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Demyelinating Diseases 01

Topic: Pharmacology

Created on Friday, September 28 2007 by jdmiles

Last modified on Friday, September 28 2007.

A 32 year-old female presents to your clinic for follow up after a recent hospitalization.  She had been hospitalized for rapidly worsening bilateral lower extremity weakness and numbness.  There had no history of trauma or recent illness.  She reports that she woke up with the symptoms, and they worsened over the course of the day.  She was admitted to the hospital, treated with steroids, and is slowly improving. 

She has a past medical history of optic neuritis 2 years earlier, which produced blindness in her left eye and resolved completely over several weeks. 

Her father has type I diabetes mellitus, and her mother has rheumatoid arthritis.

Which of the following medications have been demonstrated to modify the progression of this patient's condition?


 
        A) Infliximab
 
        B) Natalizumab
 
        C) Vitamin E
 
        D) Interferon β-2
 
        E) Oral prednisone
 

 


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This question was created on September 28, 2007 by jdmiles.
This question was last modified on September 28, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Infliximab

This answer is incorrect.


Infliximab has not been shown to modify the progression of disease in multiple sclerosis.  (See References)

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B) Natalizumab

This answer is correct.


Natalizumab (Tysabri) has been shown in double-blind, placebo-controlled trials to reduce the frequency of relapses in patients with relapsing-remitting multiple sclerosis.  (See References)

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C) Vitamin E

This answer is incorrect.


Vitamin E has not been shown to modify the progression of disease in multiple sclerosis.  (See References)

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D) Interferon β-2

This answer is incorrect.


Interferon β-2 has not been shown to modify the progression of disease in multiple sclerosis.  (See References)

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E) Oral prednisone

This answer is incorrect.


Prednisone has not been shown to modify the progression of disease in multiple sclerosis.  Furthermore, there is no role for prednisone in the treatment of acute relapses of MS, such as optic neuritis.

  (See References)

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References:

1. Olek, M.J., and Dawson, D.M. (2004). Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 1631-1664.
2. Beck, R.W., Cleary, P.A., Anderson, M.M., Keltner, J.L., Shults, W.T., Kaufman, D.I., Buckley, E.G., Corbett, J.J., Kupersmith, M.J., and Miller, N.R. (1992). "A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group." N Engl J Med, 326(9) 581-8. (PMID:1734247)
3. Zajicek, J. (2005). "Diagnosis and disease modifying treatments in multiple sclerosis." Postgrad Med J, 81(959) 556-61. (PMID:16143683)
4. Miller, D.H., Khan, O.A., Sheremata, W.A., Blumhardt, L.D., Rice, G.P., Libonati, M.A., Willmer-Hulme, A.J., Dalton, C.M., Miszkiel, K.A., and O'Connor, P.W. (2003). "A controlled trial of natalizumab for relapsing multiple sclerosis." N Engl J Med, 348(1) 15-23. (PMID:12510038)
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pharmacology
Demyelinating Diseases 01
Question ID: 092707150
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 09/28/2007
Modified: 09/28/2007
Estimated Permutations: 7200

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