Cerebrospinal fl uid analyses in Thai multiple sclerosis patients

Objective: To evaluate cerebrospinal fl uid (CSF) patterns in Thai multiple sclerosis (MS) patients particularly oligoclonal bands compared with Western MS. Methods: Retrospective review of 72 patients from the MS Clinic, Siriraj Hospital, between January 1997 and June 2004. All were diagnosed MS using the Poser’ s criteria. Results: Seventy-six patients were evaluated. There were 62 female (86.1%),10 male (13.9%) with a female:male ratio of 6.2:1. The mean age at onset was 33.11±11.76 years. The mean duration of disease was 6.62 ± 5.9 years. Among the 56 MS patients, 52 patients (72.2%) had relapsing-remitting course, 3 (4.2%) had progressive relapsing course, 1(1.4%) had secondary progressive course, none had primary progressive course. Eleven patients (15.3%) had possible MS and the remaining 5 patients had Devic’s syndrome. Approximately 46% had CSF white blood cell (WBC) less than 5 cells/μL. Only 1 (2.3%) had CSF WBC count more than 50 cells/μL. However, both opticospinal form and classic form of MS similarly showed mononuclear cell predominant in differential CSF WBC count. Presence of CSF oligoclonal bands in defi nite MS patients was low in prevalence of only 27.3%. Conclusion: The CSF of Thai MS patients have lower incidence of oligoclonal bands compared with the reports from western countries.

Patterns of single photon emission tomography (SPECT) among patients with dementia in the memory clinic at Siriraj Hospital.

OBJECTIVE: The authors hypothesized that there is a pattern difference in cerebralperfusion of the 99-Technitium L, L-ethyl cysteinate dimer Single Photon Emission Computer Tomography (99-Tc ECD SPECT) between mild and moderate to severe dementia. MATERIAL AND METHOD: The authors reported a retrospective study in the Memory Clinic, Siriraj Hospital between January 2001 and October 2003 including only patients with Alzheimer's disease, vascular dementia, and mixed dementia. Clinical dementia rating (CDR) was used to document dementia severity. Patterns of hypoperfusion were classified into no definite hypoperfusion, regional hypoperfusion, and diffused hypoperfusion. RESULTS: One hundred and seven patients were included in the present study. Only mean Thai Mental State Examination (TMSE) score was different between the two groups. There was no significant correlation between pattern of hypoperfusion in brain SPECT and severity of dementia. CONCLUSION: The authors cannot demonstrate the pattern of hypoperfusion of 99-Tc ECD SPECT among patients' difference in dementia severity.

Use of Hachinski Ischemic Score in the memory clinic: Thai experience.

BACKGROUND: The validity ofHachinski Ischemic Score (HIS) in differentiating between Alzheimer's disease (AD) and Vascular dementia (VaD) has been questioned and compared with the gold standard autopsy. OBJECTIVE: To confirm that the HIS can be used to differentiate related VaD from AD in a Thai population. MATERIAL AND METHOD: A prospective study of 398 patients who were attending the Memory Clinic, at Siriraj Hospital between January 2001 and October 2003. RESULTS: The 214 patients, with a mean age of 71.15 + 10.20 years, were classified as AD, VaD or mixed dementia (AD with cerebrovascular disease) in proportion of 60.2%, 30.4%, and 9.3% respectively. The authors propose HIS at 5 as a cut off point to differentiate patients with AD and those with VaD or AD with cerebrovascular disease with sensitivity of 85.3% and specificity of 72.9%. CONCLUSION: The HIS can be applied to differentiate dementia related vascular etiology from AD in a Thai population.