Working Diagnosis:
Multiple Sclerosis. The patient was formally diagnosed with Multiple Sclerosis following the 2024 McDonald criteria based on the presence of oligoclonal bands in her cerebrospinal fluidF, 1 clinical episode, and 2 or more radiographic lesions.

Treatment:
The patient was admitted for IV steroids then discharged with an oral steroid taper. At a later neurology followup she was started on Ofatumumab (Kesimpta).

Outcome:
One month after her admission she had no signs or symptoms of relapse with return of motor strength to her left hand. She was later able to participate in physical therapy and workouts over the summer without restriction with eventual full return to competition.

Author's Comments:
Multiple sclerosis is the most common cause of nontraumatic neurologic disability in young adults, typically onset between age 20-40. Athletes with multiple sclerosis should be encouraged to return to physical activity as regular exercise is safe and provides significant benefits for mobility, fatigue, and quality of life. Exercise does not increase the risk of relapse or serious adverse events. Disease-modifying therapy has been shown to alter the course of multiple sclerosis, decreasing the rate at which disability progresses, and is also associated with a lower likelihood of transitioning to progressive disease. Most medications used in the treatment of multiple sclerosis do not cause side effects that would contraindicate physical activity. It should be noted that S1P receptor modulators like fingolimod and siponimod can cause bradycardia and heart block.

Editor's Comments:
Multiple sclerosis is an autoimmune- mediated neurodegenerative disease within the central nervous system characterized by inflammatory demyelination within the axonal transection. There are seven primary phenotypes of multiple sclerosis though the primary pehnotype is Relapsing-Remitting which our athlete likely is presenting with. However as this is her first episode of neurologic decline continued monitoring for acute relapses would be needed to confirm the phenotype. If our athlete did not meet the 2024 McDonald Criteria then a diagnosis of clinically isolated syndrome could have been made based on their presentation being the first acute neurologic decline with recovery. On return to sporting our athlete’s coaches should be informed of the Uhtoff phenomenon which can be triggered by high temperatures and psychological stress. During episodes of Uhtoff phenomenon, patients experience transient and reversible neurologic worsening with symptoms returning to baseline with cooling. As a result training scheduling during the day and appropriate cooling strategies may need to be considered.

References:
McGinley MP, Goldschmidt CH, Rae-Grant AD. Diagnosis and Treatment of Multiple Sclerosis: A Review. JAMA. 2021;325(8):765- 779. doi:10.1001/jama.2020.26858

Hoang PD, Lord S, Gandevia S, Menant J. Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. J Sci Med Sport. 2022 Feb;25(2):146-154. doi: 10.1016/j.jsams.2021.08.015. Epub 2021 Aug 24. PMID: 34538565.

Learmonth YC, P Herring M, Russell DI, Pilutti LA, Day S, Marck CH, Chan B, Metse AP, Motl RW. Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis. Mult Scler. 2023 Nov;29(13):1604-1631. doi: 10.1177/13524585231204459. Epub 2023 Oct 26. PMID: 37880997; PMCID: PMC10637110.

Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol. 2017 Sep 16;17(1):185. doi: 10.1186/s12883-017-0960-9. PMID: 28915856; PMCID: PMC5602953.

Dimitrov LG, Turner B. What's new in multiple sclerosis? Br J Gen Pract. 2014 Dec;64(629):612-3. doi: 10.3399/bjgp14X682609. PMID: 25452512; PMCID: PMC4240117.

Cohen BA. Choosing initial MS therapy; personal, disease, and medication factors. Neurotherapeutics. 2025;22(4):e00582. doi:10.1016/j.neurot.2025.e00582.

Return To The Case Studies List.