Clinical and diagnostic aspects of multiple sclerosis in the population of Ulaanbaatar city, Mongolia / Монголын Анагаах Ухаан

ABSTRACT

Introduction: However MS having been diagnosed in Mongolia during the last 40-50 years, there are difficulties in its differential diagnoses from other demyelinating diseases. Therefore our main reasons are to do study the clinical characteristics of MS with comparison MRI findings.Goal. To determine the clinical characteristics of MS with correlations to MRI-findings using caseobserved methods.Materials and Methods: Used the “door-to-door” method to be find out and work with that 115 subjects, from which selected according to the diagnostics criteria 67 patients with following reexaminations for confirmation of diagnosis, during next 2 years these cases were studied with MRI and VEP to compare clinical manifestations, common forms by age and sex. 34 subjects for MRI and 6 patients for VEP examinations undergone respectively; SPSS-15.0 used to analyze collected materials; for description of the data used mean, median, standard deviation; to detect inter variable association used “t”-test, “Chi-square”, correlation coefficient; P-value for all significant cases.Results:Among sixty-seven MS patients the main clinical forms were cerebrospinal (55 patients – 82.1%), pure cerebral (4 patients–6.0%) and pure spinal–(8 patients–11.9%). Clinical course was relapsingremitting in 39 patients (58.2%); secondary-progressive in 12 patients (17.9%); progressiverelapsing in 13 patients (19.4%), and primary-progressive in 3 patients (4.5%). The most common location of first attacks was pyramid system–46,3%, visual pathway, predominantly causing damage to the optic nerve–43.3%, followed by the spinal cord - 37.3%, optic-spinal-20.9% and brainstem–10.3%. Pyramid, sensory and vision-dissociated symptoms were also reported in 77% of patients, and paroxysmal symptoms in 67% of patients. The MRI scan performed in 34 patients–50.7% determined dissemination-in-time 10(29.4%) and in-space 18(53%). On MRI scans in T2-weighted images, 16 hyperintense lesions within the periventricular white matter were found (56,3%); 3 lesions in area pons and cerebella (5,95%); 13 lesions in spinal cord white matter (30,4%) and 2 lesions in nervous opticus tract (7,45%). Conclusions: The main clinical forms were cerebrospinal (82%) and opticospinal, which formed more than half of the cases, in which relapsing-remitting (58%) and progressive-relapsing courses (19%) predominated. The relapsing and progressing course of the disease was directly determined by clinical symptoms and MRI scan findings of dissemination-in-time and in-space of existing lesions. As MS can be asymptomatic, it was found that MRI-findings were positive (11.8%) even when clinical manifestations disappeared.