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D.C. is a 41-year-old woman diagnosed with multiple sclerosis 14 years ago. She was treated initially with a beta interferon. She experienced ongoing disease activity and was transitioned to natalizumab 10 years ago. She was completely stable for six years. She was switched to fingolimod after a significant change in JCV index. She had no MRI changes on natalizumab and a few new MRI lesions on fingolimod. She had no new lesions while on natalizumab and few MRI changes on fingolimod. Her EDSS score a year ago was 1.5 (vision 1, sensory 1, bladder 1).

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