Barts-MS rose-tinted-odometer ★★★
Using fiction to teach and learn about MS is what I am turning to more and more. An old-fashion case scenario is a powerful tool for illustrating the difficulties we have in clinical neurology. We can create a clinical problem that is not necessarily answered by trial data or reading the summary of product characteristics. This is where clinical acumen and reasoning by analogy are required to help make a decision relevant to that individual patient. The following is an example of a case I recently used. It was quite interesting that in a room of about 10 neurologists there was no obvious consensus to the questions posed by the case scenario.
Medical fiction – case scenario malignancy
A 47-year woman with active relapsing-remitting MS has recently failed on pegylated interferon-beta with a disabling spinal cord relapse and an MRI showing numerous new brain and spinal cord lesions. She had breast cancer diagnosed and successfully treated 7 years ago and has been told by her oncologist that she has no evident detectable disease (NEDD).
After researching the literature she is worried about going onto an immunosuppressive therapy, but realises she needs to be on treatment for her MS.
What would be the most suitable DMT in this situation?
How are we going to counsel her about the malignancy risk associated with each specific MS DMT?
Do you have an answer to these questions? Is there other information you would like before making a decision? Would you like to know my personal recommendation? Would you like more medical fiction on this blog?