Clinical spectrum of multiple sclerosis at a tertiary care hospital in Pakistan

To assess the clinical presentation of multiple sclerosis. This hospital based observational study was carried out from November 2004 to June 2005 at the Department of Neurology Jinnah Post Graduate Medical Center Karachi. Patients of multiple sclerosis [MS] diagnosed on Poser's criteria were observed on the basis of age at the onset, gender, family history, symptoms and signs, clinical course, magnetic resonance imaging, visual evoked potentials, cerebrospinal fluid and oligoclonal bands. Out of 20 patients there were 13 females with M:F ratio of 1:2. Mean age at presentation was 25.8 years. Family history was negative. Clinical presentation included pyramidal weakness [75%], visual defect [70%], sphincter disturbances [60%], sensory impairment [35%], cerebellar signs [30%] and paroxysmal spasm [25%]. The clinical course of multiple sclerosis included Relapsing and Remitting RRMS [55%], Secondary Progressive SPMS [20%], Primary Progressive PPMS [15%] and Progressive Relapsing PRMS [10%]. Optico-spinal type was seen in 55%. Magnetic resonance imaging of brain was positive in 75% and of cervico-dorsal in 100%. Visual evoked potential was abnormal in 85% and oligoclonal bands were present in 5%. Multiple Sclerosis [MS] is not uncommon in Pakistan. The study revealed that young females were affected more compared with men with a ratio of 2:1 and mean age of onset was 25.8 years. Clinical type is in agreement with Asian variety of disease with high occurrence of optico-spinal presentation and low yield of oligoclonal band

Management of periocular post burn scarring in the epileptics

To assess the clinical presentation and management of patients with epilepsy presenting with periocular post burn scarring. Design: Prospective and descriptive study. Place and Duration of Study: Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi from September 1999 to September 2002. Subjects and This study included 23 patients who had epilepsy and presented with periocular post-burn scarring to the eye department for management. All patients had contractures of their lids with variable amounts of corneal scarring and damaged to the eye ball. The surgical procedure performed consisted of release of contracture, horizontal lid shortening and application of free skin graft. There were 18 [78.26%] female and 5 [21.73%] male patients. The age range was from 18 to 45 years with a mean of 28 years. In 17 [73.91%] patients, lid contracture was released to cover their eyeballs. In 6[26.08%] patients the eyeball was lost due to late presentation. There should be a high index of suspicion in facial burns for ophthalmic damage and early referral to an ophthalmologist should be made to prevent complications. Early release of contracture with application of full or partial thickness skin grafts is advisable