Multiple Sclerosis

[ronakmodi1111]

Name : Brijesh Modi
Age : 19 Years

2006-2007 - Completed his HSC with 61%. He was totally alright.

2007-2008 – Some symptoms which started from here:

 Problem of concentration
 Memorising things
 2 to 3 Degree Fever every month, for 1 Year
 Frequent Headaches
 Severe Back Pain

Jan 2008 – Some Symptoms during this month

 Forgetfulness
 No concentration and problem in remembering things

17th January to 21st Jan 2008 – Very High Fever & Extreme Weakness
– Admitted to Hospital. Diagnosis: Viral Fever

20th April 2008 – Vomitting: 3 to 4 times

23rd April 2008 – Consulted Neurologist & Took C.T.Scan & MRI

MRI Findings: The MR scan reveals Multiple Modular Lesions in Bilateral Cerebral, Cerebellar lobes & Brainstem as described above, likely to represent Demyelinating Plaques. Possibilities include, Multiple Sclerosis & Post viral Demyelination. Further evaluation as clinically indicated is recommended.


25th April to 6th May 2008 – Admitted to Hospital
– Final Diagnosis : Demylinating Disease
– Treatment : Methyl Prednisolone 1 gm for 5 days

Positive results after the hospital Treatment were No Headache and Back pain

Medicines continued after the hospital treatment

- Triptol 300
- Prednisolone 40/30/20mg
- Ecosprin 75

Effects of Treatment were like, if the Prednisolone 40 mg is changed to lesser dose then he has problem.

Alternative Medicines tried are Homeopathy & Acupuncture.

Some symptoms since July 2008

- Urination during day time (3 to 4 time a day)
- Problem in speaking
- Cant recognize things, cant see time properly, colors.
- Cant read and write, cant recognize words clearly.
- Doesn’t like to watch television

11 September 2008 – Took MRI
Conclusion : In this known case of demylinating disease, there are diffuse & focal resolving and minimal acute changes in the white matter as described above .

October 2008 – Same symptoms as since July, But Urination stopped during night. But for few days urination at day time in bed happened & also continuous spit falling from the mouth. Most importantly at this stage he doesn’t communicate at all.


Suggested treatment Options
We have been suggested Plasmapheresis and Immunoglobulin. Requesting your view on the following:
1. What exactly Plasmapheresis and/or Immunoglobulin?
2. What are the obvious side effects of Plasmapheresis and/or Immunoglobulin?
3. What are the probable side effects of Plasmapheresis and/or Immunoglobulin? (which may or may not occur)
4. What are the plus points of Plasmapheresis and/or Immunoglobulin over any other prevalent medication options?
5. What is the on-going treatment after having the Plasmapheresis and/or Immunoglobulin done?
a. What is the on-going treatment?
b. What is the cost of such treatment?
c. What is the frequency?
d. What are the obvious and non-obvious side-effects?
6. For how long the good effect of Plasmapheresis and/or Immunoglobulin last?
7. What are the long-term and short-term side-effects/good-effects?

COMPARISON
1. Which should be a preferred treatment:
a. on side-effect basis
b. on post-treatment basis
c. on cost basis
d. on logitivity of post-treatment good health
2. in either of the treatments, if dialysis is required then what would be its frequency and cost? and how critical would it be? What are the ill-effects if we fail to do on the stipulated date?
3. Is there any way we can have a combination of plasma and immune?
a. can it be done from beginning or after reaching a particular stage of treatment in either of the options? (we can go for immune initially and after certain time, we can do the follow-up medication as in the case of plasma)