PO10TU03 Multiple Sclerosis, disability and progression in Pakistan

Archives of Ophthalmology, 2003

Objective: To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of optic neuritis. Methods: Three hundred eighty-eight patients who experienced acute optic neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years. Results: The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (PϽ.001, log rank test). Among the patients who had no lesions on MRI, male gender and optic disc swelling were associated with a lower risk of multiple sclerosis, as was the presence of the following atypical features for optic neuritis: no light perception vision; absence of

Neuro-Ophthalmology, 2011

Optic neuritis (ON) is highly associated with multiple sclerosis (MS) and conversion rate has been reported to be around 50% over a period of 15 years. We revised the risk factors for developing MS after an attack of ON, in western Turkey. One hundred and twenty-four patients with acute unilateral ON, who were on follow-up for at least 5 years (range 62 to180 months, mean 85 months) were enrolled in the study. Gender, age at onset, seasonal occurrence, severity of visual loss, presence of pain, optic disc appearance, treatment, degree of recovery, presence or absence of lesions on magnetic resonance imaging (MRI) during the initial ON attack and recurrence were considered. Of the 124 patients, 89 (71.8%) were women, 35 (28.2%) were men, with a mean age of 28.7 ± 8.6 years at the time of the initial ON attack. During follow-up, 70 patients (56.5%) developed MS within 17.14 months, ranging from 1 to 125 months. Female gender (p = 0.021), experiencing the attack before 40 years of age (p = 0.02), normal-appearing optic discs (p = 0.005), presence of MRI lesions (p < 0.001), and recurring ON attacks (p = 0.014) were significantly associated with a high risk of developing MS. The period for development of MS was significantly shorter in patients with MRI lesions (p < 0.001). Optic neuritis patients with brain MRI findings showing the morphological evidence of disseminated disease can be considered to have MS at the time of the initial ON attack, and disease-modifying treatments can be initiated.

Multiple sclerosis and related disorders, 2020

Background: The epidemiology of multiple sclerosis (MS) and neuromyelitis optica (NMO) remains to be clarified or updated in many parts of Asia. This study aims to investigate the epidemiology and comorbidities of MS and NMO during 2001-2015 in Taiwan. Methods: We conducted a retrospective nationwide population-based study using data from Taiwan's National Health Insurance Research Database. Cases of MS and NMO aged 20 years or above during 2001-2015 were enrolled. The incidence, prevalence, demographic features, and comorbidities were investigated. Results: We identified 4627 MS and 861 NMO incident cases aged 20 or above during 2003-2015. The incidence of MS was relatively stationary, while that of NMO apparently rose steeply during the study period. The agestandardized incidence rate of MS and NMO in 2015 were 1.34 and 0.61 per 100,000 person-years, respectively. The age-standardized prevalence rate of MS and NMO in 2015 were 6.69 and 1.47 per 100,000 persons, respectively. The female preponderance was evident for both MS and NMO. Except for diabetes mellitus, the most common autoimmune comorbidities for MS and NMO were Sjogren syndrome and systemic sclerosis, and Sjogren syndrome and systemic lupus erythematosus, respectively. Conclusions: Taiwan has transitioned from low-to medium-risk zone during 2001-2015 in terms of MS prevalence, although its incidence remained stationary. The apparent upsurge of NMO over the period probably reflects increased awareness of this clinical entity. Comorbid autoimmune disorders were relatively common, and overlapping but differential autoimmune comorbidity profiles were noted for MS and NMO.

Acta Neurologica Scandinavica, 1997

We report a partially retrospective and longitudinal study of patients with optic neuritis (ON) that developed multiple sclerosis (MS). We assessed clinical features or factors that might differentiate these patients from those with ON that did not develop MS. Of the cases followed, 110 (67%) were found to have an idiopathic origin of the disease; whereas 55 (33%) were found to develop it secondary to another disease. Of the 110 idiopathic cases, 13 (12%), developed MS over an average of 2 years. The results of these patients in the laboratory analyses of blood and CSF as well as the results of the MRI and evoked potential studies, were significantly different from the ON patients without MS. We conclude that the percentage of patients with ON in our sample that developed MS is similar to that found in Japan and is relatively low in comparison to other reports.

