Abstract
Multiple sclerosis (MS) is a heterogeneous disease which is poorly studied in Asia, where the disease is known to be rare with significant differences in clinical and radiological presentations and intrathecal antibody response. Therefore the objective of this study was to determine clinical presentation, radiological and neurophysiological characteristics, and oligoclonal band status in Sri Lankan MS patients, following careful exclusion of patients with neuromyelitis optica spectrum disorders and other conditions mimicking multiple sclerosis. Sixty-nine MS patients were recruited to the study adhering to McDonald 2010 criteria. Their clinical presentation, characteristics of central nervous system lesions in magnetic resonance imaging, visual evoked potential (VEP) results, oligoclonal bands (OCB), and AQP4 antibody status were studied. Of 69 MS patients, 54%, 6%, and 1% were relapsing remitting, secondary progressive, and primary progressive, respectively, and 39% were patients with clinically isolated syndrome. The commonest clinical presentations were cerebral motor followed by cerebral sensory and optic neuritis. Majority had typical periventricular and infratentorial lesions in MRI. Though not clinically apparent, bilateral delay of P100 wave latency was present in 52%. OCB positivity was 42% and AQP4 antibody was positive in only one patient. In conclusion, this group of Sri Lankan MS patients shares most of the clinical and radiological features of Caucasian MS patients. However, the OCB positivity is lower in this group, when compared to the Caucasian MS populations.
Highlights
Multiple sclerosis (MS) is heterogeneous in terms of disease prevalence, clinical and paraclinical characteristics in different regions, and ethnicities in the world [1,2,3,4]
Following application of inclusion and exclusion criteria, 69 MS patients were included in the study (Figure 1)
Cerebellar and brain stem manifestations were present in only 32% and 29%, respectively
Summary
Multiple sclerosis (MS) is heterogeneous in terms of disease prevalence, clinical and paraclinical characteristics in different regions, and ethnicities in the world [1,2,3,4]. There are MS hot spots in Florida, Canada, and Norway, reinforcing the fact that geographic factors may have directly influenced occurrence of MS [6, 7]. This is probably due to the geographic isolation of populations causing selection of candidate genes responsible for MS. This aspect may be relevant to Sri Lanka which is a geographically isolated island in which the unique geography can influence its confined population genetics. It was recently proved that Sri Lankans are different to Caucasians in clinical pathologies, disease courses, outcomes, and treatment responses for many diseases [9]
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