Characteristic of Multiple Sclerosis Patients in Sri Lanka: a preliminary study

Abstract

Multiple Sclerosis (MS) is an immune mediated, chronic neurological disease. It is a heterogeneous disease of which the aetiology is considered to be both genetic and environmental. The objective of this study was to characterize MS in the Sri Lankan context.

Fifty seven (57) MS patients tentatively diagnosed by a Consultant Neurologist and a Consultant Physician were recruited from Teaching Hospitals Kandy and Peradeniya. Subsequent to informed written consent, their clinical histories, examination findings and investigation results were recorded using interviewer based questionnaires.

The analysis revealed that MS is common among females in this study group with a ratio of 1:1.85. The average age of disease onset is 33 years. Only 4 patients had a definitive diagnosis of MS whereas majority were ‘possible MS’ cases according to revised McDonald’s criteria 2010. Seventeen (17) patients had MRI (𝘔𝘢𝘨𝘯𝘦𝘵𝘪𝘤 𝘙𝘦𝘴𝘰𝘯𝘢𝘯𝘤𝘦 𝘐𝘮𝘢𝘨𝘪𝘯𝘨) features suggestive of MS. The most common presenting complaints were related to 𝘮𝘰𝘵𝘰𝘳 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 and the 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 related to 𝘰𝘱𝘵𝘪𝘤 𝘯𝘦𝘶𝘳𝘪𝘵𝘪𝘴. Of the 17 patients with MRI features suggestive of MS, 6 had positive 𝘷𝘪𝘴𝘶𝘢𝘭 𝘦𝘷𝘰𝘬𝘦 𝘱𝘰𝘵𝘦𝘯𝘵𝘪𝘢𝘭 (VEP) results. All the four confirmed MS patients had positive VEP results. The 𝘙𝘦𝘭𝘢𝘱𝘴𝘪𝘯𝘨 𝘢𝘯𝘥 𝘳𝘦𝘮𝘪𝘵𝘵𝘪𝘯𝘨 𝘵𝘺𝘱𝘦 was observed to be the commonest subtype (53%). 𝘕𝘦𝘶𝘳𝘰 𝘔𝘺𝘦𝘭𝘪𝘵𝘪𝘴 𝘖𝘱𝘵𝘪𝘤𝘢 (NMO) and vasculitis conditions are the differential diagnoses that were frequently considered in MRIs. The frequent co existence of 𝘛𝘳𝘢𝘯𝘴𝘷𝘦𝘳𝘴𝘦 𝘔𝘺𝘦𝘭𝘪𝘵𝘪𝘴 was noted among patients with MS.

The observed female predominance and the average age of onset of disease are similar to the reported data on western population. However, the presenting symptoms show considerable variations, as 𝘴𝘦𝘯𝘴𝘰𝘳𝘺 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 are found to be the commonest presenting symptom in western populations. Although𝘳𝘦𝘭𝘢𝘱𝘴𝘪𝘯𝘨 𝘳𝘦𝘮𝘪𝘵𝘵𝘪𝘯𝘨 𝘵𝘺𝘱𝘦 is common in the study group, the percentage is much lower when compared with the western population (85%). There are some atypical clinical presentations suggesting the presence of a variant of MS in our population. NMO and vasculitis conditions are frequently considered differential diagnosis of MS. Frequent presence of 𝘛𝘳𝘢𝘯𝘴𝘷𝘦𝘳𝘴𝘦 𝘔𝘺𝘦𝘭𝘪𝘵𝘪𝘴 has been reported to be typical for Asians and the same is observed in this study.

In conclusion, the diagnosis of MS is inconclusive at the onset, i.e. suggestive rather than confirmatory. A variation in the clinical presentation observed in this study group confirms the heterogeneity of MS in our population. These results should be correlated with the c𝘦𝘳𝘦𝘣𝘳𝘰 𝘴𝘱𝘪𝘯𝘢𝘭 𝘧𝘭𝘶𝘪𝘥 𝘰𝘭𝘪𝘨𝘰 𝘤𝘭𝘰𝘯𝘢𝘭 𝘣𝘢𝘯𝘥 response to refine the heterogeneity observed.