Multiple Sclerosis Patients with Markedly Low Intrathecal Antibody Response in Sri Lanka.

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.

A case of POEMS syndrome with mixed hyaline vascular and plasma cell type Castleman's disease.

We report a 43-year-old man who developed progressive ascending sensorimotor polyneuropathy, a solitary bone plasmacytoma originating from a rib and an axillary lymph node with features of Castleman's disease, mixed hyaline vascular and plasma cell type. He was diagnosed of having non-Hodgkin's lymphoma seven years back and was treated. Examination revealed a smooth goitre, thickened skin, white nails, small testes and ankle oedema. Investigations revealed a monoclonal para-proteinaemia of 7.83 g/l and elevated levels of serum TSH and prolactin. In this case the Castleman's disease is localised and the lymphoma preceded the Castleman's disease.

The prevalence of peripheral neuropathy in newly diagnosed patients with non-insulin-dependent diabetes mellitus.

INTRODUCTION: Neuropathy is considered to be a longterm complication of diabetes. AIMS: To determine the prevalence of peripheral neuropathy in 112 Sri Lankan patients with recently diagnosed non-insulin-dependent diabetes and a control population of 100 people. METHODS: A diagnosis of peripheral neuropathy was made using a clinical symptom score, clinical examination, quantitative sensory testing and electrophysiological studies. RESULTS: 9.8% of diabetic patients at diagnosis had peripheral neuropathy, 2.6% had foot ulcers, 7.1% had signs of neuropathy, abnormal vibration perception threshold and nerve conduction abnormalities and 15.1% had abnormal nerve conduction velocity without signs or symptoms of neuropathy. The peroneal nerve conduction velocity was higher in diabetic patients when compared to controls. There was an inverse correlation between nerve conduction velocity and fasting blood glucose in diabetic patients (p < 0/05). This association was stronger for peroneal nerve conduction velocity (r = -0.73) than for median nerve motor conduction velocity (r = -0.42). CONCLUSIONS: Symptomatic peripheral neuropathy is common among Sri Lankans with newly diagnosed non-insulin-dependent diabetes. This may be due to a later presentation of diabetes or a genetic predisposition.

Familial amyloid polyneuropathy in a Sri Lankan family.

A woman who presented with features of peripheral sensory, motor and autonomic neuropathy and amyloid deposits in the vitreous due to familial amyloid polyneuropathy (FAP) is described. Her father had died of a similar illness and one of her brothers and her two children had lesions suggestive of early amyloid deposits in the vitreous. Reports of familial amyloidosis are rare from Asian countries and it has not been reported in Sri Lanka previously.