| Identifier |
MS_FollowUp_1080p |
| Title |
Multiple Sclerosis Follow Up |
| Creator |
Andrew G. Lee, MD; Christine Tang |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (CT) Baylor College of Medicine, Houston, Texas |
| Subject |
Multiple Sclerosis; Fingolimod; FAME |
| Description |
Dr. Lee lectures medical students on the subject of following up on with a patient with multiple sclerosis. |
| Transcript |
All right, what I'd like to talk to you about is some patients with MS are beings followed by you, and in the follow-up period normally what we're looking for is the normal things on the afferent and efferent side for optic neuritis, which is the most common cause of afferent disease in multiple sclerosis. And on the efferent side we're going to be looking for INO and diplopia from vesicular Six, or horizontal gaze palsies things that involve the central nervous system on the efferent side or nystagmus. So this is the normal evaluation for an MS patient coming to see me is I'm going to do a visual field. I'm going to swing the flashlight, look for the pupillary defect. I'm going to check their vision and their color vision. We're going to do an OCT. This is the normal evaluation. We're going to do a motility examination to make sure they don't have nystagmus, INO or 6 or diplopia. The normal MS follow-up patient. However, you should know that sometimes we are being asked not to look at the disease but at the treatment of the disease, and know about in MS patients is a drug called Fingolimod which goes by the trade name Gilenya. This drug is aS1Psphingosine 1-phosphateinhibitor that reduces lymphocyte trafficking and reduces the inflammatory response of multiple sclerosis by blocking cell signaling mechanisms. Sphingosine, as you know from other videos, is a core molecule, however and that sphingosine is involved in other activities including endothelial cells and structural. It's a structural protein that's in the glycoprotein family from which myelin is derived, and neurotransmitters and other things are derived from sphingosine. So the thing you need to know about with Gilenya is FAME: "Fingolimod associated macular edema. "So we do a baseline evaluation and you're going to be doing something that you normally would not do on an MS patient you normally would not be doing: a spectral domain OCT of the macula. But in patients who are on this particular agent, we are going to do that and three to six months later you're going to repeat this study to make sure that they do not develop FAME: "Fingolimod associated macular edema." It otherwise looks like macular edema and as opposed to the other forms of macular edema where there's vasculopathy like diabetes or hypertension or something wrong with the blood retinal barrier, these people have localized disruption in the macula, They don't really have any other retinal vascular abnormalities. There's no hemorrhages, it just looks like macular edema but it's medication induced. So you need to look for FAME in patients who are on Fingolimod in MS and that means doing a little bit different, a little bit of extra work on the frontend. And if they complain about vision loss and they're on this agent you need to do a macular exam and a macular OCT to make sure that the vision loss isn't from FAME. Otherwise you're going to think that it's afferent optic neuritis for multiple sclerosis and that is the disease and not the treatment of the disease, and you need to be looking for the side effect of the treatment of the disease. |
| Date |
2021-06 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6bc9z80 |
| Setname |
ehsl_novel_lee |
| ID |
1701573 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6bc9z80 |
