C.B. discontinued fingolimod, conceived approximately 4 months later, and delivered a healthy male..

C.B. discontinued fingolimod, conceived approximately 4 months later, and delivered a healthy male child after a normal gestation and labor. She experienced a relapse of MS 2 months after delivery, discontinued nursing, and was treated with corticosteroids. Two months after the relapse and treatment, she returns to the neurology clinic for a follow-up appointment. She states that she is ready to restart fingolimod therapy at this time. She states that she is often very tired and feels that “she can’t continue.” However, she admits that this feeling may also be related to being a new mother. She states that her husband and daughter help significantly with care of the infant. She has noticed some jerkiness in her gait, and she states that sometimes her toes will contract toward her head involuntarily. Her neurologic examination shows spasticity in her lower extremities. What treatments would be appropriate for management of C.B.’s spasticity? How should her fatigue be addressed?]