Multiple Sclerosis Treatment in Ranchi
Expert diagnosis and comprehensive management of multiple sclerosis by Dr. Yuvraj Lahre, DM Neurology (AIIMS). From first attack evaluation to long-term disease-modifying therapy at Neurovision Clinic, Ranchi.
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a chronic, immune-mediated inflammatory disease of the central nervous system (brain, spinal cord, and optic nerves). In MS, the body's immune system mistakenly attacks myelin — the protective fatty sheath that insulates nerve fibers and enables rapid, efficient transmission of electrical impulses. This demyelination disrupts communication between the brain and the rest of the body, producing a wide range of neurological symptoms that vary between individuals. MS typically follows one of several patterns: relapsing-remitting MS (RRMS) — the most common form, with clearly defined attacks followed by periods of recovery; secondary progressive MS (SPMS) — gradual steady progression after an initial relapsing course; and primary progressive MS (PPMS) — steady progression from onset without distinct relapses. MS affects approximately 2.8 million people worldwide, with higher prevalence in women and typically presents between ages 20 and 40.
Symptoms of Multiple Sclerosis
- •Optic neuritis — sudden painful vision loss in one eye, often with washed-out color perception and pain with eye movement
- •Sensory disturbances — numbness, tingling, burning, or a band-like tightness around the trunk (the 'MS hug')
- •Motor weakness — heaviness or weakness in one or both legs, foot drop, or difficulty with fine hand movements
- •Balance and coordination problems — unsteady gait, tremor, difficulty with tandem walking
- •Bladder dysfunction — urinary urgency, frequency, hesitancy, or incontinence from spinal cord involvement
- •Fatigue — often the most disabling symptom; overwhelming tiredness not relieved by rest, worsening with heat
- •Cognitive changes — slowed processing speed, reduced multitasking, and word-finding difficulty
- •Lhermitte's sign — an electric shock sensation down the spine upon flexing the neck forward
Causes & Risk Factors
- •Autoimmune attack — T and B cells cross the blood-brain barrier and orchestrate an inflammatory attack on myelin
- •Genetic susceptibility — multiple genes (particularly HLA-DRB1*15:01) contribute; first-degree relatives have a 2 to 5 percent risk
- •Epstein-Barr virus (EBV) — compelling evidence indicates EBV infection is a necessary trigger; nearly all MS patients are EBV-seropositive
- •Vitamin D deficiency — strongly linked to higher MS risk, possibly explaining the latitudinal gradient
- •Smoking — increases MS risk and accelerates disease progression
- •Obesity in adolescence — associated with higher MS risk through chronic low-grade inflammation
Diagnostic Tests
MRI Brain and Spinal Cord
MRI detects demyelinating lesions in characteristic locations — periventricular, juxtacortical, infratentorial, and spinal cord. Gadolinium contrast distinguishes active from chronic lesions. The McDonald criteria rely heavily on MRI demonstrating dissemination of lesions in space and time.
Neurological Examination
Comprehensive neurological exam assessing cranial nerves, motor and sensory function, coordination, gait, and reflexes to document clinical evidence of lesions.
Visual Evoked Potential (VEP)
VEP testing measures the speed of electrical impulse transmission along the visual pathway. Demyelination slows conduction, producing delayed VEP responses that confirm an optic nerve lesion.
Treatment Approach
Dr. Yuvraj Lahre provides evidence-based, comprehensive MS care following the latest international treatment guidelines:
Disease-Modifying Therapy (DMT)
DMTs reduce relapse frequency, prevent new MRI lesions, and slow disability accumulation. Dr. Lahre discusses the full range of options — injectable, oral, and infusible — tailoring the choice to disease activity, prognostic factors, and personal circumstances.
Acute Relapse Management
Prompt evaluation of suspected relapses to confirm true inflammatory activity versus pseudo-relapses. For confirmed disabling relapses, high-dose intravenous corticosteroids are arranged to accelerate recovery with careful monitoring.
Symptomatic Management
Targeted treatment of MS symptoms: neuropathic pain (gabapentinoids, SNRIs), spasticity (baclofen, tizanidine), fatigue (amantadine, energy conservation), bladder dysfunction (anticholinergics, timed voiding), and depression (SSRIs, counseling referral).
Lifestyle Optimization
Vitamin D supplementation, smoking cessation counseling, regular exercise (proven to reduce fatigue), dietary recommendations, and coordination with physiotherapists and occupational therapists.
⚠️ When to See a Doctor
- !If you experience a first episode of neurological symptoms — vision loss, double vision, spreading numbness, or unexplained weakness — especially between ages 20 and 40
- !If diagnosed with MS and not on disease-modifying therapy — early treatment is the best predictor of good outcome
- !If MS symptoms are worsening or you suspect a relapse — prompt evaluation distinguishes true relapses from pseudo-relapses
- !If on a DMT and experiencing side effects — alternatives can be discussed rather than stopping treatment
- !For regular monitoring — clinical examination every 6 months and annual surveillance MRI