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Case Study #21: Multiple Sclerosis



Sharon James | 28 years old


Chief Complaint: Sharon presents with fatigue, weakness, and difficulty in coordination.


Medical History:

  • Family history of multiple sclerosis (MS)

  • No other significant medical history reported


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Nurse's Note: Sharon reports feeling fatigued and weak, with difficulty in coordination over the past few weeks. She mentions a family history of MS. Neurological assessment reveals mild ataxia and decreased muscle strength in lower extremities.


Vital Signs:

  • Blood pressure: 120/80 mmHg

  • Heart rate: 75 bpm

  • Respiratory rate: 16 breaths/min

  • Temperature: 98.6°F (37°C)


Provider Orders:

  • Perform neurological assessment.

  • Order MRI of the brain and spinal cord.

  • Start empirical treatment for fatigue with amantadine 100 mg orally twice daily.

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Question 1: What are the common presenting symptoms of multiple sclerosis (MS)?


Question 2: Why is vitamin D supplementation prescribed in patients with MS?


Question 3: What is the rationale behind initiating treatment with interferon beta-1a (Rebif)?

Answers to Questions Below




Answers

Question 1: What are the common presenting symptoms of multiple sclerosis (MS)?

Common symptoms include fatigue, weakness, difficulty in coordination, sensory disturbances (such as numbness and tingling), visual disturbances, and bladder dysfunction.


Question 2: Why is vitamin D supplementation prescribed in patients with MS?

Vitamin D supplementation is often prescribed because there is evidence to suggest that low levels of vitamin D may be associated with an increased risk of developing MS and may also contribute to disease progression. Additionally, optimizing vitamin D levels may help modulate the immune response and reduce disease activity.


Question 3: What is the rationale behind initiating treatment with interferon beta-1a (Rebif)?

Interferon beta-1a is a disease-modifying therapy used to reduce the frequency and severity of relapses in relapsing forms of MS. It helps modulate the immune response and reduces inflammation in the central nervous system, thereby slowing disease progression and reducing the formation of new lesions.



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