This case requires us to address once again the proper application of a statute of limitations

This case requires us to address once again the proper application of a statute of limitations. (See Gutierrez v. Mofid (1985) 39 Cal.3d 892, 218 Cal.Rptr. 313, 705 P.2d 886; Jolly v. Eli Lilly & Co. (1988) 44 Cal.3d 1103, 245 Cal.Rptr. 658, 751 P.2d 923 (Jolly); Bernson v. Browning-Ferris Industries (1994) 7 Cal.4th 926, 30 Cal. Rptr.2d 440, 873 P.2d 613 (Bernson); Norgart, supra, 21 Cal.4th at p. 395, 87 Cal.Rptr.2d 453, 981 P.2d 79.)

""Statute of limitations"" is the collective term applied to acts or parts of acts that prescribe the periods beyond which a plaintiff may not bring a cause of action. (3 Witkin, Cal. Procedure (4th ed. 1996) Actions, � 405, p. 509; accord, Norgart, supra, 21 Cal.4th at p. 395, 87 Cal. Rptr.2d 453, 981 P.2d 79.) There are several policies underlying such statutes. One purpose is to give defendants reasonable repose, thereby protecting parties from ""defending stale claims, where factual obscurity through the loss of time, memory or supporting documentation may present unfair handicaps."" (Bernson, supra, 7 Cal.4th at p. 935, 30 Cal.Rptr.2d 440, 873 P.2d 613; Jolly, supra, 44 Cal.3d at p. 1112, 245 Cal.Rptr. 658, 751 P.2d 923; see also Davies v. Krasna (1975) 14 Cal.3d 502, 121 Cal.Rptr. 705, 535 P.2d 1161.) A statute of limitations also stimulates plaintiffs to pursue their claims diligently. (Norgart, supra, 21 Cal.4th at p. 395, 87 Cal.Rptr.2d 453, 981 P.2d 79; Jolly, supra, 44 Cal.3d at p. 1112, 245 Cal.Rptr. 658, 751 P.2d 923; see, e.g., Bernson, supra, 7 Cal.4th at p. 935, 30 Cal.Rptr.2d 440, 873 P.2d 613.) A countervailing factor, of course, is the policy favoring disposition of cases on the merits rather than on procedural grounds. (Norgart, supra, 21

667

667 Cal.4th at p. 396, 87 Cal.Rptr.2d 453, 981 P.2d 79; Barrington v. A.H. Robins Co. (1985) 39 Cal.3d 146, 152, 216 Cal.Rptr. 405, 702 P.2d 563.)

Question 1

If a female patient with multiple sclerosis wants to become pregnant,

what are the risks, family planning advice and treatment, etc? What is the

best advice to give to her?131

Question 2

Is there a role for methotrexate and azathioprine in the treatment of

remitting-relapsing multiple sclerosis?

Question 3

Do steroids have a role in preventing or ameliorating the relapses in

relapsing-remitting multiple sclerosis?

Question 4

Has cyclophosphamide a role in decreasing the rate and number of

relapses in relapsing-remitting multiple sclerosis?

Question 5

Is there evidence of the efficacy of cyclic pulse cyclophosphamide

therapy in the treatment of relapsing-remitting multiple sclerosis?

Question 6

Glatiramer acetate and interferon-beta are recommended by some people

for the treatment of multiple sclerosis. Which drug should I use for a

patient with a 2-year history of relapsing-remitting MS.

Question 7

1. Most neurological books available to me say that high-dose IV

dexamethasone can be used in acute relapses of multiple sclerosis

(MS). What is the recommended dosage and regimen for this drug?

2. I understand that depot preparations of betamethasone (Depofos)

can also be used in acute relapses of MS, as well as treatment for

idiopathic Bell's palsy. If so, can you tell me the recommended dosage

and regimen for this drug?

Question 8

What are the most common causes of chronic meningitis and what

investigations must be done?

Question 9

What is Hib meningitis?

Question 10

How often is tuberculosis a cause of chronic meningitis in comparison to

other causes?"

What are the risks, family planning recommendations and management guidelines for a woman with multiple sclerosis if she wishes to conceive? What can one tell her?

 Risks: There is no evidence that pregnancy worsens MS, but there may be higher risk of relapse after delivery. Processing of disease-modifying therapies is recommended as some of them are not recommended to be used during the pregnancy.

 Family Planning Advice: It is advisable to consult a neurologist and an obstetrician before planning for conception and in the management of MS. Some changes may be made to the medications that are being taken if at all needed.

 Treatment: Discontinue those DMTs which are contraindicated during pregnancy and if needed, switch with the safer drugs.

 Best Advice: Continue with frequent follow up with the healthcare providers, ensure the disease is well controlled prior to conception and plan on the management of the disease in the postpartum period in case of relapses.

 Methotrexate and azathioprine in the treatment of relapsing-remitting multiple sclerosis: are they useful?

 Methotrexate and azathioprine are not often used in the treatment of RR MS. Interferon-beta and glatiramer acetate are used more often as disease-modifying drugs.

 Can steroids play a preventive or therapeutic function in the course of relapse-remitting multiple sclerosis?

 Steroids do not have any effect on the prevention of relapses although they may help to reduce the severity and duration of acute relapses. Methylprednisolone at high doses given intravenously is quite frequent.

 Does cyclophosphamide have a part in reducing the rate and number of relapses in relapsing-remitting multiple sclerosis?

 Cyclophosphamide is not used in the management of relapse-remitting multiple sclerosis. This is often used for the patient with severe or progressive type of MS who have not responded to other therapies.

 Cyclic pulse cyclophosphamide therapy has been prescribed for the treatment of relapsing-remitting multiple sclerosis; is there proof that it helps?

 There is not much evidence for the use of cyclophosphamide in treating RRMS in the form of cyclic pulse therapy and hence it is not a recommended treatment. Several other DMTs are usually prescribed for the relapsing forms of MS according to most treatment guidelines.

 Glatiramer acetate and interferon beta are advised for the treatment of multiple sclerosis. What drug should I prescribe for a patient with a history of relapsing-remitting MS for the last two years?

 It is to note that while both glatiramer acetate and interferon-beta are effective in relapsing-remitting MS. The decision between the two depends on the patient’s characteristics, possible side effects and, last but not the least, patient preference.

 1. Almost all neurological books suggest high-dose intravenous dexamethasone for acute relapses of multiple sclerosis. How many milligrams should I take, and when?

 The usual course of high-dose IV dexamethasone is 500 mg to 1 g per day for 3 to 5 days.

 2. Depot preparations of betamethasone (Depofos) can also be used. What should be the best dose and how often should it be taken?

 In treatment of acute relapses of MS with depot betamethasone, the usual dose is 4 mg to 6 mg intramuscularly; the regimen is usually adjusted according to the response.

 Chronic meningitis: Which are the most frequent pathogens and what tests should be ordered?

 Common Causes: Tuberculosis, fungal infections, cryptococcal infections, and syphilis are the others.

 Investigations: Lumbar puncture with CSF, blood tests, cultures, imaging studies such as MRI and sometimes PCR testing.

 What is Hib meningitis?

 Hib meningitis is that meningitis which is caused by Haemophilus Influenza type b, a bacterium that used to be one of the major causes of bacterial meningitis in children before the introduction of the Hib vaccine.

 How frequent is tuberculosis as a cause of chronic meningitis in relation to other causes?

 Meningeal tuberculosis should be considered in the differential diagnosis of chronic meningitis; however, it is less frequent than viral or bacterial meningitis, although the incidence is still important in areas with high tuberculosis prevalence.