الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Multiple sclerosis (MS) is a complex immune mediated disorder of central nervous system. Multiple sclerosis is the most common non-traumatic cause of neurological disability in middle adulthood.
There are four clinical phenotypes of MS. Initially, more than 80% of individuals with MS experience a relapsing-remitting disease course (RRMS) characterized by clinical exacerbations of neurologic symptoms followed by complete or incomplete remission. After 10 to 20 years, or median age of 39.1 years, about half of them gradually accumulate irreversible neurologic deficits with or without clinical relapses, which is known as secondary progressive MS (SPMS). Another 10% to 20% of individuals with MS are diagnosed with primary progressive MS (PPMS), clinically defined as a disease course without any clinical attacks or remission from onset.
Viruses appear to play a role in modulating the neuro-immunological system of genetically susceptible individuals to cause MS. For instance, IgG antibodies against several viruses including VZV, CMV, measles, rubella, mumps and HSV-1 have been identified in the CSF of patients with MS.
HCV has a major impact on public health with over 170 million infected individuals. It has been considered to cause 25% of hepatocellular carcinoma (HCC) and 27% of cirrhosis cases all over the world. Death rate due to HCV infection is very high and approximately 350, 000 people die every year after being infected with HCV.
Egypt has one of the highest prevalence rates of hepatitis C virus (HCV) infection in the world. The HCV epidemic appears to have been initiated by vigorous public-health campaigns using intravenous tartar emetic from the 1950s until 1982 to eradicate schistosomiasis. This iatrogenic mode of infection has now resulted in a high incidence of hepatic morbidity and mortality from the late complications of HCV infection, such as chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Among the six major HCV genotypes found worldwide, genotype 4 is the most predominant in Egypt with 4a as the dominant subtype.
In the present study 203 Egyptian patients were included in our sample from MS Unit, Neurology department at Ain Shams University Hospital with inclusion and exclusion criteria aiming to eliminate factors that cause MS- like symptoms in different medical and neurological conditions to insure only the RRMS type is correctly diagnosed. All subjects underwent HCV Ab screening by commercially available ELISA kits in El Demerdash internal medicine laboratory, then those with positive Ab in serum did PCR and follow up after 6 months clinically and radiologically which were compared with baseline MRI at the beginning of the study, the aim was to determine prevalence of HCV in patients having RRMS and Its effect on clinical aspect in such patients compared to others free from HCV.
The results showed that prevalence of HCV among studied patients with RRMS was 4.9%, however prevalence of HCV in Egypt is 10.6% as postulated by Egyptian study in 2017.
There was a higher percentage of positive family history of MS among cases with positive HCV compared to negative cases and the difference is significant statistically, so it may ensure the importance of asking about FH in the first visit.
Although there was a lower mean age at onset (22.7 years)among cases with HCV compared to cases with no HCV (25.4 years), the difference is not significant statistically.
Although there was a higher mean duration of illness among HCV positive patients compared to HCV negative patients , the difference is not significant statistically.
There was a higher mean number of relapse among HCV positive compared to HCV negative and the difference is highly significant statistically, It was also found that the HCV cases had 4.9 times the risk of developing relapse during the study compared to HCV negative patients.
Our study showed that a higher mean EDSS among HCV positive compared to negative patients after 6 months but the difference is not significant statistically.
It was found that higher percentage of lesions in T2 infratentorial among HCV patients compared to HCV negative and the difference is significant statistically.
It was also found that It was found that a higher percentage of positive flair cervical spine among HCV positive after follow up compared HCV negative but the difference is not significant statistically.
It was found that no significant difference statistically between cases with low or high count PCR count (infectivity) as regards occurrence of relapse during the study.