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PD – Off-Period Dystonia — SCE Neurology MCQ

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HardMovement DisordersPD – Off-Period DystoniaSCE Neurology

A patient completed year 1 of cladribine for highly active relapsing MS. At the planned year-2 course, lymphocytes are 650 cells/mm3 and remain 720 cells/mm3 after a six-month delay. What is the authorised next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Do not give the year-2 cladribine course because recovery above 800 has taken longer than six months

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

B is correct: year 2 requires at least 800 lymphocytes/mm3; it may be delayed for up to six months, but if recovery takes longer the patient should not receive further cladribine tablets. A confuses monitoring thresholds with the treatment-entry threshold. C exceeds the maximum permitted delay and uses the wrong threshold. D and E invent unvalidated dose modifications. This is a stop rule, not an invitation to suppress toxicity with supportive drugs.

Reference: Mavenclad 10 mg tablets SmPC: https://www.medicines.org.uk/emc/product/8435/smpc