Natural history of multiple sclerosis from the Indian perspective: Experience from a tertiary care hospital.

CONTEXT: Multiple sclerosis (MS) has a spectrum of heterogeneity, as seen in western and eastern hemispheres, in the clinical features, topography of involvement and differences in natural history. AIM: To study the clinical spectrum, imaging, and electrophysiological as well as cerebrospinal fluid (CSF) characteristics and correlate them with outcome. SETTINGS AND DESIGN: Retrospective analysis of MS patients during a period of 20 years. SUBJECTS AND METHODS: Cases were selected according to recent McDonald's criteria (2010), They were managed in the Department of Neurology, Christian Medical College, Vellore. STATISTICAL ANALYSIS USED: Chi-square and Fisher's exact tests were used for categorical variables. Multiple binary logistic regressions were done to assess significance. Kaplan-Meier curves were drawn to estimate the time to irreversible disability. RESULTS: A total of 157 patients with female preponderance (55%) were included. The inter quartile range duration of follow-up was 9.1 (8.2, 11) years for 114 patients, who were included for final outcome analysis. Relapsing remitting MS (RRMS) (54.1%) was the most common type of MS seen. RRMS had a significantly better outcome (odds ratio: 0.12, 95% confidence interval: 0.02-0.57, P = 0.008) compared to progressive form of MS (primary progressive, secondary progressive). The Expanded Disability Status Scale score of patients at presentation and at final follow-up was 4.4 ± 1.31 and 4.1 ± 2.31, respectively. During the first presentation, polysymptomatic manifestations like motor and sphincteric involvement, incomplete recovery from the first attack; and, during the disease course, bowel, bladder, cerebellar and pyramidal affliction, predicted a worse outcome. CONCLUSION: A high incidence of optico-spinal presentation, predominance of RRMS and a low yield on cerebrospinal fluid (CSF) studies are the major findings of our study. A notable feature was the analysis of prognostic markers of disability.

Meningo-Encephalitis due to Spotted Fever Group Rickettsia--A Rare Case Report with Serial Follow up MRI.

Spotted fever group (SFG) Rickettsial infection has rarely been reported to develop severe central nervous system involvement. We report a case of meningoencephalitis presenting with fever, headache, drowsiness, seizures, and a skin rash, showing ELISA IgM positivity to SFG Rickettsia group. MRI brain showed multifocal bilateral asymmetric patchy areas of T2W/FLAIR hyperintensity with significant diffusion restriction. Treatment with doxycycline resulted in clinical & radiological improvement. Rickettsial meningoencephalitis is a relatively under-diagnosed entity, probably due to the low index of suspicion and the lack of definitive diagnostic facilities in developing countries. This case was presented to highlight the importance of clinical suspicion mainly in endemic areas, the potential severity of the disease, and the need of early initiation of therapy to prevent mortality and long term neurological morbidity.