Two questions from a healthcare provider about multiple sclerosis

Here is My Question:
Is it possible to have multiple sclerosis without any vision involvement? The patient had demyelinating plaques in the MRI with typical clinical findings of ataxia, hyperreflexia and clonus. He never complained of visual symptoms. The optic nerve was normal. 

Second question: Do we treat patients with prophylaxis such as pegylated interferon if they present with a first attack with no such attacks before?
Thank you.

Answers:

1. Yes it is possible to have multiple sclerosis without any vision involvement.  The majority of patients with multiple sclerosis will eventually have problems with their vision due to the MS but a small minority may never have vision problems due to the MS.

2. In general most multiple sclerosis specialists do recommend treating patients who have had a first attack of demyelination suggestive of MS, even if they do not meet the diagnostic criteria for MS yet.  There have been several trials involving almost all of the injectable medications (interferons and glatiramer acetrate) demonstrating benefit from early treatment after the initial first attack.

Dr Osborne

Benjamin J. Osborne, MD, is an attending physician in the Department of Neurology and an associate professor of neurology and ophthalmology at MedStar Georgetown University Hospital.Dr. Osborne is board certified in neurology, with concentrations in neuro-opthalmology and multiple sclerosis.