Drugs For Multiple Sclerosis

Ans. is ‘d’ i.e., Spasticity

Ans. is ‘b’ i.e. Interferon – beta

Treatment of multiple sclerosis

o Multiple sclerosis is an autommune disease characterized by chronic inflammatory demylination that affects the CNS.

o The most common course of the disease is the relapsing-remitting subtype, which is characterized by unpredictable acute attacks (relapses) followed by periods of relative remission with no new signs of disease activity.

The other type (less common) is progressive subtype, which is characterized by a steady functional decline from disease onset.

o Therapy for MS can be divided into several categories:‑

1. Treatment of acute attack

• Corticosteroids (Methylprednisolone, prednisolone) are used

2. Treatment with disease-modifing agents that reduce the biological activity of MS

• Disease modifying agents for multiple sclerosis are (i)IFN-f1 la; (ii) IFN-fl lb, (iii) Glatiramer; (iv) Natalizumab; (v) Finoglimod: (vi) Mitoxantrone; (vii) Cladaribine.

3. Other treatment options

• Other off-label treatment options are (i) methotrexate; (ii) cyclophosphamide; (iii) IV immunoglobulins; (iv) azathioprine.

4. Symptomatic Treatment

• It includes healthy diet, regualr exercise, and:

i)      Treatment of rigidity (baclofen, diazepam, tizanidine, dantroline)

ii)     Treatment of weakness (Potassium channel blockers like 4-aminopyridine)

iii)   Treatment of pain by anticonvulsants (carbamezapine, phenytoin, gabapentin, pregabalin), or antidiepressants (mexiletin).

iv)    Treatment of UTI, bladder dysfunction, constipation, depression, fatigue and cognitive problems.

Ans. is ‘d’ i.e. Mycophenololate

Treatment of RRMS

o Treatment of RRMS is divided into:‑

(i)      In acute attack: Corticosteroids are given

(ii)    Prophylaxis of acute attack (relapse) during remission: Disease modifying agents for MS are used to reduce the biological activity. Treatment is started by IFN-131a or IFN-131b or Glatiramer or fingalimod. If there is poor response or intolerance to these drugs, Natalizumab is started.

Treatment of progressive subtype of MS

o Treatment is started with l FN-fil a or IFN-$lb.

o If there is poor response or intolerance, one of the following should be considered: (i) Mitoxantrone; (ii) Azathio‑ prine; (iii) Methotrexate (iv) IV immunoglobulin; (v) Pulse cyclophosphamide; (vi) Pulse methylprednisolone.

Ans is ‘c’ i.e. Natalizumab

o EDSS (Expanded disability status scale) is a method of quantifying disability in multiple sclerosis.

o EDSS steps 1.0 to 4.5 refer to people with MS who are fully ambulatory. EDSS steps 5.0 to 9.5 are defined by the impairment in amubulation. EDSS 10 is defined as death due to MS.

o Natalizumab silences disease activity and rapidly improves disability status and walking performance, possibly through delayed relapse recovery in patients with RRMS who had shown a high level of disease activity under other disease modifying drugs for multiple sclerosis.

Answer is B (Medial Medullary Syndrome):

Horner’s syndrome is associated with Lateral Medullary Syndrome or Wallenberg Syndrome and not with Medial Medullary Syndrome.

Answer is B (Interferon Beta) :

Interferon Beta should be considered in patients with Relapsing / Remitting MS (RRMS) and Secondary Progressive MS (SPMS) with superimposed relapses.

Interferon Beta reduces the attack rate in M.S. patients and also improves disease severity measures and disease burden.

Interferons

Interferons are cytokines that exhibit antiviral activities, immunomodulating properties and antiproliferative properties.

DNA recombinant technology has made available highly purified a, (3 and y interferons.

IFNs are not available for oral administration but must be given intramuscularly, subcutaneously or intravenously.

Also Note :

Interferon is not curative for any tumor but can induce partial responses in (Harrison 16^th / 482)

Follicular lymphoma Hairy cell leukaemia CML

Melanoma

Kaposi’s sarcoma

IFN y has been successfully used in the treatment of Leprosy, Nontuberculous Mycobacteria and Visceral Leishmaniosis. – Harrison I6^th / 357

Ans. C: Spasticity

Baclofen have been tried for symptomatic treatment of spasticity in motor neuron disease

Baclofen

• It is an agonist for the GABAB receptors.
• Its beneficial effects in spasticity result from actions at spinal and supraspinal sites.
• Baclofen can also be used to treat hiccups
• A very beneficial property of baclofen is that tolerance does not seem to occur to any significant degree — baclofen retains its therapeutic anti-spasmodic effects even after many years of continued use.
• Baclofen is widely used for the treatment of spastic movement disorders, especially in instances of spinal cord injury, spastic diplegia cerebral palsy, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig’s disease), peripheral neuropathy and trigeminal and glossopharyngeal neuralgias
• The drug is rapidly absorbed after oral administration and is widely distributed throughout the body.
• Biotransformation is low and the drug is predominantly excreted in the unchanged form by the kidneys.
• Discontinuation of baclofen can be associated with a withdrawal syndrome which resembles benzodiazepine withdrawal and alcohol withdrawal.

Ans. is ‘a’ i.e., Multiple sclerosis

Treatment of multiple sclerosis

• Multiple sclerosis is an autommune disease characterized by chronic inflammatory demylination that affects the CNS.
• The most common course of the disease is the relapsing-remitting subtype, which is characterized by unpre­dictable acute attacks (relapses) followed by periods of relative remission with no new signs of disease activity. The other type (less common) is progressive subtype, which is characterized by a steady functional decline from disease onset.
• Therapy for MS can be divided into several categories:‑

1. Treatment of acute attack

• Corticosteroids (Methylprednisolone, prednisolone) are used

2. Treatment with disease-modifing agents that reduce the biological activity of MS

• Disease modifying agents for multiple sclerosis are (i) IFN-13 la; (ii) IFN-13 lb, (iii) Glatiramer; (iv) Natalizumab; (v) Finoglimod: (vi) Mitoxantrone; (vii) Cladaribine.

3. Other treatment options

• Other off-label treatment options are (i) methotrexate; (ii) cyclophosphamide; (iii) IV immunoglobulins; (iv) azathioprine.

4. Symptomatic Treatment

• It includes healthy diet, regualr exercise, and:

1. Treatment of rigidity (baclofen, diazepam, tizanidine, dantroline)
2. Treatment of weakness (Potassium channel blockers like 4-aminopyridine)
3. Treatment of pain by anticonvulsants (carbamezapine, phenytoin, gabapentin, pregabalin), or antidiepressants (mexiletin).
4. Treatment of UTI, bladder dysfunction, constipation, depression, fatigue and cognitive problems.

Ans. is ‘d’ i.e., TNF – a