A 40 -year-old woman has relapsing/remitting multiple sclerosis. She has experienced two attacks of disease previously that have left her with residual lower extremity weakness. She was initially treated with glucocoicoids with some improvement in her symptoms. However, she is currently only able to walk with a rolling walker about 100 m. A prior antibody test shows that she is negative for reactivity to the JC virus. You are planning to sta a disease-modifying therapy. Which of the following drug that causes a maximum reduction in appearance of new lesions and change in disease severity ?

Treatment of Multiple Sclerosis- Acute attack of optic neuritis = IV methylprednisolone Natalizumab: Highly effective in reducing attack rate Improves all measures of disease severity in MS. Once a month infusion- Inhibit binding of T lymphocyte to capillaries related to blood brain barrier- Damage to BBB is minimised S/E = JC virus (John Cunningham virus) activation leading to PMF Progressive multifocal leukoencephalopathy - worsening of neurological features. It is ideal for patient with JC virus negative are eligible to get Infusion of natalizumab. Ocrelizumab = acts by attacking mature B cell which express CD 20 Is allowed for management of P.P.M.S Drugs given in MS: HIGHLY EFFECTIVE Moderately effective -Natalizumab -Ocrelizumab -IFN ss -Glatiramer -Fingolimod -Dimethyl Fumarate