A 36-year-old female presented with pain and tingling in her left hand and fingers that progressed to her arm and neck, as well as blurred vision in her right eye for 15 days. MRI revealed acute demyelinating optic neuritis. She was diagnosed with multiple sclerosis and right optic neuritis. Treatment included intravenous methylprednisolone, gabapentin, prednisolone, supplements, amlodipine for hypertension, and pantoprazole for acidity. Her medications, diet, disease monitoring, and follow up were discussed to manage her multiple sclerosis and symptoms.

1. CASE PRESENTATION ON
MULTIPLE SCLEROSIS
AYESHA FAREED
PHARM D 5TH YR
ROLL NO: 07
SVCP
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2. CHIEF COMPLAINT: A 36YOF c/o pain and
tingling in fingers of left hand which progressed to
arm and neck
Blurred vision- right eye since 15 days
SUBJECTIVE:
PMH: HTN
FAMILY HISTORY: Nil
SOCIAL HISTORY: Nil
ALLERGIES: NKDA
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3. OBJECTIVE:
Physical examination:
 General appearance:
Height: 165cm Weight: 65 kg BMI: 23.8 Kg/m²
 Vital signs:
Pulse: 78 beats/min
RR: 20 breaths/min
BP: 100/70mmHg
Temp: 98.2o F
HEAD TO TOE EXAMINATION:
EXT: weakness
EYE: blurred vision (right eye)
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4. Laboratory investigations:
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TEST VALUE REFERENCE
Albumin 3.4* 3.5-5.5 g/dl
Urea 27 20-40 mg/dl
Sr. creatinine 0.8 0.6-1.6 mg/dl
TLC 11.7* 4-11000cells/mm
Platelets 2.6 1.5-4.5lakh/mcL
Hb 14.3 13-18 g/dl
PCV 42 40-54%
MEDICATION RECONCILIATION:
• T. ESLO (amlodipine) 5mg PO OD (HTN)
• T. PANTEL (pantoprazole) 40mg PO OD

5. Diagnostic test:
 MRI: revealed acute demyelinating optic neuritis
 CSF analysis (oligoclonal bands) done- reports
awaited
DIAGNOSIS: Rt optic neuritis- Multiple
sclerosis
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6. 6
BRAND
NAME
GENERIC NAME DOSE ROUTE FREQ INDICATION DAY
Inj.
SOLUMEDRO
L
methylprednisolon
e
1g in
200 NS
over 2
hrs
IV OD Optic neuritis D1
T. PANTODAC pantoprazole 40 mg PO OD APD D1
T. REMYLIN-
D
α-lipoic acid,
pyridoxine,
methylcobalamine
, vitamin- D
1 tab PO OD Neuropathy D1
T. DOLO paracetamol 650 mg PO OD Headache STAT
D2
T. STAMLO amlodipine 5 mg PO OD hypertension D3
T.
OMNACORTI
L
prednisolone 40 mg PO OD MS D3
T. GABAPEN gabapentin 300 mg PO HS Neuropathy D3

7. ASESSMENT:
 A 36 YOM c/o pain and tingling in fingers of left
hand which progressed to arm and neck and
blurred vision in right eye since 15 days
 MRI was done which revealed optic neuritis
MULTIPLE SCLEROSIS:
 Inj. SOLUMEDROL (methylprednisolone) 1g in
200 ml NS over 2 hrs was given as pulse therapy
 Intravenous methylprednisolone has been shown
to shorten the duration of acute exacerbations, and
it may delay repeat attacks for up to 2 years after
optic neuritis
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8.  T.GABAPEN (gabapentin) 300mg PO HS
 T. OMNACORTIL (prednisolone) 40 mg
PO OD
 T. REMYLIN- D 1tab PO OD
HTN:
 T.S.NUMLO (amlodipine) 5 mg PO OD
APD:
 T. PANTODAC (pantoprazole) 40 mg PO
OD
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9. PLAN
Goals:
 To decrease mortality and long term disability
 To reduce ongoing neurologic injury
 To prevent progression of the disease
 To control relapses
 To manage the signs and symptoms
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10. Disease monitoring parameters
Monitor Blood pressure
CBC
Thyroid profile
Lipid profile
Liver enzymes
Drug monitoring parameters
 Prednisolone: Blood pressure; blood glucose,
electrolytes, intraocular pressure
 Amlodipine: BP, HR, signs of edema
 Gabapentin: depression, behavioural changes, suicidal
thoughts
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11. Patient counselling
 Multiple sclerosis is a disease that causes vision problems,
numbness and tingling, muscle weakness, and other
problems. It happens when the body’s infection-fighting
system attacks and damages nerve cells and their
connections in the brain and spinal cord
DIET:
 Have a diet low in saturated fats and supplemented
by Omega-3 (from fatty fishes, cod-liver oil, or flaxseed
oil) and Omega-6 (fatty acids from sunflower or safflower
seed oil and possibly evening primrose oil)
 Eliminate sugar (fructose) from your diet. Keep a daily
fructose intake of not more than 25 gms
 Eliminate pasteurized milk and dairy
 Eat plenty of raw food- fruits and vegetables
 Optimize your vitamin- D levels by getting regular sunlight
exposure
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12. DISCHARGE MEDICATIONS:
 T. S.NUMLO (amlodipine) 5 mg 1 tab orally once
daily (HTN)
 T. PAN (pantoprazole) 40 mg 1 tab orally once daily
(APD)
 T. REMYLIN- D 1 tab orally once daily (neuropathy)
 T. GABAPEN (gabapentin) 300 mg 1 tab orally once
daily after dinner (neuropathy)
 T. OMNACORTIL ( prednisolone)
40 mg 1 tab orally once daily for 1 week then
20 mg 1 tab orally once daily for 1 week then
10 mg 1 tab orally once daily for 1 week and stop
FOLLOW UP: Review with CSF reports in neuro OPD
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