Skill Checkup: Suboptimally Treated Relapsing-Remitting Multiple Sclerosis (RRMS)

Christopher Luzzio, MD

Disclosures

September 24, 2021

The Skills Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 37-year-old woman with relapsing-remitting multiple sclerosis (RRMS) presents with new-onset blurred vision and unilateral periocular pain. The patient also reports difficulty distinguishing colors and states that this is interfering with her work as a graphic designer. Her symptoms began approximately 24 hours earlier, developing over 5 hours. The patient was diagnosed with RRMS 2 years ago after episodes of hand paresthesia and trigeminal neuralgia.

The patient's height is 5'3" and weight is 170 lb. Current medications include interferon beta-1b 0.25 mg every other day by subcutaneous injection, atorvastatin 20 mg/d, and fluoxetine 20 mg/d. The patient receives physiotherapy to help control her chronic fatigue and maintain fitness. She admits to missing some doses of her interferon because she dislikes the self-injection process.

The patient's most recent brain MRI was consistent with the diagnosis of MS in showing infratentorial and supratentorial lesions, but it showed no new lesions compared with imaging 1 year earlier. Ophthalmologic examination findings at today's visit include optic disc swelling, decreased pupillary light reaction, altitudinal field loss, reduced color sensitivity, and a relative afferent pupillary defect in the affected eye.

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