A 37-year-old woman with a history of multiple sclerosis presents for follow-up. Since her previous visit 7 months ago, she has had a few episodes of monocular vision impairment and weakness and incoordination in her right upper extremity. Although these symptoms resolved completely, she reports that one episode of vision impairment 2 months ago was so severe that she was admitted to the hospital and received intravenous corticosteroids.
Which of the following is often used to decrease the frequency of relapse and slow the progression of this patient’s disorder?a. Methotrexate
Interferon-β. The patient in this question has multiple sclerosis (MS), specifically the relapsing–remitting form. Relapsing–remitting MS involves unpredictable attacks followed by periods of remission. Interferon-β has been shown to be effective in several clinical trials for the relapsing–remitting form of MS in that it decreases the frequency of relapse and reduces overall disability in patients. (A, D) Methotrexate and cyclosporine are immunosuppressive medications that are often used in the primary progressive form of MS. This type of MS is characterized by a steady decrease in disability without obvious remissions. In the progressive form of MS, these medications are helpful in stopping such a rapid course of the disease, but provide only temporary relief and have not been shown to offer long-term benefits. Other types of MS include secondary progressive in which an initial relapsing–remitting MS suddenly declines without periods of remission and progressive relapsing in which there is a steady decline after the onset of symptoms with superimposed attacks. (C) High-dose corticosteroids are the first line for acute attacks of all types of MS. They do not slow down the long-term progression of the disease.