Diffuse Sclerosis Follow-up
- Author: Robert Stanley Rust, Jr, MD, MA; Chief Editor: Niranjan N Singh, MD, DM more...
Further Inpatient Care
The approach to inpatient management is as is indicated in Treatment.
Inpatient & Outpatient Medications
See the list below:
- Patients who have received intravenous methylprednisolone should generally receive oral methylprednisolone for a period of 6 weeks, during which time they are tapered from an initial daily dose to every-other-day doses over 3 weeks and then the remaining alternate-day dose is tapered over the ensuing 3 weeks. The initial dose is 2 mg/kg/d or a maximum daily dose of 60-80 mg/kg/d. This taper may be prolonged as needed for patients who demonstrate recurrence of such symptoms and signs of illness as may have resolved during intravenous treatment. The enteral doses may be administered by nasogastric tube or other feeding tubes if the neurologic condition of the patient does not permit the doses to be swallowed. Coadministration of antacids or of histamine (H2) blockers is prudent during the entire course of corticosteroid therapy.
- Patients must be monitored for such possible complications of corticosteroid therapy as hypertension, gastrointestinal hemorrhage, hypokalemia, hyperglycemia, and opportunistic infection.
No known method of prevention or deterrence exists.
Complications include cerebral herniation, inexorable progression of disease to death, development of pneumonia, sepsis, pulmonary embolization, skin breakdown and ulceration in individuals who are moribund, and the various complications due to corticosteroid administration noted above.
See the list below:
- Prognosis depends upon definition of illness. In the current state of knowledge, determining the duration of disease, rate of progression, and outcome from the strictly defined category of diffuse sclerosis (Schilder disease 1912 type) that includes approximately 9 cases is impossible. This is also true because potentially valuable therapies such as intravenous high-dose corticosteroids have not been subjected to carefully designed trials in these cases.
- In those individuals who have been reported as having Schilder disease but whom Poser has placed into the category of transitional sclerosis, the outlook derived from 70 cases Poser reported in 1957 demonstrated mean duration of survival to be 6.2 years after onset (range 3 d to 45 y). Disease duration was less than 1 year in as many as 40% of cases, but survival times of at least 10 years were experienced in more than 23%. These cases are in all likelihood examples of an often aggressive form of multiple sclerosis, hence the survival of these individuals tends on average to be shorter than that experienced by most individuals with multiple sclerosis.
- In those prepubertal cases with a good response to intravenous corticosteroids, and particularly those who are found to have smaller lesions in locations typical for acute disseminated encephalomyelitis (eg, cortical ribbon, deep gray nuclei, thalamus), a better prognosis may be found in some cases. Information concerning this group and the potential of corticosteroids for remediation of illness is limited. The authors have encountered a small number of patients with large lesions who have had recurrent bouts of illness that have proven difficult to prevent and for whom, despite survival times for as long as 5 years without many cumulative deficits, the prognosis remains guarded.
For excellent patient education resources, see eMedicineHealth's patient education article, Multiple Sclerosis.
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