Relapsing-Remitting MS in a 29-Year-Old: From Misdiagnosis to Disease-Modifying Therapy
PATIENT PROFILE
Age | 29 years |
Gender | Female |
Occupation | Marketing Professional |
City | Bangalore |
Presenting Complaint | Two distinct episodes of limb weakness and blurred vision over 18 months, initially attributed to unrelated causes |
Diagnosis | Relapsing-Remitting Multiple Sclerosis (RRMS), confirmed on MRI brain and spine with contrast, VEP testing, and CSF oligoclonal bands |
Duration of Issue | 18 months of intermittent, unexplained neurological symptoms before definitive diagnosis |
Previous Treatments | First episode treated as anxiety with reassurance and anxiolytics; second episode treated as cervical spondylosis with physiotherapy and a cervical collar; neither treatment resolved the underlying problem |
Date of Initial Consultation | April 2025 |
Outcome | RRMS confirmed and high-efficacy disease-modifying therapy started; no relapse and no new MRI lesion activity at 12 months |
THE PROBLEM
Condition
The patient’s first episode occurred nearly a year and a half before diagnosis: a few weeks of right leg weakness that made stairs and long walks difficult, with no clear trigger. It was worked up as stress-related, given her demanding job, and she was reassured, prescribed a short course of anxiolytics, and told the weakness was likely psychosomatic. The weakness resolved on its own over several weeks, seemingly confirming that explanation.
About a year later, she developed blurred vision in one eye alongside mild limb weakness and neck discomfort. A cervical spine MRI at the time showed mild degenerative changes, and the constellation of symptoms was attributed to cervical spondylosis. She was started on physiotherapy and a cervical collar. The visual symptoms partially settled, but new sensory disturbances, tingling and numbness in patches on her trunk and limbs, began appearing over the following weeks, and the visual blurring never fully cleared.
It was this second, incompletely explained cluster of symptoms, combined with the earlier episode of leg weakness, that prompted referral to Dr. Guruprasad Hosurkar, a neurologist in Bangalore. The relapsing-remitting pattern, two distinct episodes, months apart, affecting different parts of the nervous system, was the key clue that this was not anxiety or degenerative spine disease, but a possible demyelinating condition such as Multiple Sclerosis.
Emotional and Psychological Impact
Being told repeatedly that her symptoms were “just anxiety” had a lasting effect on the patient’s confidence in her own perception of her body. She described second-guessing every new symptom and feeling reluctant to seek further medical opinion after being dismissed twice. When MS was first raised as a possibility, the fear that followed was significant, shaped largely by outdated assumptions about disability and wheelchair dependence. The consultation addressed both threads directly: validating that her earlier symptoms had been real and organic all along, and giving her an accurate, current picture of what an early RRMS diagnosis with modern high-efficacy treatment actually means for long-term function.
CONSULTATION & TREATMENT PLAN
What Was Assessed
- Detailed history of both episodes, mapping the relapsing-remitting temporal pattern and the distinct anatomical systems involved: corticospinal tract (limb weakness) and optic nerve (blurred vision)
- Full neurological examination: visual acuity, relative afferent pupillary defect (RAPD), motor and reflex testing of all four limbs, sensory examination, and history of Uhthoff’s phenomenon (symptom worsening with heat)
- MRI brain with contrast, assessed for periventricular, juxtacortical, and infratentorial lesions, and for active gadolinium-enhancing lesions
- MRI whole spine with contrast to look for cord lesions
- Visual Evoked Potentials (VEP) to objectively document a prior episode of optic neuritis through delayed P100 latency
- Cerebrospinal fluid (CSF) analysis for oligoclonal bands present in CSF but absent in serum, supporting intrathecal inflammation
- Blood workup to exclude mimics: anti-AQP4 (NMO) antibodies, anti-MOG antibodies, ANA, vitamin B12, thyroid profile, and relevant infectious markers
- Re-review of the earlier cervical spine MRI in light of the new findings
- Formal application of the 2017 McDonald Criteria to confirm dissemination of lesions in both space and time
Why This Approach Was Chosen
Multiple Sclerosis in young women is frequently missed on first presentation, often labelled as anxiety, migraine, or degenerative spine disease, precisely because early relapses can be subtle, self-limiting, and anatomically nonspecific. Confirmatory testing before starting lifelong therapy is essential: MRI defines lesion location and activity, VEP objectively documents a clinically silent optic nerve episode, and CSF oligoclonal bands support the diagnosis independent of MRI findings, together satisfying the dissemination-in-space-and-time requirement of the McDonald Criteria. Because she was young at onset, had a significant MRI lesion burden including spinal cord involvement, and had already experienced two clinical relapses within 18 months, all recognised markers of a more aggressive disease course, the case was built for starting high-efficacy disease-modifying therapy upfront rather than the traditional escalation approach.
