COPY FOR AUTO TRANSLATION
The blood work revealed no diagnostic abnormalities. That leaves us with the possibility of the trial of intravenous methylprednisolone therapy as we had discussed in the office. This is something that could be done in Charlotte with the involvement of his physician. Specifically, we would be using this trial as not simply therapy but for diagnostic purposes. To accomplish that, a limited neurologic examination is appropriate prior to starting treatment to establish a baseline. At a minimum, standing and taking a few steps would be a good reference point since the imbalance was rather striking. This would be followed by five consecutive days of 1000 mg of intravenously administered methylprednisolone. It typically is administered over 90 minutes. At the end of the five days the exam is then repeated. If there is meaningful benefit and more than can be expected by chance or placebo effect, that would be interpreted as possible evidence of an autoinmune condition. In that case, I would like to be back in the loop to learn how things have gone, and I would then be happy to advise what to do beyond that. If there was rather striking improvement, the usual strategy we have done here is to continue the intravenous methylprednisolone once a week to complete 6 to 12 weeks of treatment. Beyond that, a decision must then be made how to extend immunosuppression but with modalities other than methylprednisolone. In that, case, I would then considerar involving colleagues from our Neuroimmunology group. I also advised a brief videotape of the before and after results in case we need to have objetive evidence of the degree of improvement.
