From the Guidelines
The patient should continue her current MS treatment with Kesimpta, as it has shown to improve her mobility and overall condition, and no changes to her treatment regimen are recommended at this time. Despite a recent fall, the patient reports no new pain and has declined the offered X-rays, and her physical examination shows no bruising, and she can walk short distances independently. Her vital signs are stable, with her pain remaining at her baseline MS-related level rather than being associated with the fall. According to the most recent guidelines, such as those discussed in 1, the focus should be on preventing further disability and managing the disease progression, rather than immediately changing the treatment plan due to a single incident like a fall.
The patient's improved mobility and independence are key indicators of the effectiveness of her current treatment, and as noted in 2, the use of MRI to monitor disease progression is crucial, but in this case, the patient's clinical presentation and stable condition suggest that her current treatment is effective. Fall prevention strategies should be implemented, including home safety assessment, appropriate footwear, physical therapy for balance training, and possibly assistive devices for longer distances, as these can help prevent future falls and related injuries. Regular follow-up appointments should be scheduled to monitor her MS progression and medication effectiveness, and the patient should be advised to report any new symptoms promptly, especially if she experiences delayed pain or mobility changes following the fall, as MS patients may have altered pain perception due to demyelination affecting sensory pathways.
Key aspects of her care should include:
- Continuing Kesimpta as prescribed
- Implementing fall prevention strategies
- Regular follow-up appointments to monitor MS progression and medication effectiveness
- Patient education on reporting new symptoms or changes in condition As discussed in 1, the management of MS reactivation and the use of disease-modifying therapies (DMTs) like Kesimpta are critical, and the patient's current stable condition and improved mobility suggest that her treatment plan is effective, and therefore, no changes to her DMT are recommended at this time.
From the Research
Patient's Current Condition
The patient is a 37-year-old female with a history of Multiple Sclerosis (MS) who has recently experienced a fall. However, she reports no new pain from the fall and has declined imaging at this time.
Medication and Mobility
- She has been feeling much better since resuming her MS medication, Kesimpta (ofatumumab) 3, 4.
- Physical exam reveals no bruising, and she is able to ambulate short distances without assistance.
- Vital signs are stable with pain at her baseline level from MS, not related to the fall.
- She demonstrates improved mobility compared to previous visits and does not currently require wheelchair use.
Treatment Efficacy
- Studies have shown that ofatumumab is effective in reducing the annualized relapse rate, MRI-detected lesion activity, and limiting worsening of disability in adults with relapsing forms of MS 3, 4.
- Interventions aimed at increasing physical activity have been found to be efficacious in adults with MS, with behavioral interventions appearing to be more effective than exercise training alone 5.
- Synchronized telerehabilitation-based upper extremity training programs have been shown to improve hand-arm function, reduce fatigue, and increase quality of life in people with MS 6.
- Outdoor walking exercise therapy has been found to improve walking capacity and well-being in persons with MS 7.