Multiple Sclerosis: Experience in a Single Center in the UAE
Dr Rahashekher Garikapati, Neurologist, Aster Hospital, Mankhool
Dr Mahendra Ramadas, Neurologist, Aster Clinic, Bur Dubai, Dubai
Dr Amit Arora, Neurologist, Aster Clinic, Al Muteena, Deira, Dubai
Dr Pawan Kumar Maniyar, Radiologist, Aster Hospital, Mankhool, Dubai
Dr Naveen Bhardwaj, Radiologist, Aster Hospital, Mankhool, Dubai
CASE REPORTS:
CASE 1: A 56 - year old lady of Scottish extraction, living in Dubai for many years, working as director of company, presented with right upper and lower limb stiffness, paresthesia and difficulty walking of 6 weeks’ duration. (Clinically Isolated Syndrome).
CASE 2: A 48 - year old Indian housewife presented with sudden onset of bilateral lower limb sensory symptoms, with dysesthesia, cutaneous allodynia, pain and sensory level at D4. (Clinically Isolated Syndrome).
CASE 3: A 28 - year old Myanmarese lady working as restaurant staff presented with visual blurring, ataxia, and hemisensory symptoms. (Relapsing - Remitting MS, previously unrecognized).
CASE 4: A 32 - year old Lebanese man, working as hotel staff, already on bi - weekly treatment with Interferon since two years, presented with symptoms of ataxia. (Relapsing - Remitting MS, previously recognized).
CASE 5: A 49 - year old Filipina, working as supermarket assistant, presented with atypical facial pain and non - neurological symptoms, found incidentally on MRI to have lesions fulfilling criteria for MS. (Radiologically Isolated Syndrome).
CASE 6: A 21 - year old Egyptian lady, working as office assistant, presented with recurrent episode of blurring of vision, hemisensory loss, and ataxia; she had previous episodes not recognized to be MS. (Relapsing - Remitting MS, previously unrecognized).
ABSTRACT
Multiple Sclerosis is a common neurological condition among younger people in the UAE. Diagnosis and management of MS and its complications remain difficult and are evolving. We describe the experience in a single-center of managing the condition in the local population. In the period between January 2019 and October 2019, six patients (5 women) were diagnosed with definite MS. Three were started on oral Disease Modifying Therapy (DMT), FINGOLIMOD, one was started on bi-weekly Interferon (PLEGRIDY). We describe here the experience and discuss the pros and cons of early versus delayed treatment.
All the patients fulfilled the Modified McDonald (2017) criteria for Dissemination in Time (DIT) and Dissemination in Space (DIS) at the time of diagnosis. At the time of presentation, two patients presented with Clinically Isolated Syndrome (CIS), one patient presented with Radiologically Isolated Syndrome (RIS), and two others presented with relapse of a recognized (one) and unrecognized Relapsing - Remitting form of MS. Confirmation of definite MS in most of the patients was done by identifying CSF Oligoclonal bands. MRI scan of brain and
