A 35-year-old female presented to the medicine OPD with paresthesias and weakness of B/L lower limbs with a band like sensation of tightness around the torso along with painful loss of vision in both eyes along with diplopia and periorbital pain. There is a history of similar attacks in the past with period of normalcy in between O/E, Ataxia- present Papillitis (on fundus examination) Facial myokymia Bladder incontinence and constipation CSF studies revealed mononuclear cell pleocytosis along with increased IgG. Which of the following are the oral drugs approved for the above condition: - 1. Fingolimod 2. Natalizumab 3. Teriflunomide 4. Glatiramer acetate

This is a case of relapsing-remitting multiple sclerosis. 1ST IMAGE: -Demonstrates multiple bright signal abnormalities in white matter, typical for MS. 2ND IMAGE: - Shows the classical Dawson finger sign. DRUGS APPROVED: - Interferon beta: inhibition of T-lymphocyte proliferation Glatiramer acetate: immunomodulation (GIVEN SUBCUTANEOUSLY) Teriflunomide: reduces both T-cell and B-cell activation and proliferation (GIVEN ORALLY) Dimethyl fumarate: immunomodulation Fingolimod: prevents lymphocyte migration out of lymph nodes and into CNS (GIVEN ORALLY) Natalizumab: inhibits binding of lymphocytes to endothelium (INTRAVENOUSLY GIVEN) Alemtuzumab: immunomodulation of T-cell and B-cell function Mitoxantrone: reduces T-cell and B-cell proliferation and reduces T-cell activation