A 56-Year-Old Woman Is Evaluated for a Monthlong History of Intermittent

A 56-year-old woman is evaluated for a monthlong history of intermittent weakness of the right foot and a 3-month history of progressive left arm weakness.  The patient has no dysphagia, dysarthria, sensory loss, or bowel or bladder impairment.  Other medical conditions include type 2 diabetes mellitus, hypercholesterolemia, and hypertension.  She takes metformin, atorvastatin, and lisinopril.  Temperature is 36.9 C (98.4 F) , blood pressure is 130/78 mm Hg, pulse is 80/min, and respirations are 14/min.  Neurologic examination reveals normal speech, language, and mental status.  Moderate weakness and atrophy of the distal muscles in the right leg and left arm is noted.  Fasciculations are present in the right leg.  Deep tendon reflexes are brisk in the upper and lower limbs.  Sensory examination shows no abnormalities.  Laboratory results are as follows: Which of the following would be most helpful in treating this patient's current symptoms?

A) Intensive blood glucose control
B) Interferon beta
C) Levothyroxine
D) Prednisone
E) Riluzole
F) Statin discontinuation

Correct Answer:

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