Infectious diseases - Brucellosis, Lyme disease (c) Granulomatous disorders - Sarcoidosis, Wegner's granulomatosis. These disorders may be associated

Infectious diseases - Brucellosis, Lyme disease (c) Granulomatous disorders - Sarcoidosis, Wegner's granulomatosis. These disorders may be associated with oligoclonal bands in CSF and multifocal white matter lesions on Acute disseminated encephalomyelitis - usually preceded by viral illness produces widespread CNS disturbance with drowsiness or coma. (a) Compressive lesions, progressive spastic paraplegia (tumours and A-V malformations of the cord). (b) Tropical spastic paraparesis must be excluded by testing for antibodies to human T lymphocyte virus type 1. (c) Leber's optic neuropathy if severe, persistent visual loss Management: No effective curative treatment. I. TREATMENT MODIFYING TM COURSE OF DISEASE (a) Non-specific immunosuppressants - Short course of cyclophosphamide or continuous administration of azathioprine may prevent relapses. (b) Cytokines and cytokine inhibitors -interferon-1b 8 million units s.c. Side-effects - Flu-like symptoms particularly in first month, skin reactions. The drug has a number of immunological effects - as an antagonist of both production and action of interferon, down regulation of major histocompatibility complex class gene products and macrophage production of inflammatory mediators. 2. ACUTE RELAPSE - (a) Corticosteroids - Methyl prednisolone 500 mg day by slow infusion for 5 days or 1 g/day for 3 days. Response rapid and side-effects negligible. (b) ACTH - to shorten duration of acute relapse. 40 units ACTH gel b.d. for one week reducing the dose over next 2 weeks. 3. SYMPTOMATIC TREATMENT - (i) Spasticity - In severe spasticity, intrathecal baclofen. Local nerve block with botulinum toxin or phenol may also help. (ii) Tremor -Isoniazid 600-1200 mg/day with pyridoxine 10 mg/day, b-blockers, primidone. (iii) Paroxysmal symptoms (including trigeminal neuralgia, tonic seizures, paroxysmal dysarthria and ataxia) - Carbamazepine. (iv) Chronic dysaesthetic pain - Tricyclic antidepressants. (v) Urinary frequency and urgency - Oxybutynin (vi) Nocturia -Desmopressin. (vii) Fatigue - Amantadine, pemoline, calcium antagonists. 18. DEFICIENCY DISORDER OFa