How to manage norovirus infection with MS?

Question

Hello doctor,

I am a 36-year-old female having norovirus during multiple sclerosis treatment. Ocrevus is due next week. Should we delay? Cannot keep Tecfidera down and experiencing new symptoms. Which is causing this? Fever of 102.1°F and worsened balance. Is this an MS flare or a virus? How long can we skip medications? Is this triggering a relapse?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood it.

Norovirus infection and multiple sclerosis treatment:

Delay Ocrevus (Ocrelizumab) administration: It is recommended that the Ocrevus infusion be postponed until the norovirus infection has resolved. This will help minimize potential risks and ensure the patient is in optimal condition for treatment.
Tecfidera intolerance: The patient's inability to tolerate Tecfidera (Dimethyl Fumarate), combined with new symptoms, warrants further evaluation. Consider alternative disease-modifying therapies (DMTs) for multiple sclerosis (MS).

Differentiating MS flare from norovirus:
1. Fever and balance issues: The patient's fever (102.1°Ferenheight) and worsening balance could be attributed to either the norovirus infection or an MS flare.
2. Clinical evaluation: A thorough clinical assessment is necessary to determine the cause of the new symptoms. Consider consulting an infectious disease specialist and/or a neurologist for guidance.
  
  Impact of skipping medications:
  1. Short-term discontinuation: Temporarily skipping MS medications, such as Tecfidera, is unlikely to trigger a relapse. However, prolonged discontinuation may increase the risk of disease activity.
    
    I hope this has helped you.
    
    Kindly follow up if you have more doubts.
    
    Thank you.