The Condition: Update of Recent Appointment with Consultant Neurologist.

Mr. O. SpaceMan - DOB- 20.01.1958

Diagnosis:
                   Relapsing/remitting MS - sensory episode left buttock 2009 (that should read 2010)
                   Sensory transverse myelitis March 2012
                   Left optic neuritis September 2012 treated with three days of oral Methylprednisolone
                   Past history of depression

Investigations:
                   MRI brain scan - left optic nerve enhancement and periventricular lesions
                   MRI spine - non-specific, no clear white matter lesions.
                   Chest x-ray - nil of note
                   Blood tests pending.

I saw this 55 year old right handed gentleman as a follow up to Dr. S. seeing him in December 2012.
He is awaiting an outpatient appointment at Southampton to discuss disease modifying therapy.  He has had no further episodes since September.  He has spoken to our MS Specialist Nurse and has not conducted the blood tests suggested as yet, but will do so via GP, as he still has the forms at home.

Today, I have rediscussed with the diagnosis, the mild episodes that he has had in the past, the left optic neuritis, the lack of lesions on his MRI spine scan and the possibility of a lumbar puncture to confirm inflammation and rule out any other causes.  He is reluctant to have this conducted, and will think about  it.

On examination today,  he was alert and orientated and looked well.  On cranial nerve examination there was no abnormality.  I could not detect an RAPD or any optic disc pallor.
There was no INO.  On limb examination, he had a postural tremor, but tone, power, coordination and reflexes were all normal.  Plantar reflexes were down going today.  Sensory examination to all modalities, except vibration was normal.  Vibration was reduced to the metatarsophalangeal joints bilaterally and gait was nomad.

Today, I explained to him that it could be helpful if he could have the blood tests done which he will do .
He will await an outpatient appointment with Dr. H. and think about the lumbar puncture, and I will see him again in 12 months time.

We briefly discussed disease modifying therapy in terms of allowing reduction in relapse rate, but perhaps not halting them completely, and his mild symptoms which he was not particularly troubled by at present.

Yours sincerely

Electronically signed.

Since this meeting I have made the decision not to follow up the disease modifying therapy options.

Now let's see what happens...