Analysis of 50 cases of demyelinating diseases of central nervous system

Demyelinating disorders of the central nervous system were common among younger age group patients(50%).Females were more affected than males. (58% vs 42%). Most of the patients presented with pyramidal tract involve ment-68%. Bladder involvement seen in 20% of patients and the remaining cases presented with brain stem, cerebellar, optic nerve and sensory involvement. Four patients had Secondary Demyelination, among which two cases were HIV ELISA positive, one case occurred following Herpes Zoster, one case occurred following chicken pox. CSF analysis showed positive oligoclonal band in 54% of the patients. Patients with periventricular T2 weighted lesions and posterior fossa lesions in MRI had more disability with EDSS score of 6.0 Primary demyelinating diseases were more common than secondary demyelinating diseases. Primary demyelinating disorders include twelve cases of Multiple Sclerosis, two cases of Devic’s disease and eleven cases of ADEM. There were four cases of Secondary demyelinating disorders, the causes of which include HIV in 2 patients, Herpes Zoster in one patient and Chicken pox in one patient. Twenty one cases were diagnosed to have clinically isolated syndrome of demyelination presented in the form of idiopathic demyelinating transverse myelitis. These patients had 70-80% chance of devoleping multiple sclerosis later as the MRI images of these cases showed more than three T2 weighted lesions in spinal cord. Hence these patients need further regular follow up with MRI imaging studies. The response to steroid therapy was good in 75% of MS patients, 50% of the idiopathic demyelinating transverse myelitis patients and in 46% of the ADEM cases. All the patients were followed up for six weeks after steroid therapy Patients who had more than three segmental involvement in spinal cord and those with more than three peri callosal, peri ventricular and posterior fossa lesions in MRI images showed poor clinical recovery. CONCLUSION : 1. Demyelinating disorders of the central nervous system are common among younger age group patients 2. Females are more affected than males. 3. Primary demyelinating diseases are more common than secondary demyelinating diseases. 4. Clinically isolated demyelination syndrome patients need regular follow up with MRI imaging in due course. 5. Patients with more than three segmental involvement in spinal cord and those with more than three peri-callosal, peri- ventricular and posterior fossa lesions in MRI images has poor clinical recovery after treatment. 6. MRI brain and spine provides more prognostic information than clinical assessment