Multiple Sclerosis Symptoms in Kathmandu: Early Signs and Evaluation

Multiple sclerosis (MS) is a chronic autoimmune condition in which the immune system attacks the myelin sheath —— the protective coating around nerve fibres in the brain and spinal cord. This demyelination disrupts electrical signals, producing neurological symptoms that vary depending on the location and extent of lesions. MS is diagnosed more commonly in women, typically between ages 20 and 40, and its presentation can be relapsing-remitting (the most common pattern at onset) or progressive.

Common early symptoms: Visual changes are among the most frequent presenting symptoms. Optic neuritis —— pain with eye movement and blurred or reduced vision in one eye —— is a classic early manifestation. The vision loss typically develops over hours to days and recovers over weeks, though some residual deficit may persist. Double vision (diplopia) from brainstem demyelination is another visual presenting feature.

Dr. Jitendra Prasad Yadav — consultant neurologist & headache specialist at Kathmandu Neurology Clinic & Cognitive Center provides evidence-based evaluation for peripheral neuropathy.

Numbness and sensory changes: Tingling, numbness, or a "pins and needles" sensation in the limbs, trunk, or face often prompts evaluation. The pattern may be partial —— affecting one side of the body or a specific dermatome —— and may be mistaken for cervical or lumbar pathology before the neurological picture clarifies.

Weakness: Limb weakness from corticospinal tract involvement may present as difficulty with walking, climbing stairs, or fine motor tasks. It may be subtle at first —— a foot that catches or a hand that feels clumsy —— and is sometimes attributed to fatigue before neurological evaluation identifies the true cause.

Balance and coordination: Cerebellar demyelination causes unsteadiness, intention tremor, and difficulty with rapid alternating movements. Patients may describe bumping into doorways, spilling drinks, or walking as if drunk without alcohol intake.

Other early symptoms: Lhermitte's sign —— an electric-shark sensation running down the spine on neck flexion —— is characteristic but not specific to MS. Fatigue, often disproportionate to activity level, is extremely common and may precede motor symptoms by months or years. Cognitive changes —— slowed processing speed, difficulty concentrating —— occur early in many patients despite being under-recognized.

How MS is diagnosed: MS diagnosis relies on demonstrating dissemination in time (lesions at different time points) and space (lesions in different CNS locations) using the McDonald criteria. There is no single blood test or imaging finding that confirms MS —— the diagnosis integrates clinical history, examination, MRI, and sometimes cerebrospinal fluid (CSF) analysis.

Role of MRI: Brain and spinal cord MRI with gadolinium contrast is the primary investigation. Typical MS lesions appear as ovoid, periventricular, juxtacortical, infratentorial or spinal cord areas of T2 hyperintensity. Enhancement with gadolinium indicates active inflammation and helps demonstrate dissemination in time. Not every white matter lesion is MS —— migraine, small vessel disease, and other conditions produce MRI changes that must be distinguished from MS by an experienced clinician.

Role of lumbar puncture: CSF analysis for oligoclonal bands and IgG index supports the diagnosis when MRI findings are equivocal. Oligoclonal bands —— present in CSF but not in blood —— indicate intrathecal immune activation and are found in approximately 90% of MS patients.

Dr. Jitendra's evaluation approach: At Kathmandu Neurology Clinic & Cognitive Center (Durbar Marg, Opposite of Yak & Yeti Hotel), Dr. Jitendra Prasad Yadav (NMC 8029) evaluates suspected MS with detailed symptom history (onset, distribution, duration, recovery, relapse pattern), full neurological examination including optic fundoscopy, visual acuity and field testing, motor and sensory assessment, coordination and gait evaluation, and cognitive screening. MRI brain and spine with gadolinium is ordered when clinical suspicion warrants it, and CSF analysis is discussed when MRI findings require clarification. He coordinates with neuroradiology for lesion characterization and with ophthalmology when visual symptoms are prominent. Treatment discussion is transparent about the distinction between relapse management, disease-modifying therapy, and symptom management, with realistic expectations about outcomes.

This article is educational and does not replace individual medical advice.