Emergency Department (ED) management of Multiple Sclerosis (MS) includes two components:
(1)immunomodulatory therapy for the underlying immune disorder, often with high dose
intravenous (IV) steroids which speeds recovery, and
(2) management of symptoms through supportive measures and amelioration of risk factors
associated with precipitating acute exacerbations such as infection through aggressive use
of antibiotics. Treatment of fever with antipyretics also key as even small increases in
temperature can significantly affect conduction through partially demyelinated fibers.
In patients withfulminant MS or disseminating acute encephalitis, management includes the following:
--- Stabilize acute life-threatening conditions
--- Initiate supportive care and seizure precautions
--- Monitor for increasing intracranial pressure
--- Consider emergent plasmapheresis. (may be superior to IV steroids in severe cases. 2011
AANplasmapheresis guideline update reflects this assertion.)
References
AAN Guideline: Plasma Exchange Effective in Treating Severe MS Relapses, Neuropathies. American Academy of Neurology. January 2011. Retrieved from: http://www.aan.com/press/index.cfm?fuseaction=release.view&release=893.
