A CASE OF RELAPSING MULTIPLE SCLEROSIS MANAGEMENT WITH DISEASE MODIFYING THERAPY

Abstract

Introduction. Multiple sclerosis (MS) is a chronic inflammatory disease characterized by central nervous system lesions that can lead to severe physical or cognitive disability as well as neurological defects. The pathologic hallmark of MS is focal demyelination within the brain and spinal cord. Currently, there is no definite cure for MS, immunomodulating and antiinflammatory agents can diminish its progression and decrease some of the pathological symptoms. Case report. We report a case of 18 years female patient. The patient had first approached to neurology hospital on May 2019 after upper respiratory tract infection with neurology symptoms, such as numbness on the right side and problems with balance as well as coordination. On neurological examination, she had involuntary laughing attacks. Muscle power: lower extremities proximal part – 5/5, distal part – 3/5, upper extremities 4/5. Reflexes are increased in all extremities, D=S. Babinski sign was positive bilaterally. There are bilateral dysmetria and adiadochokinesia. Gait is ataxic. Brain MRI: multiple white matter demyelinating lesions in the mesencephalon, pons and bulbus with contrast enhancement. Spine MRI: multiple white matter demyelinating lesions within C2-C4, C7-T4 , T5-T7 level, without contrast enhancement. She started on treatment methylprednisolone pulse therapy afterwards continued with oral steroid. After she had clinical and radiological improvement. 3 month later, she admitted to hospital with progressive walking disturbance and imbalance. She did MRI again and 6 months after and it revealed new contrast enhanced plaques in brain and spine. The progressive white matter lesions and clinical symptoms were judged as the MS relapse, the patient was given methylprednisolone for five consecutive days. Fingolimod was started at this time because the patient had no neurological improvement. She lost ability to walk without support. She has been taking Fingolimod for 1 year. (Lymphocyte count 0.59). In response to this therapy, her walking ability slightly improved and there were no new neurological symptoms. Since clinically and radiologically positive dynamics is observed in the patient, the treatment is continued with Fingolimod and patient is being monitored.