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After completing this case study, the reader should be able to:

  • Describe the signs and symptoms of multiple sclerosis (MS) that often mimic those of other neurologic diseases.

  • Design a pharmacotherapeutic regimen for treating an acute exacerbation of MS.

  • Identify patients for whom disease-modifying therapy (DMT) would be appropriate and recommend the most appropriate alternative for an individual patient.

  • Implement a pharmacotherapeutic plan for a patient with worsening MS.

  • Educate patients and healthcare practitioners on the proper dosing, self-administration (if appropriate), adverse effects, and storage of various medications used for MS.


Chief Complaint

“My legs are numb and weak, and I’m having trouble walking and urinating.”


Loretta Mansfield is a 26-year-old woman who was in excellent health until 4 days ago when she developed numbness and tingling in her left foot. Over the course of the next 4 days, the numbness extended higher up her leg to her lower abdomen, stopping at the umbilicus, and then going down the right leg. She also developed weakness in both of her legs, is having trouble walking, and is bothered by urinary urgency.


Frequent migraine headaches since adolescence that are now well controlled with acetaminophen, aspirin, and caffeine (Excedrin) and oral sumatriptan

Mild recurrent bouts of depression that have not been treated pharmacologically

Obesity most of her life


English descent. She was born in Arizona and moved to Ohio at the age of 12. She has no siblings, and both parents are alive and well. There is no family history of neurologic disease.


Married; employed as an accountant; smoked one pack per day for 8 years; use of alcohol is limited to an occasional glass of wine or beer on weekends.


Acetaminophen, aspirin, and caffeine (Excedrin) two tablets PO PRN headache

Sumatriptan 50 mg PO PRN migraine, at the onset of pain




Unremarkable except that she reports feeling run down and tired most of the day. No previous history of visual disturbance (eg, pain, blurred, double vision), sensory, motor, bowel, bladder, or gait disturbance

Physical Examination


The patient is a Caucasian woman who appears to be slightly anxious but is otherwise in NAD.


BP 120/72 ...

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