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
Clinical Observations at Neurovision
At Neurovision, Dr. Yuvraj Lahre is diagnosing MS more frequently in young Jharkhand women than historical data would predict. Despite abundant sunlight in Jharkhand, cultural practices of full-body clothing and limited outdoor time for women result in surprisingly high vitamin D deficiency rates — challenging the latitude-based assumption that tropical populations are protected from MS.
Standard medical literature states:
Multiple sclerosis is classically described as a disease of temperate latitudes with low prevalence in tropical regions. Vitamin D deficiency is a well-established risk factor.
We check vitamin D levels in every suspected MS patient and initiate aggressive supplementation where deficient. We counsel patients in Hindi about the importance of 15–20 minutes of morning sunlight exposure on arms and legs. We also maintain a low threshold for MRI brain with contrast in young women presenting with transient neurological symptoms.
— Dr. Yuvraj Lahre
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
Frequently Asked Questions
What are the early signs of multiple sclerosis?
MS often begins with a clinically isolated syndrome (CIS) — a single episode of neurological symptoms caused by inflammation and demyelination. Common presentations include: optic neuritis (painful vision loss in one eye with reduced color perception), transverse myelitis (numbness, weakness, or band-like sensation around the trunk with leg involvement), brainstem symptoms (double vision, facial numbness, vertigo, or incoordination), or sensory symptoms (numbness and tingling spreading over hours to days). Because these symptoms can mimic many other conditions, expert neurological evaluation with MRI is essential. Dr. Yuvraj Lahre at Neurovision Clinic provides timely diagnosis and distinguishes MS from its mimics — neuromyelitis optica spectrum disorder (NMOSD), MOG antibody disease, and other autoimmune or vascular conditions.
What disease-modifying treatments are available for MS?
Disease-modifying therapies (DMTs) are the cornerstone of MS treatment, aimed at reducing relapse frequency, slowing disability accumulation, and preventing new MRI lesions. Dr. Lahre discusses the range of DMTs — from injectable therapies (interferon-beta, glatiramer acetate) to oral agents (dimethyl fumarate, fingolimod, teriflunomide) and high-efficacy infusible treatments (ocrelizumab, natalizumab, rituximab). The choice is individualized based on disease activity, prognostic factors, comorbidities, family planning considerations, and risk tolerance. Dr. Lahre provides detailed counseling on each option's efficacy, safety profile, monitoring requirements, and coordinates therapy initiation.
How is an MS relapse managed?
An MS relapse is the new onset or worsening of neurological symptoms lasting more than 24 hours, separated from a previous attack by at least 30 days, in the absence of infection. Dr. Lahre evaluates suspected relapses promptly — not every symptom fluctuation represents a true relapse. For confirmed, functionally significant relapses, treatment typically involves a short course of high-dose intravenous methylprednisolone (3 to 5 days) to speed recovery. After the relapse is controlled, Dr. Lahre reassesses the DMT strategy — a relapse on current therapy may indicate the need to escalate treatment. Symptomatic treatments for residual issues (spasticity, neuropathic pain, fatigue, bladder dysfunction) are also provided.
Can people with MS lead a normal life?
With modern treatment, the outlook for people diagnosed with MS today is significantly better than a decade ago. Early diagnosis and initiation of effective disease-modifying therapy can dramatically reduce relapse rates, slow disability accumulation, and preserve brain volume. Many people with MS continue to work full-time and maintain active lives. The key is early, proactive treatment. At Neurovision Clinic, Dr. Lahre emphasizes comprehensive care: disease-modifying therapy to control the immune attack, symptomatic management for daily challenges, lifestyle optimization (vitamin D supplementation, smoking cessation, exercise), and regular monitoring with clinical examinations and MRI surveillance.