Regarding the comments presented by one of our reader, I need to explain two points: First, our representation did not mean that hoarseness by itself is equal to multiple sclerosis disease (MS) without any history of sign or symptoms of another CNS involvement. As mentioned in our manuscript, the patient had some history of dysuria, paresthesia and some minor signs in physical examination indicating CNS damage.
Second, in literature we can see repeated reports of peripheral nervous system involvement alongside the main CNS signs of the disease, as peripheral neuropathy or cranial nerve involvement in MS. So MS is essentially a CNS disease which can present unusually with some extra axial features. Thanks for your attention.