1) Welcome to a new joint-accredited #tweetorial on Strategies for Symptom Management and Quality of Life for Patients with MS. I am @DrJNicholas. Follow this tweetorial to earn FREE 0.5h credit, #physicians #nurses #pharmacists! #MStwitter #neurotwitter @GavinGiovannoni pic.twitter.com/7JSZ5fLwf7
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
3) Let's start with a poll. The most common symptom experienced by individuals with #MS is:
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
5) Fatigue is multifactorial in etiology in MS and the following tool can help in assessing and managing patients with MS: pic.twitter.com/lvabUve5h0
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
7) The interested learner is referred for these full-text 🔓studies to a) Ciampi et al at https://t.co/462vsBgEzV
b) Klevan et al at https://t.co/gz5K8HzQ9b,
c) Kratz et al at https://t.co/c7AIVJMie2, and d) Samartzis et al athttps://t.co/LWOHlLXAyt— MultipleSclerosis_CME (@ms_cme) September 7, 2021
8) The interested learner is referred for these full-text 🔓studies to a) Ciampi et al at https://t.co/PebUJh8WBg, b) Hyncicova et al at https://t.co/w57FD6UkpL, and c) Carletto et al at https://t.co/G64529dyYs.
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
10) In the treatment of sexual dysfunction, it is key to address MS symptoms such as mood, fatigue, spasticity, dysesthesia, pain, bowel & bladder dysfunction & consider side effects of meds. Domingo et al. Int Journal MS Care 2018; Namey M. Int Journal MS Care 2012;14 Suppl 1 pic.twitter.com/CXQLyeigFT
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
12) . . . and pharmacologic agents for female hypoactive sexual desire disorder such as flibanserin or the Eros Device can be considered. Domingo et al. Int Journal MS Care 2018; Namey M. Int Journal MS Care 2012;14
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
14) So . . . a polling question:#Spasticity, a velocity dependent increase in muscle tone, is common in #MS. Spasticity occurs when there is damage to which of the following:
— MultipleSclerosis_CME (@ms_cme) September 7, 2021
16) Welcome back! I am @DrJNicholas and we are continuing our discussion on Strategies for Symptom Management and Quality of Life for Patients with #MultipleSclerosis. You are just a few clicks away from 0.5h CE/#CME, here at your home for accredited #tweetorials on #MS care!
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
18) See Pandvan AD et al. Disabil Rehabil 2005; Miligan J et al. Can Fam Physician 2019. The image shows the muscle contraction pathway. pic.twitter.com/J5r3e4SgHy
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
20) Spasticity also has many disadvantages in #MS: Pain, Increased risk of pressure ulcers, weight loss (caloric expenditure), orthopedic deformity (contractures), sleep disturbance, impairment of ADLs (dressing, bathing, toileting) to name a few.
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
22) So let's check out more on your knowledge of spasticity. Infections (like UTIs), pain, cold temperature, and changes in position can be expected to:
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
24) Spasticity treatments include stretching, physical therapy, adequate hydration, oral antispasmodics, botulinum toxin injections, intrathecal baclofen. See Rae-Grant A. et al. Mult Scler and Rel Disorders. Demos Medical Pub 2013.
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
26) The SAVANT study, evaluated the efficacy of nabiximols, a THC:CBD oral mucosal spray as add-on therapy to optimized standard antispasticity treatment in patients with moderate to severe multiple sclerosis (MS) spasticity. pic.twitter.com/04XFzd6cRc
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
28) Due to decreased neural input to the bowels, constipation is a common symptom of bowel dysfunction in MS. In addition to increasing fiber intake, recommendations for managing constipation in MS include:
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
30) See Newsome S. Int J MS Care 2017;19:42-56; Namey M. Int J MS Care 2012;14 Suppl 1 for more on this topic.
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
32) The CMSC Consensus Panel also released an algorithm to help clinicians in the management of constipation with bowel incontinence in those who are mobile vs. immobile: (Namey M, Halper J. Int J MS Care. 2011;14(Suppl 1):1-26) pic.twitter.com/p41SoWgleZ
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
34) Detrusor muscle overactivity (storage dysfunction) occurs in 60-80% with MS bladder dysfunction. Low urine volumes trigger inappropriate bladder contraction often leading to urgency, frequency, urge incontinence and nocturia. pic.twitter.com/AmJDSEZYwx
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
36) . . . bladder neurostimulator use and posterior tibial nerve stimulation (PTNS) have all been shown to help with #MS storage dysfunction. See Namey M. Int J MS Care. 2012;14 Suppl 1.
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
38) Bladder Emptying Dysfunction in #MS can be improved with timed voids, pelvic floor therapy, bladder stimulator use, intermittent and/or permanent catheterization and with the use of alpha blockers such as tamsulosin (see Namey M. Int J MS Care. 2012;14 Suppl 1).
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
40) This leads to difficulty initiating urination, double voids and incomplete emptying (see Namey M. Int J MS Care. 2012;14 Suppl 1).
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
42) So we set out to discuss strategies for symptom management and #QoL for patients with #MS. We've talked about the evaluation of and treatment approaches to a litany of issues that impact our MS patients, including fatigue, depression, anxiety, sexual dysfunction, . . .
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
44) We'll do our job here at @ms_cme and keep providing excellent CE/#CME from world-renowned expert faculty in the #MS space. So if you aren't doing so already, follow us NOW so you don't miss any content. For now, you have completed this #tweetorial, and you can go . . .
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
45) . . . claim your credit! Go to https://t.co/DXbkrfXdPO and after answering a handful of questions, your certificate will be ready to download/print! I am @DrJNicholas and program chair @SKriegerMD and I are honored that you have joined us for this program!
— MultipleSclerosis_CME (@ms_cme) September 8, 2021
