الفهرس | Only 14 pages are availabe for public view |
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. |