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Distorted vision. MRI showed demyelination and suspected MS. Prescribed Predmet. Want to be sure of diagnosis

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Posted on Sun, 9 Sep 2012
Question: My wife has been suffering with distorted vision for about 2 months now. We went to see a neurologist in Manipal Hospitals, Bangalore and he suggested MRI scan. Based on that, he diagnosed demyelination and suspected multiple sclerosis. He prescribed predmet 4 mg which she took for about 1 months and solved the problem temporarily but the ailment reappeared a few days back. We went to an another doctor, and he also agreed with the diagnosis, but suggested 3 doses of 1000 mg predmet first and then to be continued with 4mg predmet. Before we wanted to take these 1000 mg predmet, we wanted to be 100% sure that we are treating the right ailment and that the prescription is correct.

Can you please help us? If required, please suggest some good doctors whom we should consult
doctor
Answered by Dr. Sudhir Kumar (1 hour later)
Hi XXXXXXX

Thank you for writing to us.

I have gone through your mail and I understand that a possible diagnosis of multiple sclerosis- a demyelinating disease of brain and spinal cord- has been made. It is an auto-immune disease, where antibodies are formed against one's own tissues, in this case- central nervous system.

The diagnosis of multiple sclerosis is made on the basis of MRI, CSF analysis, evoked potential studies and clinical features.

Treatment in the initial stage consists of steroids- and the medicine and dose recommended by your doctor is correct.

One also needs to continue treatment to prevent future relapses of multiple sclerosis. Please discuss this issue with your doctor, once the initial steroids treatment is completed.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad

Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Sudhir Kumar (30 minutes later)
Dr XXXXXXX
thank you so much with quick and concise response. I am little confused on the dosage as two different doctors prescribed two different dosage. The initial dosage was 40 mg which worked initially but after 2-3 weeks, the problem reappeared and the drug seemed inaffective thereafter. The other doctor prescribed three sessions of 1000mg initially which we have not undergone yet. So, what do you suggest? Go back to the doctor who prescribed 40 mg predmet?
doctor
Answered by Dr. Sudhir Kumar (39 minutes later)
Hi XXXXXXX

The correct dosage is INJ. METHYLPREDNISOLONE 1000 mg once daily for three days. Please take it under the supervision of the treating doctor.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sudhir Kumar (3 days later)
Dr XXXXXXX my wife underwent another MRI scan, this time contrast MRI. The reports are not very reassuring. It says "Hypertense Lesion in the right temporal white matter ? demylenation. However a possibility of neoplasia cannot be excluded. Suggested follow up/further evalaution"

Can you pleaase quickly suggest us some good neurologist/neurosurgeon in Bangalore (or anywhere in India, we can travel)
doctor
Answered by Dr. Sudhir Kumar (5 hours later)
Hi XXXXXXX

Thank you for sending the MRI report. As you have correctly pointed out, the MRI report does not give a final conclusion- there is a doubt whether it is demyelination (such as multiple sclerosis) or neoplasia (tumor). The final diagnosis depends on the clinical picture of the patient, reports of other tests (such as CSF analysis), etc. Sometimes, a biopsy of the brain lesion may be advised.
In Bangalore, you can either consult Dr XXXXXXX XXXXXXX at Manipal Hospital or Dr XXXXXXX at Columbia Asia Hospital.
Just to let you know, I would be too pleased to help you in case you wish to travel to Hyderabad.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Sudhir Kumar (5 days later)
After a couple of follow ups, the doctors have confirmed that my wife is suffering from MS. Can you please suggest some specialists in Bangalore or anywhere in India who have proven track record in hanlding MS cases?
doctor
Answered by Dr. Sudhir Kumar (2 hours later)
Hi XXXXXXX
Thank you for getting back.
Neurologists in India who have very good experience in treating MS are: Dr B S Singhal (Mumbai), Dr XXXXXXX XXXXXXX (Hyderabad Apollo, Ex-HOD, CMC Vellore), Dr Lekha Pandit (Mangalore).
I hope your wife will get the best treatment and would recover fast. Please get back if you require any additional help.
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Distorted vision. MRI showed demyelination and suspected MS. Prescribed Predmet. Want to be sure of diagnosis

Hi XXXXXXX

Thank you for writing to us.

I have gone through your mail and I understand that a possible diagnosis of multiple sclerosis- a demyelinating disease of brain and spinal cord- has been made. It is an auto-immune disease, where antibodies are formed against one's own tissues, in this case- central nervous system.

The diagnosis of multiple sclerosis is made on the basis of MRI, CSF analysis, evoked potential studies and clinical features.

Treatment in the initial stage consists of steroids- and the medicine and dose recommended by your doctor is correct.

One also needs to continue treatment to prevent future relapses of multiple sclerosis. Please discuss this issue with your doctor, once the initial steroids treatment is completed.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad