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Dr. Dr. Jitendra Prasad Yadav • Consultant Neurologist & MS Specialist • NMC 8029
Sudden vision loss, limb weakness, imbalance, or numbness lasting days? You may have multiple sclerosis (MS) — a chronic autoimmune disease affecting the brain and spinal cord. Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides MS diagnostic workup, MRI interpretation, and disease-modifying therapy (DMT) coordination at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu.
Nepal Medical Council Reg. No. 8029 • 15+ years National Trauma Center, NAMS • Part of Clinics Tree Healthcare Network
What is Multiple Sclerosis?
Multiple sclerosis causes immune-mediated damage to myelin in the brain and spinal cord, leading to varied neurological symptoms that typically relapse and remit.
In multiple sclerosis, the immune system mistakenly attacks myelin — the protective fatty sheath around nerve fibers (axons) in the central nervous system (brain, spinal cord, optic nerves). This inflammation causes demyelination (myelin loss), disrupting electrical signal transmission along nerves. Over time, repeated inflammation can damage axons themselves, leading to permanent neurological deficits.
MS lesions (plaques) appear as bright white spots on MRI, scattered throughout white matter — hence "multiple" sclerosis (multiple scars). Lesions in different anatomical locations cause different symptoms: optic nerve lesions cause vision loss, spinal cord lesions cause weakness or sensory changes, brainstem lesions cause double vision or imbalance, cerebral lesions cause cognitive changes.
Diagnosis follows McDonald criteria, requiring evidence of central nervous system demyelination disseminated in time (more than one episode) and space (more than one CNS location), with exclusion of alternative explanations.
Diagnostic tests:
MRI availability is limited to major centers in Kathmandu valley and select regional hubs, with cost barriers (MRI brain + spine NPR 20,000-30,000+ range). Lumbar puncture oligoclonal band testing is not universally available. VEP testing is available at select centers. These access issues can delay diagnosis, underscoring importance of thorough clinical evaluation and targeted testing.
Dr. Jitendra coordinates MRI at available centers, interprets results in clinical context, and arranges specialized testing when needed to confirm diagnosis and exclude mimics.
DMTs reduce relapse frequency (30-70% reduction depending on agent), slow MRI lesion accumulation, and delay disability progression. Early DMT initiation (within first years after diagnosis) improves long-term outcomes.
Injectable DMTs (interferon beta-1a, interferon beta-1b, glatiramer acetate) are established first-line options. Availability in Kathmandu pharmacies varies; some require import coordination. Side effects: injection site reactions, flu-like symptoms (interferons), liver enzyme elevations. Regular monitoring (blood counts, liver function) is essential.
Oral DMTs (fingolimod, dimethyl fumarate, teriflunomide) offer convenience but availability in Nepal is inconsistent. Fingolimod requires first-dose cardiac monitoring (heart rate drop). Dimethyl fumarate can cause flushing and GI upset. Teriflunomide requires liver monitoring and is teratogenic (pregnancy must be avoided).
Infusion therapies (ocrelizumab, natalizumab, rituximab) are highly effective, particularly ocrelizumab (approved for RRMS and PPMS). Availability in Nepal requires international procurement, specialized infusion facilities, and substantial cost. Dr. Jitendra discusses these options with patients who have aggressive disease or inadequate response to first-line DMTs and coordinates access where feasible.
Acute relapse treatment: High-dose IV methylprednisolone (1 gram daily × 3-5 days) hastens recovery from acute relapses. This is readily available at hospitals in Kathmandu and is coordinated promptly when relapses occur.
MS is a chronic disease requiring ongoing follow-up: annual brain MRI (more frequent if clinically active) to detect subclinical disease activity, regular blood/liver monitoring while on DMTs, assessment for treatment side effects (infections, liver toxicity, cardiac effects depending on agent), and relapse surveillance. Dr. Jitendra provides structured monitoring schedules tailored to each patient's DMT and disease course.
Beyond DMTs, symptom-focused treatments improve quality of life:
Seek urgent evaluation if you experience: sudden complete vision loss, severe weakness preventing walking, difficulty swallowing or breathing, severe vertigo with vomiting, or sudden severe headache (thunderclap). These may represent severe relapses, complications, or alternative urgent diagnoses requiring hospital-level care.
Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides:
Book MS Consultation
Kathmandu Neurology Clinic & Cognitive Center
Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600, Nepal
Phone: 974-7736624 • +977 9747978200
Sun-Sat 9AM-7PM • By Appointment • Near Narayanhiti Palace Museum • 27.7172, 85.3240
Book MS Evaluation NowRelated MS & Neuroimmunology Pages
Emergency Red Flags
Seek emergency care if MS symptoms include sudden complete vision loss, severe weakness preventing walking, difficulty swallowing/breathing, or sudden severe headache — these may require hospital-level intervention.
Page Information
Multiple sclerosis is a chronic autoimmune neurological disease where the immune system attacks myelin — the protective insulation around nerve fibers in the brain and spinal cord. This causes inflammation, demyelination, and eventually nerve damage, leading to varied symptoms including vision problems, weakness, numbness, balance difficulties, and cognitive changes. MS typically begins in young adults (20-40 years) and follows relapsing-remitting (most common), primary progressive, or secondary progressive patterns.
Diagnosis requires evidence of central nervous system lesions separated in time and space (McDonald criteria). Brain and spinal cord MRI with contrast is essential, showing characteristic white matter plaques. Lumbar puncture may detect oligoclonal bands in cerebrospinal fluid. Visual evoked potentials test optic nerve conduction. Blood tests exclude MS mimics like neuromyelitis optica (NMO), lupus, Lyme disease. At Kathmandu Neurology Clinic, Dr. Jitendra Prasad Yadav (NMC 8029) coordinates MRI at available centers and interprets results in clinical context.
Disease-modifying therapies (DMTs) reduce relapse frequency and slow progression. Injectable options (interferon beta, glatiramer acetate) are available in Kathmandu pharmacies, though sometimes require import coordination. Oral DMTs (fingolimod, dimethyl fumarate, teriflunomide) availability varies. High-dose IV methylprednisolone treats acute relapses and is readily available at hospitals. Monoclonal antibodies (ocrelizumab, natalizumab) require specialized infusion centers and international procurement. Dr. Jitendra coordinates DMT access, monitors for side effects (liver function, blood counts), and manages symptomatic treatments for spasticity, fatigue, neuropathic pain.
No cure exists, but MS is increasingly manageable. Early DMT initiation (within first years after diagnosis) reduces long-term disability risk. Treatment goals are: prevent relapses, slow progression, maintain quality of life, manage symptoms. Many patients remain ambulatory and employed for decades with appropriate therapy. Stopping DMTs without medical guidance risks disease reactivation.
Optic neuritis (sudden vision loss, eye pain with movement) is common first presentation. Other symptoms: unilateral limb weakness or numbness, double vision, electric-shock sensation down spine with neck flexion (Lhermitte sign), imbalance, bladder urgency, heat-induced symptom worsening (Uhthoff phenomenon), fatigue, cognitive slowing. Symptoms typically develop over days, peak, then partially or fully resolve — this relapsing pattern distinguishes MS from stroke (sudden) or brain tumor (progressive without remission).
MS prevalence is lower in tropical and subtropical regions including Nepal compared to temperate zones (latitude gradient). However, cases do occur and are likely under-diagnosed due to limited MRI access and referral delays. Young adults with unexplained neurological episodes lasting days to weeks warrant MS evaluation, especially with optic nerve or spinal cord features.
Seek evaluation for: sudden vision loss in one eye with eye pain; unilateral weakness, numbness, or tingling lasting days; double vision; severe imbalance or vertigo lasting days; bladder control difficulties; electric shock sensation with neck movement; recurrent unexplained neurological episodes. Early referral after first demyelinating event allows timely MRI, diagnosis discussion, and DMT consideration — early treatment improves long-term outcomes.
Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600 — led by Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS). Services: MS diagnostic workup, MRI interpretation, DMT coordination and monitoring, relapse management, symptomatic treatment (spasticity, pain, fatigue). Book via /book-appointment or call 974-7736624, Sun-Sat 9AM-7PM by appointment. Bring prior MRI reports, blood tests, and symptom timeline.
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