الفهرس 
MULTIPLE SCLEROSIS OVERVIEWOnly 14 pages are availabe for public view
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Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease
of the brain and spinal cord that is a common cause of
serious physical disability in young adults. Occurrence of MDs
is not uncommon as was previously known. Presence of MDs
in MS patients and its prevalence is variable and has different
effect on QOL. MDs occurrence may be associated with
different degrees of depression and CI. Our study aimed to
show different types of MDs, their prevalence, associated
clinical findings and their effect on QOL.
This study included 250 patients diagnosed with RRMS,
184 females and 66 males, age from 18-60 years with no other
associated immunological disorders. Co-morbidities present in
our patients are diagnosed after development of MDs. Patients
were recruited consecutively from the MS clinic of Ain Shams
and Nasr institute hospitals. inclusion and exclusion criteria
aimed to exclude MS activity at time of interviewing and
progressive forms, Presence of MDs primarily and presence of
chronic severe illness causing MDs (e.g severe hepatic and
renal impairment). Complete demographic and clinical data
were gathered from the patients.
Prevalence of MDs among our patients is estimated.
Cerebellar signs occurred in our patients recording 26% of our
total sample mostly are combined ataxic gait and upper limbs
intentional tremors. Tremors affecting about 14.4% of the total sample mostly are mixed postural and intentional tremors in
both upper and lower limbs and tongue tremors are reported in
one case. MDs were the presenting symptom in MS patients in
16.4% of the total number of MDs patients and 4.4% of the
total sample. Rest tremors was presenting symptom in one case.
This study showed presence of 5 cases of restless leg
syndrome, 4 cases of dystonia are present in this study
accounting for 2%, 1.6% of total sample respectively.
Ataxia in this study was assessed using SARA scale and
most our patients were minimal to mild affection with only 2
cases were severe affection. Our patients with tremors were only
mild to moderate with no patients showed severe affection.
Presence of MDs in our sample of RRMS patients showed
mean MS duration of 6.6 years with mean onset of 2.6 years from
MS diagnosis and showed significant correlation with MS
duration, activity of the disease shown as increased total number
of relapses since diagnosis of MS and relapses last year. Also
their occurrence was more with male sex.
As a consequence of disease activity and presence of
movement disorders, EDSS is increased and showed more
escalation from first to second line therapy as a result of disease
activity and increased disability. Increased EDSS had negative
impact on all domains of QOL except RE.Presence of tremors in our patients showed significant
correlation with MS duration and activity with no significant
correlation with age, gender, age of diagnosis or current DMT
our patients on for MS.
Severity (total score) of tremors didn’t correlated with
EDSS score but correlate negatively with QOL implying its
disability effect in patients with MS so, disability caused by
tremors may be independent of EDSS and should be assessed
cautiously as a cause of disability not to be missed.
Severity (total score) of ataxia is correlated well with
EDSS and negatively with PF domain of QOL which is good
indicator for increased disability.
Presence of MDs in our patients is associated with both
higher lesion load either number or confluent lesions in brain
MRI and strategic location of these lesions as infratentorial
either cerebellum or cerebellar peduncle and spinal lesions.
Co-occurrence of depression in patients with MDs was
common and most patients with movement showed mild to
moderate affection and only 6 cases showed severe affection
with depression and this co-occurrence was not correlated with
severity of tremors but correlated well with severity of ataxia
and showed negative impact on all domains of QOL.
Cognitive function was assessed also in patients with
MDs and 71.6% of patients showed cognitive impairment with no correlation present with severity of tremors or ataxia.
Presence of CI is early in MS patients with MDs although
didn’t show correlation with any domain of QOL but should be
taken in consideration and assessed well early.