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Early-detection demo · Optic neuritis → MS confirmed

Vision blur + Lhermitte's · OCTON ranked MS at 14× lift · DMT started within 11 days

Four periventricular FLAIR lesions + one juxtacortical + one infratentorial — dissemination in space + time per McDonald 2017.

Patient: Theo · 32 · software engineerModality: MRIRisk: high · 68/100
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01

Risk profile

What OCTON knew before the scan
Risk
68
high
Tier
high
Caucasian male · 1-week left eye blur with pain on eye movement · Lhermitte's sign (electric tingle on neck flexion) · no prior episodes · vitamin D 18 ng/mL.
Contributing factors
  • Acute optic neuritis (typical MS presenting symptom)+28
  • Lhermitte's sign (cervical cord involvement)+14
  • Age 32 (peak MS onset 20–40)+10
  • Latitude origin (Northern Europe ancestry)+8
  • Vitamin D deficiency (18 ng/mL)+8
Narrative

Theo presents with two clinical events (optic neuritis + cord) — dissemination in time clinically satisfied. MRI confirmed dissemination in space (≥1 lesion in ≥2 of: periventricular, juxtacortical, infratentorial, spinal cord). McDonald 2017 criteria met at presentation; no second clinical attack needed.

01.5

Cinematic findings

Bayesian posterior · Hebbian cross-specialty co-activation
Bayesian posterior
Multiple sclerosis (RRMS)
14.3×
Lift
Pretest 6.0%→Posterior 86.0%
Evidence chain · LR per signal
  • Acute optic neuritisLR ×6.0
    ONTT, Beck · Arch Ophthalmol 2003;121:944 — ON predicts MS in ~50% over 15 yrs (HR ≈ 6 with MRI lesions).
  • Lhermitte's sign (cord)LR ×2.4
    Al-Araji & Oger · Mult Scler 2005;11:398 — Lhermitte's is highly specific for cervical-cord demyelination.
  • ≥3 periventricular FLAIR lesionsLR ×4.0
    Thompson et al · Lancet Neurol 2018;17:162 (McDonald 2017) — periventricular DIS lesions are core MRI criterion.
  • Active enhancing cord lesion (DIT)LR ×3.2
    Thompson et al · Lancet Neurol 2018;17:162 — gadolinium-enhancing + non-enhancing satisfies DIT in McDonald 2017.
Cross-specialty co-activation
Primary: Neurology
4
Edges fired
Neurology↔Ophthalmology
78%
Optic neuritis is presenting feature; OCT thinning useful biomarker
Neurology↔Mental Health
62%
Depression prevalence 50% in MS — proactive screening
Neurology↔Musculoskeletal
44%
Spasticity/gait → falls prevention
Neurology↔Metabolic
32%
Vit D deficiency + bone health long-term
01.75

Lifespan forecast

Where you'll be in 30 years · with vs without intervention
Without intervention
73.5years
−5.8 years vs baseline
With OCTON intervention
83.4years
Returns to ~baseline (79.3 yrs)
Net years protected
+9.9years · 12.6 QALYs
10-yr event risk: 40% → 5%
30394857667584+0y+5y+10y+15y+20y+25y+30y73.5 yrs83.4 yrsFORECAST · 30-YEAR LIFE EXPECTANCY · AGE 32 → AGE 62
No intervention With OCTON Baseline US life table
EvidenceAAN 2018 + ECTRIMS + MS-Base registry + Marrie 2018 lifestyle-MS cohort — early high-efficacy DMT outperforms escalation; layered with Mediterranean + vitamin D ≥4000 IU + smoking cessation + zone-2 cardio, NEDA-3 is maintained in 60-70% at 5 years and projected life recovers ~13 years over the untreated trajectory.
How to actually realise the gain

These are the specific levers OCTON puts on your plan — each one comes with the expected impact below.

drug
Ofatumumab 20 mg SC monthly (anti-CD20 high-efficacy)
10-yr disability progression < 8%; NEDA-3 ~65%
scan
Annual brain MRI + cervical cord
Disease-activity surveillance
diet
Mediterranean + Vit D 4000 IU/day + omega-3
Adjunct; ↓ flare rate; bone health
exercise
Aerobic 3×/wk + resistance + balance training
Improves fatigue, cognition, BDNF; falls prevention
lifestyle
Tobacco cessation + stress management + CBT
Smoking ↑ MS progression by 2×; depression screening
02

Scan + AI report

What MRI found · 3T brain MRI · FLAIR + post-contrast T1 · MS protocol
MRI · DEMO
McDonald 2017 RRMS criteria MS confirmed
OCTON · scanning · live
conf 0.85
OCTON Impression · 90% confidence

Multiple FLAIR-hyperintense lesions in characteristic MS distribution: 4 periventricular (Dawson's fingers configuration), 1 juxtacortical (right frontal), 1 infratentorial (pons), 1 cervical cord at C2 (active enhancement). Pattern + clinical history meet McDonald 2017 criteria for MS at first presentation.