“Multiple Sclerosis in a young woman is still commonly mistaken for anxiety or a spine problem, especially when the first episode resolves on its own. The pattern, not any single symptom, is what points to MS: relapses affecting different parts of the nervous system over time. Once that pattern is confirmed with MRI, evoked potentials, and CSF analysis, the evidence increasingly favours starting a high-efficacy therapy early in patients with poor prognostic markers, rather than waiting for further relapses to justify escalation.” — Dr. Guruprasad Hosurkar.
BASELINE CLINICAL ASSESSMENT
MRI brain with contrast showed multiple periventricular and juxtacortical T2/FLAIR hyperintense lesions, including one actively gadolinium-enhancing lesion. MRI whole spine with contrast identified a cervical cord lesion, also enhancing, previously misread as degenerative change. VEP testing showed prolonged P100 latency in the right eye, confirming a prior subclinical episode of optic neuritis. CSF analysis demonstrated oligoclonal bands present in the CSF but not in paired serum, supporting intrathecal antibody synthesis. Blood workup for AQP4 and MOG antibodies was negative, as was ANA, and vitamin B12 and thyroid profiles were normal, excluding the principal mimics. Baseline Expanded Disability Status Scale (EDSS) score was mild, at approximately 1.5 to 2.
TREATMENT DETAILS
Step-by-Step Overview
- Diagnosis explained in detail using the McDonald Criteria framework: dissemination in space (multiple lesion locations on MRI and VEP) and dissemination in time (a new enhancing lesion in the context of two separated clinical relapses)
- Discussion of moderate-efficacy versus high-efficacy disease-modifying therapy options, with high-efficacy therapy recommended upfront given her age at onset, MRI lesion burden, and spinal cord involvement
- Pre-treatment screening: JC virus antibody status, hepatitis B and C and tuberculosis screening, vaccination review, and a detailed discussion on family planning and contraception given the therapy’s implications
- High-efficacy disease-modifying therapy initiated as a day-care infusion with standard pre-medication to reduce infusion-related reactions
- Structured monitoring protocol: repeat MRI brain and spine at 12 months, clinical relapse review at each visit, EDSS reassessment, and periodic lymphocyte count and immunoglobulin monitoring
- Patient education on early relapse recognition and the importance of reporting new neurological symptoms promptly
- Counselling on supportive lifestyle measures: vitamin D optimisation, regular exercise, and smoking cessation where relevant
- Psychological support to address the lasting impact of the earlier misdiagnoses and to rebuild confidence in symptom reporting
Treatment Facts
Duration | Ongoing: initial infusion followed by scheduled maintenance dosing every 6 months |
Setting | Outpatient infusion day-care unit and neurology clinic, KIMS Hospital, Mahadevapura, Bangalore |
Procedure | High-efficacy Disease-Modifying Therapy (anti-CD20 infusion) for Relapsing-Remitting Multiple Sclerosis |
Medication | High-efficacy disease-modifying therapy, administered as a scheduled infusion |
Allied Therapies | MS nurse counselling, psychological support, physiotherapy for residual deficits |
Complications | Mild, self-limiting infusion-related reaction during the first cycle, managed with standard supportive measures |
Inpatient Admission | Not required; managed as scheduled day-care infusions |
POST-TREATMENT RESULTS
At 12 months of follow-up, the patient had experienced no further clinical relapses. Repeat MRI brain and spine showed no new or enhancing lesions compared to baseline, meeting the criteria for No Evidence of Disease Activity (NEDA). Her visual symptoms had fully resolved, limb strength had returned to normal, and her EDSS score remained stable at baseline levels. She had returned to full capacity at work and reported considerable relief and improved confidence once her symptoms were correctly explained and actively managed, rather than repeatedly attributed to anxiety or spine disease.
