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RJ, age 38 years, has a 15-year history of relapsing-remitting multiple sclerosis. She initially presented with highly-active MS and was started on beta-interferon-1a 44µg. She continued to have significant clinical disease activity and ongoing MRI lesions in both brain and spine. She was transitioned to fingolimod in 2012.
Her MS was generally well-controlled for many years. She was relapse-free with no definite progression although there were occasional breakthrough MRI lesions over the next six years. RJ reported worsening symptoms and difficulty concentrating. Her MRI at that time showed three new lesions. She opted to switch to an anti-CD20 agent three and a half years ago.
She has had no relapses on anti-CD20 therapy. Her neurological examination has been stable for years. Positive findings are: visual acuity 20/30 on the right and 20/25 on the left with optic disc pallor; asymptomatic left INO; moderate limb dysmetria; mild bilateral hip flexor weakness with no other motor abnormalities except minimal spasticity; bilateral extensor plantars; absent vibration at the great toes; normal gait except for some minimal difficulty with tandem; normal bladder function; and no cognitive impairment. Her disability score is EDSS 3.5.
RJ tried to get pregnant for a year prior to her diagnosis without success. There was no fertility assessment or treatment at that time. She stopped pregnancy planning when the relationship ended and has consistently stated over the years that she had no plans to get pregnant. However, at her last visit, RJ said she is in a new relationship and she and her new partner would like to have a child.