Multiple Sclerosis in Hyderabad: A Chronic Condition That Can Be Effectively Controlled — If Diagnosed Early and Treated at the Right Efficacy Level

A single episode of optic neuritis is called a Clinically Isolated Syndrome — it may be the first sign of MS, but the diagnosis of MS requires evidence of damage at more than one location and/or more than one time point. The critical question is what your brain MRI shows. If the MRI shows multiple white matter lesions typical of MS — even if you have had only one clinical episode — the 2024 McDonald Criteria may allow an MS diagnosis to be made now, enabling earlier treatment. If the MRI shows only an optic nerve lesion, you are monitored for a second event. Either way, you need a specialist assessment and MRI urgently. Please call KIMS Neuroscience on 040-44885000 — optic neuritis is a priority referral.

The brain infection risk you are referring to is Progressive Multifocal Leukoencephalopathy (PML) — an opportunistic brain infection caused by the JC virus that can occur in patients on natalizumab, particularly in those who test positive for the JC virus antibody and who have been on natalizumab for more than two years. The risk is real and ranges from very low (less than 1 in 10,000 in JC-antibody-negative patients) to meaningfully higher (up to 1 in 100 or more) in JC-antibody-positive patients on long-term treatment at high antibody index values. At KIMS, every natalizumab patient is enrolled in a structured monitoring programme: JC virus antibody testing every 6 months, risk stratification at each result, and an agreed plan for switching therapy if the antibody index exceeds a pre-agreed threshold. The decision to use natalizumab is made individually — balancing its very high efficacy against the PML risk, with a personalised monitoring plan in place.

MS has a genetic component — but it is not a straightforward inherited condition in the way that some single-gene disorders are. The risk of MS in a first-degree relative (child, sibling) of someone with MS is approximately 2–5% — higher than the general population risk of about 0.1–0.2%, but still small in absolute terms. There is no genetic test that predicts whether a family member will develop MS. The most appropriate advice for family members is: be aware of the early symptoms (optic neuritis, sensory disturbance, unexplained weakness), seek early evaluation if any occur, and ensure good vitamin D status — low vitamin D is consistently associated with higher MS risk in Indian studies.

Two relapses in one year on a disease-modifying therapy is evidence of treatment failure — the current medication is not adequately controlling your disease. The appropriate step is not to change the dose or add another platform therapy. It is to escalate to a high-efficacy therapy. At KIMS, a patient with breakthrough disease activity on a moderate-efficacy DMT is assessed for escalation — the choice of therapy (natalizumab, ocrelizumab, rituximab, or cladribine) is made based on disease activity level, your AQP4-IgG result (to confirm MS not NMO), pregnancy plans, and your JC virus antibody status. Please call 040-44885000 for an urgent review appointment.

No dietary intervention, supplement, or Ayurvedic preparation has been shown in rigorous clinical trials to alter the course of MS — specifically, to reduce relapse rates, prevent new lesions on MRI, or slow disability progression. Certain supportive measures are evidence-based: vitamin D supplementation (relevant in India where levels are often low), regular aerobic exercise (shown to improve fatigue, mood, and mobility), and a healthy overall diet. These support overall neurological health but do not replace disease-modifying therapy. The stakes of untreated or undertreated MS are high — every lesion is a potential scar, and scars are permanent. KIMS treats MS with the evidence-based therapies that have been proven in large trials to reduce disease activity.

This is a complex question that depends on your age, which DMT you are on, your current MRI activity, your disability level, and your personal priorities. Some data suggest that older patients on stable moderate-efficacy therapies with low disease activity may be able to safely discontinue under careful monitoring. However, stopping a high-efficacy therapy carries meaningful risk of rebound disease activity. This decision should never be made without specialist involvement. KIMS will review your MRI history, your current disability status, and the evidence base for your specific therapy before any advice on discontinuation is given. Call 040-44885000 to discuss.

Vitamin B12 deficiency can produce demyelination of the spinal cord — a condition called subacute combined degeneration of the cord — producing tingling, weakness, and gait problems that can look like MS on clinical examination. Brain MRI clearly distinguishes the two: MS produces the characteristic periventricular white matter lesions; B12 deficiency produces dorsal column changes in the spinal cord but not the typical MS lesion pattern. Serum B12 and methylmalonic acid levels confirm B12 deficiency. Both conditions can coexist — and both can be present in young Indians simultaneously. At KIMS, B12 deficiency is always tested before an MS diagnosis is confirmed, and both are treated if present.