Decision Tree for Neurological and Musculoskeletal Disorders

 

Week 6: Decision Tree for Neurological and Musculoskeletal Disorders

Student’s Name
Institution
Course
Lecturer’s Name
Date

 

 

 

 

 

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Multiple sclerosis (MS) is a nervous system disorder affecting the spinal cord and the brain. The myelin sheath is normally destroyed in people diagnosed with MS, slowing down or blocking messages between the body and the brain leading to the associated symptoms. Most people normally start displaying symptoms between the ages of 20 and 40 years (Ferraro et al., 2018). Such symptoms include muscle weakness, visual disturbances, coordination, and balance problems, numbness, and memory problems among others. However, with appropriate treatment patients’ quality of life and well-being can be improved. The purpose of this paper is to demonstrate appropriate decision-making in selecting the most effective medication for the treatment of a 26-year-old with multiple sclerosis.
Summarize the Patient Case Study
The patient in the provided case study is a 26-year-old female with a diagnosis of multiple sclerosis. She was scheduled for a follow-up appointment with her physician but is still concerned about more knowledge about her MS diagnosis. She also needs to be informed concerning the impact of the disorder on her neurologic and musculoskeletal system in addition to the specific drug therapy plans on which she can decide.
Treatment Decisions
From the available option, the best medication to consider for initial therapy for the patient is 25mg Amitriptyline orally at bedtime. Based on the patient outcome, the drug can be titrated upwards at intervals of 25mg per week, not exceeding 200mg per day. Amitriptyline is a tricyclic antidepressant that has proven to be effective in the management of painful parenthesis in the legs and arms among MS patients (Rae-Grant et al., 2018). The second intervention was to continue with the same medication and increase the dose to 125mg at bedtime given that the patient displayed a minimal reduction of symptoms but great tolerance to the medication. The last intervention was to continue the same drug and dose, 125mg amitryptiline at bedtime, and advise the patient to see a life coach for counseling on good dietary habits and exercise (Mésidor et al., 2021). This decision was based on the great effectiveness displayed by the drug in the management of the patient’s symptoms, with weight gain as the only side effect.
Expected Outcome
With the use of Amitriptyline 25mg once daily, the patient was expected to display at least 50% remission of symptoms, with common side effects such as nausea, vomiting, headache, and dry mouth (Stankiewicz & Weiner, 2020). These side effects were however expected to diminish with time as the patient continues taking the drug. The dose was expected to be titrated upwards at the rate of 25 mg per week to an optimal dose with complete remission of the patient’s symptoms within 8 to 12 weeks.
Difference Between Expected and Actual Outcome
The patient displayed great effectiveness with the medication just as expected. Her pain level reduced gradually with an increased dose with the optimum dose attained at 125mg orally at bedtime (Stamoula et al., 2021). However, she displayed significant weight gain which was not expected. As such, it was necessary to introduce a life coach to help with lifestyle modification that will help the patient maintain healthy body weight.
Conclusion
Multiple sclerosis is a disabling neurological and musculoskeletal disorder that can be managed by the use of several medications. For the 26-year-old patient in the provided case study, the use of 125mg amitriptyline once daily displayed great effectiveness in the management of the MS symptoms.

References
Ferraro, D., Plantone, D., Morselli, F., Dallari, G., Simone, A. M., Vitetta, F., … & Vollono, C. (2018). Systematic assessment and characterization of chronic pain in multiple sclerosis patients. Neurological Sciences, 39(3), 445-453. https://doi.org/10.1007/s10072-017-3217-x
Mésidor, M., Rousseau, M. C., Duquette, P., & Sylvestre, M. P. (2021). Classification and visualization of longitudinal patterns of medication dose: An application to interferon‐beta‐1a and amitriptyline in patients with multiple sclerosis. Pharmacoepidemiology and drug safety, 30(9), 1214-1223. https://doi.org/10.1002/pds.5297
Rae-Grant, A., Day, G. S., Marrie, R. A., Rabinstein, A., Cree, B. A., Gronseth, G. S., … & Pringsheim, T. (2018). Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 90(17), 777-788. https://doi.org/10.1212/WNL.0000000000005347
Stamoula, E., Siafis, S., Dardalas, I., Ainatzoglou, A., Matsas, A., Athanasiadis, T., … & Papazisis, G. (2021). Antidepressants on multiple sclerosis: a review of in vitro and in vivo models. Frontiers in Immunology, 12. DOI: 10.3389/fimmu.2021.677879
Stankiewicz, J. M., & Weiner, H. L. (2020). An argument for broad use of high efficacy treatments in early multiple sclerosis. Neurology-Neuroimmunology Neuroinflammation, 7(1). https://doi.org/10.1212/NXI.0000000000000636