Japanese Journal of Ophthalmology, 2006

Caspian Journal of Internal Medicine, 2015

Background: Multiple sclerosis (MS) is an inflammatory and demyelinating disease of central nervous system (CNS). The aim of the present study was to determine the type and the frequency of initial presenting symptoms in patients with MS and their relation with demographic characteristics in Babol, northern Iran. Methods: All patients of this study were recruited over a ten year period from 2002 to 2012 from single neurologic clinic. Diagnosis of MS was confirmed according to the McDonald criteria, demographic and clinical features Then, all the clinical findings and demographic variables including: age, sex, marital status, age at onset, education, place of residence, disease duration, initiation pattern of disease have been collected. Expanded Disability Status Scale (EDSS) was used for the evaluation of disability at the onset of disease. Data analysis was performed by chi-square test. Results: A total of 263 consecutive MS patients with the age range of 17 to 61 yr were examined. Optic neuritis was the most prevalent initial presenting symptom in 123 (46.8%) patients followed by sensory disturbances as the second common presenting symptom of MS. Significant difference was found between patients with or without optic neuritis and the onset age of the disease and EDSS (p<0.001). The mean EDSS score at the time of initial presentation was 1.67±0.77. Conclusion: The findings of this study indicated that optic neuritis is the most prevalent initial presentation of MS in the geographic region of northern Iran. In patients less than 30 years, development of visual disturbances justifies neurologic examination.

Acta Neurologica Scandinavica, 2011

The Tohoku Journal of Experimental Medicine, 2013

Romanian Journal of Neurology, 2012

Our aim was to identify possible correlations between physical disabilities assessed by expanded disability status score (EDSS) and neurodegenerative process measured by retinal nerve fi bers thickness, and also with demyelization process measured by visual evoked potential with P100 wave latency at optic nerve level on patients diagnosed with multiple sclerosis (MS). This study aimed to fi nd a structural biomarker at central nerve system (CNS) level which could correlate with clinical disability. The optic nerve is an accessible structure of CNS easy to investigate. We analyzed a population of 111 patients diagnosed with different clinical forms of multiple sclerosis based on 2005 revised Mc Donald criteria, for whom we assessed clinical disability by EDSS, and by different subscales of multiple sclerosis composite (MSFC) as timed to walk 25 foot (TW25F) and nine hole peg test (9HPT). Optic nerve involvement was assessed for each eye measuring visual acuity (VA) (Snellen chart), P100 wave latency by visual evoked potential (VEP) and retinal nerve fi ber layer thickness (RNFL) by optical coherence tomography (OCT). The medium age of our population was 38.09 and the medium EDSS was 3.3.-76 out of 111 were women. 79 patients were diagnosed with relapsing remitting (RR) MS, 7 with clinically isolated syndrome (CIS), the other were diagnosed with progressive form of MS: 7 with primary progressive MS and one with primary progressive with relapse MS. We obtained positive correlations, and statistically signifi cant between EDSS and 9HPT for dominant hand (r= 0.58, p = 0.0001) and also for non dominant hand (r = 0.66, p = 0.0001) using Pearson correlation. EDSS score correlates statistically signifi cant with P100 wave latency and visual acuity for both eyes using Pearson correlation, so we obtained negative correlation between EDSS and VA for right eye (r =-0.45, p = 0.0001), and for left eye (r =-0.49, p = 0.0001). We also observed statistically signifi cant positive correlation between EDSS and P100 wave latency for right eye (r = 0.405, p = 0.0001), and left eye (r = 0.400, p = 0.0001). RNFL doesn't correlate with EDSS, VA or P100 wave latency. Using chi square correlation between EDSS score (we choose a cut of value of 3) and pathological value of RNFL by OCT we didn't obtain a statistical signifi cant result. The results were : for right eye phi = 0.01, p = 0.9), and for left eye (phi =-0.1, p = 0.3). Similar results were obtained for EDSS of 4.0. The results were: for right eye (phi=-0.009, p= 0.9), and for left eye (phi = 0.017, p = 0.8). In conclusion, in order to understand the pathology of multiple sclerosis the anterior optic nerve pathway offers an attractive model. Optic nerve assessment can be realized through non-invasive complementary methods. Functional and structural data of optic nerve can be obtained by VA measurement, VEP and OCT assessments. Our study showed that axonal pathology of the optic nerve (part of CNS exclusively composed by white matter) correlates with clinical disability measured by EDSS, suggesting that P100 latency is a functional biomarker of the disease. A prospective study to validate such a marker of the progression of the disease is needed.

Neurology, 2022

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