• Multiple Sclerosis: 2010 McDonald Diagnostic Criteria 
  • Dissemination in space is demonstrated with MRI by one or more T2 lesions in at least two of four MS-typical regions of the central nervous system (periventricular, juxtacortical, infratentorial, or spinal cord) or by the development of a further clinical attack implicating a different CNS site. CSF profile no longer included.
  • Dissemination in time is demonstrated with MRI by the simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time, or a new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan, or by the development of a second clinical attack.
  
  
  MRI with contrast: Will see hyperintense lesions (new) and hypontense lesions (old). Old lesions on T1 imaging will appear as black holes. 
  
  

  Posted 01/26/17 11:13:54 AM by Adam Faye

• Multiple Sclerosis:
  • Relapsing Remitting - Intermittent exacerbations (most convert to secondary progressive)
  • Primary Progressive - Progressive disability without clear exacerbations
  • Secondary Progressive - Progressive disability after years of relapsing/remitting  
  
  
  Prognostic Markers: 
  -- Primary Progressive – more rapid disease progression
  -- Men progressed more quickly but outcomes not affected
  -- Type of symptoms at onset did not predict disease progression
  
  Primary Care Needs;
  • Ensure adequate Physical Therapy
  • Current evidence suggests it's safe to give influenza vaccination
  • Smoking cessation- Increases risk of secondary progressions
  
  

  Posted 01/26/17 11:22:14 AM by Adam Faye

• Acute MS Exacerbations:
  • Corticosteroids or ACTH (Cochrane Review)
    • Compared with placebo, patients treated with ACTH or methylpred had a significant reduction in the risk of worsening/not improving within 5 weeks from randomization.
    • One study looking at low-dose PO steroids found increased risk of recurrence in optic neuritis
  
  

  Posted 01/26/17 11:26:45 AM by Adam Faye

• Ocrelizumab for MS:
  • Ocrelizumab- Recombinant anti-CD20 (binds to different etiope than Rituximab) 
  • Relapsing Remitting NEJM Study: 
    • •600mg q24 weeks Ocrelizumab vs. Subq interferon beta-1a at a dose of 44ugtiw for 96 weeks
      •Annual Relapse Rate: 0.16 (Ocrelizumab) vs. 0.29 (Interferon)
      •Lower rates of disease activity and progression over a period of 96 weeks 
  
  
  • Primary Progressive NEJM Study
    • 730 patients with Primary Progressive MS
    • 600mg q24 weeks Ocrelizumab vs. Placebo --> Primary End Point- % of patients with disability progression
    • 32.9% in treatment arm vs. 39.3% placebo (lower rates of clinical/MRI progression)
    • Week 12: 25 foot walk test worsened 38.9% in treatment vs. 55.1% in placebo
  
  

  Posted 01/26/17 11:31:32 AM by Adam Faye

Created by Christopher Kelly

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