Treatment initiation
Scenario 1
A 38-year-old, right-handed male presented with a 5-day history of numbness and tingling in his right hand and forearm, along with an intermittent “spinning” sensation that caused him to feel unsteady. The physical exam was notable for impaired smooth-pursuit eye tracking, decreased sensation (pin and vibration) in the right arm and hand, and slightly ataxic gait. MRI of the brain and spinal cord showed contrast enhancement in the right cerebellar peduncle and several periventricular and juxtacortical hyperintense T2 lesions. There were no spinal cord lesions.
Using the latest (2017) McDonald criteria, the patient was diagnosed with relapsing MS. He was treated with a short course of high-dose corticosteroids (methylprednisolone 1 gram/day for 3 days).
At the current visit, 4 weeks later, his symptoms have resolved, and his neurological exam is normal. The patient is hesitant to begin disease-modifying therapy (DMT), claiming that he feels fine and asking if he could “just wait and see” if treatment becomes necessary in the future.