CLINICAL CASE 01 2019 Multiple sclerosis Clinical Case TABLE OF CONTENTS 2 01 04 02 03 ABOUT THE PATIENT Demographics, medical psych history Description of recommendations and treatments DISCUSSION. nvuaigfuywbvjsdedzbzewhbdsnbsdeheszgdvbsehewhzherhjredfsh
Clinical Case Multiple sclerosis TABLE OF CONTENTS 01 ABOUT THE PATIENT DIAGNOSIS Demographics, medical & psych history DISCUSSION Summary and impression 02 Neuropsych assessment resul ts and observations 03 TREATMENT 04 Description of recommendation s and treatments TEAM Lauren Dalokay Extern, neuropsych evaluation Dr Tehila EilamStock Supervisor of neuropsychology case Maureen Sessa Extern, Cognitive Behavior Therapy INTRODUCTION Referral reason A 33-year-old, righthanded, Asian American woman referred by neurologist for an evaluation due to reported cognitive difficulties, in the context of relapsing-remitting multiple sclerosis (MS) diagnosed in 2019. IDENTIFYING INFORMATION Background: 33 y/o female, Raised in NY, speaks, Gujarati and English, Lives alone, no children Good social support Education: Bachelor’s degree in nursing (BSN); took Adderall when studying for her college and board exams, with benefit Occupation: OR nurse at a private practice for plastic surgery PATIENT MEDICAL & PSYCH HISTORY Onset of numbness and tingling in her right hand, Dx with CIS 2018 Depression & anxiety following her brothers death; passive SI Current Medications:: include venlafaxine (75 mg), and vitamin D3 Other Hx: High cholesterol Neuroimaging study showed disease progression, diagnosed with MS 2019 She was arrested for DWAI Trials of Zoloft and psychotherapy Discontinued DMT: difficulty accepting her diagnosis and concerns of medication sideeffects; 20202021 Numbness, tingling, and weakness in her right hand, intermittent pain and tingling in her right leg (from foot to knee), and fatigue 2022 Discontinued meds and therapy due to the COVID-19 pandemic’s social restrictions Recently started cognitive behavioral therapy (CBT) at Burke and COGNITIVE & MOOD COMPLAINTS Fluctuating changes over past 1-2 years: ◂ Attention and concentration (e.g., not being able to follow content of books, losing track of television show plots, misplacing objects) ◂ Memory (e.g., difficulty recalling details of conversations, repeating questions ◂ Slow processing speed and executive dysfunction (decision making) ◂ Occasionally forgets to take medications ◂ Significant levels of depression with features of anxiety ◂ Marked by sadness, anhedonia, frequent crying ◂ Poor appetite (with no significant weight loss), ◂ Disturbed sleep ◂ Irritability ◂ Smokes marijuana nightly for anxiety management ◂ Drinks 2-3 glasses of wine once a week (increased use in past) IMAGING RESULTS Neuroimaging: Brain MRI on 8/8/22 showed multiple white mater lesions in the periventricular and collasoseptal areas, Spine MRI on 8/8/22 and 8/23/22 showed stable demyelinating lesions at levels C2, C3, C6, C7, T3, T11, and T12, FINDINGS: GENERAL INTELLECTUAL FUNCTIONING Attention and Processing Speed Executive Functioning 1 LEARNING AND MEMORY VISUOSPATIAL/VISUOM OTOR DISCUSSION SUMMARY Mild to moderate impairment in processing speed, executive functions, and visual learning, suggesting frontal-subcortical dysfunction In addition, variability in performance across tasks suggest difficulty maintaining cognitive stamina and focus. Significant levels of emotional distress, alcohol and cannabis use, poor sleep, and fatigue, are likely further exacerbating her daily cognitive functioning. Finally, reported history of developmentally-based attention and learning difficulties, as well as slowed processing speed since childhood; these premorbid vulnerabilities may have been worsened by MS TREATMENT & Recommendations 1. MS treatment and management, adherence to medications 2. Workplace accommodations for individuals with MS 3. Psychotherapy, she has started a course of CBT at Burke Dialectical behavior therapy (DBT) is also recommended 4. Limiting alcohol and cannabis use 5. occupational therapy referral is recommended for fine motor rehabilitation Driving evaluation through the occupational therapy department 7. Lifestyle and behavioral recommendations Follow-up neuropsychological evaluation is recommended in 12-18 months THANKS Does anyone have any questions? ldalokay@burke.org ... Lauren Dalokay Extern, neuropsych evaluation Dr Tehila EilamStock Supervisor of neuropsychology case Maureen Sessa Extern, Cognitive Behavior Therapy INTRODUCTION Referral reason A 33-year-old,