Skill Checkup: Suboptimally Treated Relapsing-Remitting Multiple Sclerosis (RRMS)

Christopher Luzzio, MD


January 26, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 37-year-old woman with relapsing-remitting multiple sclerosis (RRMS) presents with new-onset blurred vision and unilateral periocular pain. The patient also reports difficulty distinguishing colors and states that this is interfering with her work as a graphic designer. Her symptoms began approximately 24 hours earlier, developing over 5 hours. The patient was diagnosed with RRMS 2 years ago after episodes of hand paresthesia and trigeminal neuralgia.

The patient's height is 5'3" and her weight is 170 lb. Current medications include interferon beta-1b 0.25 mg every other day by subcutaneous injection, atorvastatin 20 mg/d, and fluoxetine 20 mg/d. The patient receives physiotherapy to help control her chronic fatigue and maintain fitness. She admits to missing some doses of her interferon because she dislikes the self-injection process.

The patient's most recent brain MRI was consistent with the diagnosis of MS in showing infratentorial and supratentorial lesions, but it showed no new lesions compared with imaging 1 year earlier. Ophthalmologic examination findings at today's visit include optic disc swelling, decreased pupillary light reaction, altitudinal field loss, reduced color sensitivity, and a relative afferent pupillary defect in the affected eye.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.