39-year-old man diagnosed with RRMS 2 years ago. The patient is self-employed and has to drive a car and travel regularly 1 Gad-enhancing lesion. A CSF analysis showed the presence of oligoclonal bands. for work. The patient is the primary caregiver of his 2 adolescent children.
At his initial visit, the patient reported an onset of weakness in the left arm, which was followed by subsequent weakness descending down to the left leg that lasted for 5 days. Additionally, he reports difficulty with mood control, particularly depression and agitation.
Motor examination revealed moderate paresis in the left upper extremity and mild ataxia in tandem gait. His EDSS at the time of presentation was 3.0. Initial diagnostic workup with MRI showed lesions concentrated in the frontal and parietal white matter of the brain: 3periventricular lesions; 4 T2 lesions;