Some neuropsychiatric and MRI manifestations in patients with multiple sclerosis

Abstract

Background Neuropsychiatric abnormalities are common in multiple sclerosis (MS) patients. Cognitive dysfunction affects ∼40% of MS patients. Advances in neuroimaging are increasing our understanding of the pathogenesis of these disorders. Aim This study aimed to assess the possible neurological and psychiatric complications and cognitive impairment in MS patients and to correlate the psychiatric symptoms with clinical types, severity, and MRI findings in MS patients. Participants and methods This is a cross-sectional descriptive study that was carried out on 25 patients diagnosed with definite MS according to McDonald’s criteria. All patients were subjected to a semi-structured interview that included demographic data and full neurological and psychiatric examination, Expanded Disability Status Scale (EDSS) evaluation, Mini-Mental State Examination (MMSE), and MRI brain with assessment of the lesions number, site, and brain atrophy. Results This study included 25 adults, 19 women and six men. They ranged in age from 22 to 55 years, mean age 33±9 years. The mean disease duration was 6.4±3 years. Sixty-four percent of the patients were married. Sixty-four percent of the patients had the relapsing remitting type of MS. Fatigue was the most prevalent symptom (96%), followed by sphincter troubles, (80%) visual symptoms (76%), dizziness (64%), sexual dysfunction (60%), and pain (56%). EDSS showed that 44% of the patients had moderate disability, 32% of the patients needed intermittent or constant unilateral assistance, and 24% of the patients needed constant bilateral support. On applying the Structural Clinical Interview for DSM-IV Axis I (SCID-I), it was found that depression (60%), dysthymia (60%), and generalized anxiety disorder (68%) were the most prevalent psychiatric presentations. For the MMSE, 24% of the patients showed an MMSE score between 17 and 25 and 4% the patients showed scores less than 17. Assessment of MRI brain showed that atrophic brain changes were present in 72% of the patients. All the patients studied had supratentorial plaques and 44% had frontal plaques. Infratentorial lesions were present in 72% of MS patients. Conclusion and recommendations Attention should be focused on the other important presentations of the disease such as psychiatric disorders and cognitive impairments, and a comprehensive biopsychosocial neuropsychiatric approach should be adopted, which is essential for optimal care of patients with MS.