OPD12

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