PPT clinical case 20221222

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

Multiple sclerosis

Clinical Case

TABLE OF

CONTENTS

2

01

04 02

03 ABOUT THE PATIENT

Demographics, medical & psych history

Description of recommendation

s and treatments

DISCUSSION

Neuropsych assessment resul

ts and observations

TREATMENT

Summary and impression

DIAGNOSIS

Extern, neuropsych

evaluation 

Supervisor of

neuropsychology

case

Extern, Cognitive

Behavior Therapy

Dr

Tehila Eilam-Stock

Maureen Sessa

Lauren Dalokay

TEAM

Referral reason

A 33-year-old, right-handed, 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. 

4 INTRODUCTION

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

5 IDENTIFYING

INFORMATION

Current Medications::

include venlafaxine (75 mg), and vitamin D3

Other Hx: High cholesterol

Onset of numbness

and tingling in her

right hand, Dx with

CIS

Discontinued DMT:

difficulty accepting her diagnosis and concerns of

medication side-effects;

Numbness, tingling, and weakness in her right hand, intermittent pain and tingling in her right leg (from foot to knee), and fatigue

6

PATIENT MEDICAL &

PSYCH HISTORY

Neuroimaging study showed disease

progression, diagnosed with MS

2018

Depression &

anxiety following

her brothers

death; passive SI

She was arrested for DWAI.

Trials of Zoloft and

psychotherapy

Discontinued meds and therapy due to the COVID-19

pandemic’s social restrictions

Recently started cognitive behavioral therapy (CBT)

at Burke and Effexor.

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)

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,

IMAGING

RESULTS

FINDINGS: GENERAL

INTELLECTUAL

FUNCTIONING

1 0 Attention and

Processing Speed

1 1 Executive Functioning

1 2

LEARNING

AND

MEMORY

1 3 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

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

6 Driving evaluation through the occupational therapy department 

7. Lifestyle and behavioral recommendations

8 Follow-up neuropsychological evaluation is

5

TREATMENT &

Recommendations

1 6

THANKS

Does anyone have any

questions?

ldalokay@burke.org