Findings
  • 4 periventricular FLAIR lesions (Dawson's fingers) · Bilateral periventricular WM
  • 1 juxtacortical lesion · Right frontal lobe
  • 1 infratentorial lesion · Pons
  • Active enhancing cervical cord lesion · C2 spinal cord
  • 1 active enhancing periventricular lesion (DIT) · Left frontal periventricular
Differential diagnosis
  • Relapsing-remitting multiple sclerosis (RRMS)86%
  • Clinically isolated syndrome (CIS) — high conversion risk8%
  • NMOSD (AQP4-IgG)3%
  • Acute disseminated encephalomyelitis (ADEM)2%
  • Migraine-associated WM changes1%
Recommended actions
  • ▸AQP4-IgG + MOG-IgG to rule out NMOSD before DMT selection
  • ▸CSF (OCB + IgG index) for confirmation; not required if MRI meets criteria
  • ▸Neuro-ophthalmology evaluation; high-dose IV methylprednisolone if vision dropping
  • ▸Initiate disease-modifying therapy: ofatumumab or ocrelizumab (high-efficacy first-line per AAN 2018)
Caveats
  • Early high-efficacy DMT reduces 10-year disability progression vs. escalation strategy.
  • Vitamin D repletion to 50–80 ng/mL is adjunct, not therapy.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Disease-modifying therapy (ofatumumab 20 mg SC monthly)
FrequencyMonthly, indefinite
Startsage 32
AAN 2018 + ECTRIMS — high-efficacy first-line
Medical
Vitamin D + B12 + folate
FrequencyAnnual
Startsage 32
MS supportive care 2024
Monitoring
Brain MRI surveillance
Frequency6 months, then annual
Startsage 32
ECTRIMS treatment-monitoring
Monitoring
EDSS scoring + cognitive baseline (SDMT)
FrequencyAnnual
Startsage 32
MS clinical surveillance
Monitoring
Mood + cognition surveillance
  • ▸PHQ-9 every 6 months (treat ≥10)
  • ▸GAD-7 every 6 months (treat ≥10)
  • ▸SDMT cognitive baseline at diagnosis, annual thereafter
  • ▸Same-day referral to MS-trained psychotherapist if PHQ ≥15
FrequencyEvery 6 months
Startsage 32
AAN MS Quality Measures 2018 — depression prevalence 50% in MS
Lifestyle 360°
Diet · exercise · sleep · stress — the behaviours that move the needle
Diet
Mediterranean + Vit D + omega-3
  • ▸Vitamin D 4000 IU/day · target serum 25(OH)D 50-80 ng/mL
  • ▸Omega-3 EPA+DHA 2-3 g/day (fatty fish 3×/wk OR algal supplement)
  • ▸High-fibre Mediterranean base · ≤25 g added sugar/day
  • ▸Ultra-processed foods minimised (gut-MS axis emerging evidence)
  • ▸Adequate protein 1.2 g/kg/day for muscle preservation
FrequencyDaily
Startsage 32
Iranian Whole-grain MS 2021 + Vit D MS meta-analysis 2022 (modest evidence)
Exercise
Aerobic + resistance + balance (MS-specific)
  • ▸Aerobic 3×/wk · moderate intensity (RPE 5-6) · 30-40 min
  • ▸Resistance 2×/wk · 60-70% 1RM · 8-12 reps · 3 sets
  • ▸Balance + proprioception 2-3×/wk (BOSU, single-leg work, Tai Chi)
  • ▸Cooling strategies on hot days (Uhthoff symptom prevention)
  • ▸Pacing: stop before exhaustion · rest:work 1:1
Frequency5 days/wk (cardio · resistance · balance rotation)
Startsage 32
MS Society 2023 + Motl MS Exercise 2017 RCT — improves fatigue, gait, mood, BDNF
Lifestyle
Sleep · stress · tobacco abstinence
  • ▸Zero tobacco / vaping (smoking 2× speeds disability progression)
  • ▸7-8 hr sleep · screen for nocturia, restless legs, REM disturbance
  • ▸Stress management — CBT, mindfulness, or DBT for adjustment
  • ▸Alcohol ≤7 drinks/wk · avoid binge episodes (interacts w/ DMT)
  • ▸Heat avoidance — cool showers, cooling vests in summer
FrequencyDaily
Startsage 32
Hedström BMJ 2023 — smoking doubles MS progression; sleep + stress predict relapse
04

What changed

The early-detection win

Theo's vision blurred on a Tuesday. He thought it was eye strain from late hours. By Friday his right hand was tingling and his neck flexion sent a sharp electric pulse down his spine. OCTON's tools moved his MS posterior probability from 6% (general population) to 86% (clinical + 7 MS-pattern lesions on MRI). DMT started day 11. Two years later: EDSS 1.0, full vision recovered, zero new lesions. Without the early diagnosis + high-efficacy DMT, RRMS 10-year disability progression averages 35%; with it, <8%.

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