Clinical spectrum of multiple sclerosis at a tertiary care hospital in Pakistan

To assess the clinical presentation of multiple sclerosis. This hospital based observational study was carried out from November 2004 to June 2005 at the Department of Neurology Jinnah Post Graduate Medical Center Karachi. Patients of multiple sclerosis [MS] diagnosed on Poser's criteria were observed on the basis of age at the onset, gender, family history, symptoms and signs, clinical course, magnetic resonance imaging, visual evoked potentials, cerebrospinal fluid and oligoclonal bands. Out of 20 patients there were 13 females with M:F ratio of 1:2. Mean age at presentation was 25.8 years. Family history was negative. Clinical presentation included pyramidal weakness [75%], visual defect [70%], sphincter disturbances [60%], sensory impairment [35%], cerebellar signs [30%] and paroxysmal spasm [25%]. The clinical course of multiple sclerosis included Relapsing and Remitting RRMS [55%], Secondary Progressive SPMS [20%], Primary Progressive PPMS [15%] and Progressive Relapsing PRMS [10%]. Optico-spinal type was seen in 55%. Magnetic resonance imaging of brain was positive in 75% and of cervico-dorsal in 100%. Visual evoked potential was abnormal in 85% and oligoclonal bands were present in 5%. Multiple Sclerosis [MS] is not uncommon in Pakistan. The study revealed that young females were affected more compared with men with a ratio of 2:1 and mean age of onset was 25.8 years. Clinical type is in agreement with Asian variety of disease with high occurrence of optico-spinal presentation and low yield of oligoclonal band