RESUMO
INTRODUCTION/IMPORTANCE: Pharmacotherapy for multiple sclerosis has increased significantly since 1993 when the first disease modifying therapy was approved. The expansion of therapies has been accompanied with differences in adverse effect profiles, efficacy, and cost. The most recent therapies pose the challenge of balancing these issues while providing optimal care. OBSERVATIONS: Several measures such as generic conversion and standardization of therapies can be employed to control costs of therapy. The safety and efficacy of these agents can be monitored by implementation of criteria for use and/or medication utilization evaluations. CONCLUSIONS: A formulary management system encompasses methodologies to evaluate the relevant clinical and medical literature and includes a systematic approach for selecting medications for different diseases, conditions, and patients. Formulary systems often contain prescribing guidelines and clinical recommendations that assist health care professionals with providing high quality, value-based care for patients.
RESUMO
This was a study of a 33-year-old man with bipolar disorder treated with lithium who developed cerebellar atrophy after an event of extreme hyperthermia. Unlike previously reported cases of acute cerebellar atrophy after heat stroke, neuroleptic syndrome or lithium toxicity, this case was characterized by a chronic cerebellar atrophy that developed after sepsis-induced hyperthermia in the setting of non-toxic lithium levels. Unique to this case also was the early finding of cerebellar atrophy on MRI 2 weeks after the episode of hyperthermia, long-term neurotoxicity after the novo lithium therapy, and longest follow-up case of chronic cerebellar syndrome after hyperthermia with non-toxic lithium levels.