Outcomes at a Glance
| Relapse Activity | ✔ No clinical relapses in 12 months |
| MRI Disease Activity | ✔ No new or enhancing lesions at 12-month scan (NEDA) |
| Visual Symptoms | ✔ Fully resolved |
| Limb Strength | ✔ Returned to normal |
| Functional Status | ✔ Full return to work; EDSS stable |
| Complications | ✔ One mild, self-limiting infusion reaction; none since |
PATIENT FEEDBACK
“I spent almost a year and a half being told my symptoms were anxiety, and later that they were from my neck. I started doubting myself and stopped mentioning new symptoms to anyone. Dr. Guruprasad Hosurkar was the first doctor to actually connect the two episodes and order the right tests. Being diagnosed with MS was frightening at first, but starting treatment early and understanding what modern therapy could do changed everything. I have had no relapses since, and I finally trust my own body again.”
- Profile: 29 years · Marketing Professional · Bangalore
- Condition: Relapsing-Remitting Multiple Sclerosis, symptomatic intermittently for 18 months before diagnosis
- Neurologist:Dr. Guruprasad Hosurkar | KIMS Hospital, Mahadevapura, Bangalore | April 2025 onward
POST TREATMENT CARE & RECOVERY
Instructions Given to Patient
- Attend all scheduled disease-modifying therapy infusions on time; do not delay without discussing with the treating team
- Undergo annual or 12-monthly MRI brain and spine monitoring, even in the absence of new symptoms
- Report any new neurological symptom promptly, however minor it may seem, rather than waiting for it to resolve on its own
- Plan any vaccinations around infusion timing in consultation with the treating team
- Maintain vitamin D supplementation, regular exercise, and a healthy lifestyle as supportive measures
- Discuss family planning and contraception with the treating team well in advance of any planned pregnancy, given therapy-specific considerations
- Continue routine blood monitoring as scheduled to track treatment safety
Recovery Timeline
Milestone | Details |
Visit 1 (Month 0) | RRMS confirmed via MRI, VEP, and CSF analysis; high-efficacy DMT started after pre-treatment screening |
Month 1–3 | First infusion cycle completed; mild infusion reaction managed; no new symptoms |
Month 3–6 | Visual symptoms fully resolved; limb strength normalised; second infusion cycle completed |
Month 6–9 | No relapses; routine blood monitoring stable |
Month 12 | Repeat MRI confirms no new or enhancing lesions (NEDA); EDSS stable; full return to work |
Ongoing | Maintenance infusions every 6 months with continued clinical and MRI surveillance |
FAQs
1. Why is Multiple Sclerosis often misdiagnosed in young women?
2. What tests confirm a diagnosis of Relapsing-Remitting MS?
3. What is a high-efficacy disease-modifying therapy, and why start it early?
4. Does starting treatment early prevent long-term disability in MS?
5. Can someone with RRMS on treatment still plan a family?
Disclaimer: This case study is for educational purposes only. Patient identity has been withheld per confidentiality guidelines. For a related recovery story, see our Parkinson’s Disease case study, or browse more patient stories on our Case Study and Blog pages.