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MS – Cladribine Dosing Schedule — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Cladribine Dosing ScheduleSCE Neurology

A 29-year-old with a pathogenic CACNA1A variant has hours-long attacks of ataxia, diplopia and vertigo triggered by exertion. She has no epilepsy or renal-stone history. Which preventive plan best reflects UK specialist practice?

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Reveal the answer and explanation

Correct answer: C — Use acetazolamide with hydration, renal-stone counselling and periodic ultrasound surveillance

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

A is not the established EA2 preventive strategy and fluid restriction is counterproductive. B mistakes a genetic channelopathy for immune disease. C is wrong because flunarizine is not the licensed UK first-line treatment. D omits that 4-aminopyridine is unlicensed for EA2 in the UK and should be avoided in people with seizures. E is correct: acetazolamide remains the mainstay; paraesthesia is common, renal calculi require counselling, good hydration and periodic urinary-tract surveillance. Alternative therapies are specialist choices when acetazolamide fails or is unsuitable.

Reference: Diagnosis and management of progressive ataxia in adults: https://pn.bmj.com/content/19/3/196