الفهرس 
Definition, Etiology and EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Summary
Multiple sclerosis (MS) is a progressive inflammatory disease of the central nervous system. It is the most common cause of neurologic disability in young adults, with onset generally occurring between ages 15 and 40 years old (Fernando, 2009). Our study in Ain Shams University hospitals from January 2012 till April 2014 includes 300 Egyptian MS patients diagnosed according to Revised McDonald criteria 2010 (Polman et al., 2011), showed that 26.7% of cases were males while 73.3% were females.
The mean age of our patients was 30.9±8.5, the mean age of onset of disease was 25.69±7.27, the mean duration of illness was 5.28±4.82, the mean EDSS was 3.41± 2.01, the mean Number of relapse was 3.58+2.59 and the mean Number of relapse in last 2 years was 1.63+1.19.
As regard family history of the patients there was (4.7%) of patients had family history of MS, and (15.7%) of patients had history of consanguinity. While (3%) of patients had past history of steroid induced DM (onset of DM after onset of MS and related to use of steroid), 3 (1%) had past history of depression.
Majority of our patients (85.3%) has age of onset of disease between 18-40 years old, while (11.3%) had onset of disease less than 18 years old and (3.3%) had onset of disease more than 40 years old.
RRMS is the most common type of MS in our patients (75.7%) while (17.3%) had SPMS, (2.7%) had PPMS and (4.3%) had PRMS.
32We found in our study that motor presentation is the commonest presentation (23.7%), followed by visual (18.3%), sensory (17.7%) and brain stem (12.7%) and the least is sphincteric presentation (0.3%).
According to EDSS; (56.7%) of patients had EDSS (0-3), (31.3%) of patients had EDSS (3.5-6), (12%) of patients had EDSS (6.5-9).
Also (35.3%) of our patients receiving Interferons, (17.3%) Cytotoxic drug, (2.7%) Fingolimod, (0.3%) Natalizumab, (17%) corticosteroids yet (27.3%) did not receive any disease modifying drug.
Nearly all patient (99%) of patients had T2 periventricular lesion, (95.3%) had T2 Juxtacortical lesion, (71.7%) had T2 Infratentorial, while (57.7%) of patients had T2 Cervical lesion, (47.3%) of had T2 Dorsal lesion and as regard T1 black holes there were (62.3%) of patients had black holes in T1 and (32.5%) had contrast enhanced lesions.
As regard VEP (43.9%) of patients had unilateral demyelination of retinocortical pathway, (25.9%) had bilateral demyelination, (28.8%) had no abnormality yet (1.4%) had axonal affection of retinocortical pathway.
We found that sex of patients correlated with clinical presentation, Type of MS and disability of patients measured by EDSS as following; Motor presentation is the commonest presentation in both sex yet female has high focal spinal and combined presentation compared to male. While Females has lower EDSS compared to males, (61%) of females and (43.8%) of males has EDSS 0-3. And also females commonly has RRMS type, (76.7%) of RRMS patients were females compared to (23.3%) were males while males commonly has progressive type of MS.
Mean age of our patients in female 30.79 years old yet in male 31.25 years old, mean age of onset in female 25.77 years old yet in male 25.48 years old.
As regard Age of our patients in different types of MS being younger in RRMS 29.41 years old, while older age found in other progressive types SPMS 35.56, PPMS 32.25, and PRMS 37.69 years old.
Age of onset differ in different types of MS, showed correlation between grouping of patients according to age of onset of MS and their type. RRMS is the common type in different age groups (p value > 0.05). However (30%) of patients more than 40 years were PRMS compared to (5.9%) of patients less than 18 years, and (3.1%) of patients between 18-40 years (p value < 0.01).
Age of onset has direct proportional relationship with disability of patients measured by EDSS (p value 0.038).
Relapsing remitting MS commonly presented by sensory (20.7%), followed by visual (19.8%) and motor (18.5%). yet progressive type commonly presented by motor presentation being (18.5%) of RRMS compared to (36.5%) of SPMS and (75%) of PPMS and (30.8%) of PRMS (p < 0.05).
Forty percent of RRMS patients were on INF compared to cytotoxic (9.3%). While in SPMS cytotoxic drug is more common (42.3%) compared to INF (21.2%) (P value < 0.05).
Seventy two percent of RRMS had EDSS 0-3 compared to 7.7% of SPMS, 12.5% of PPMS. Yet in progressive type it was (40% of SPMS, 50% of PPMS, and 46.2% of PRMS) had EDSS 6.5-9 (p value < 0.01).
The mean duration of disease is 5.28 + 4.82 years for all patients. Yet it is being shorter in RRMS compared to progressive type; RRMS 4.13 years, SPMS 9.13 years, PPMS 8.37 years, PRMS 7.92 years (p value 0.0001).
We found early diagnosis in patients presented by motor then visual and combined presentation. Compared to late diagnosis was found in sensory presentation (P value > 0.05).
Mean EDSS of our patients were 3.41+2.01 yet in female 3.25 and in male 3.85 (p < 0.05). Also it differs between different types of MS being lower in RRMS (2.63) compared to SPMS (5.85), PPMS (5.38) and PRMS (6.02) (p value 0.0001). Also EDSS has significant direct proportional relationship with total numbers of relapses (r= 0.0144, P value 0.013).
Patient with lower EDSS (0-3) (41.2%) are receiving INF compared to (7.6%) are receiving cytotoxic drugs. While in group of patients with higher EDSS (6.5-9) (38.9%) are receiving cytotoxic drugs compared to (13.9%) are receiving INF (p < 0.05).
EDSS were lower in patients whom first presentation was sensory (2.56) and visual (2.74) compared with higher EDSS in patients with first presentation cerebellar (5.04) then motor (4.06) (p value 0.0001).
Black holes lesion in MRI considered as indicator of more disability so it is correlated with patients sex and type of MS and EDSS; Black holes were more common in male (72.5%) than female (58.6%). Also were more prevalent in SPMS (82.7%) than RRMS (58.8%).
Black holes also were more prevalent in patients with first clinical presentation being motor (27.8%) followed by
visual (18.2%), sensory (16.6%). And also were more common in patients with higher EDSS, (88.9%) and (70.2%) of patients with EDSS (6.5-9) and (3.5-6) respectively compared with (52.4%) of patients with EDSS (0-3) (p value < 0.01).
Infratentorial lesion commonly present in patients higher disability, 94.4% of patient with higher EDSS (6.5-9) had Infratentorial lesion and 78.7% of patients with EDSS (3.5-6) had Infratentorial lesion compared to 62.9% of patients with EDSS (0-3) had Infratentorial lesion (p < 0.01).
Cervical lesion correlation with disability, among 225 patients who performed cervical MRI, patient with higher EDSS (95.2% of patients with EDSS 6.5-9) and (80% of patients with EDSS 3.5-6) were shown to have cervical lesion compared to (72.4% of patients with EDSS 0-3) (p < 0.01).
PASAT testing done for 135 patients showed that the result range from 40 to 60 with mean+ SD score 52.8+ 4.8. it has inverse relationship with EDSS as patients with high EDSS has lower score in PASAT and patients with lower EDSS has higher score in PASAT (r= -0.461, p value 0.0001).