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Avoid exposure to sunlight without sunscreen as she is at increased risk of sunburning
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She should be on contraceptives if she is currently or will be sexually active, as this drug is teratogenic
She should be screened regularly for serum lipid abnormalities and glucose resistance
She is at increased risk of osteoporosis
She should increase the folate intake in her diet
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This patient's history of neurologic deficits separated by both time and space with a return to baseline in between is consistent with relapsing-remitting multiple sclerosis (RRMS). Interferon-beta, used in the treatment of RRMS, is a known teratogen and women should be started on contraceptives if prescribed this medication. Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system resulting in episodic neurologic dysfunction that often recovers. There are four major classes of MS: RRMS, secondary progressive MS, primary progressive MS, and benign MS. MS affects twice as many women as men. Saguil et al. report that symptom exacerbations are seen in approximately 85% of patients with MS. Corticosteroids are used in the acute setting to relieve symptoms. They note that disease-modifying agents should be initiated early in MS to delay disease progression and preserve function. Current immunomodulatory agents used include interferon beta and glatiramer, as well as five immunosuppressive agents, fingolimod, teriflunomide, dimethyl fumarate, natalizumab, and mitoxantrone. Goodin et al. in the American Academy of Neurology's report on disease-modifying therapies for MS, summarize the available evidence for IFN-beta in the treatment of RRMS. They assert that there is Class I evidence that treatment with IFN-beta delays the development of clinically definite MS by delaying the time between attacks 2 and 3 or between attacks 3 and 4. They caution though that studies do not show that early treatment affects long-term disability outcome. Incorrect Answers: Answer 1: Tetracyclines are a common cause of photosensitivity. Answer 3: Atypical antipsychotics are a common cause of lipid and glucose abnormalities. Answer 4: Long-term corticosteroid use is a common cause of drug-induced osteoporosis. Answer 5: Phenytoin is a common cause of folate deficiency.
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