Initial presentation of multiple sclerosis in northern Iran; Is there any comparison to other countries Initial presentation of multiple sclerosis in northern Iran; Is there any comparison to other countries Amin Zarghami 1 Seyyed Mohammad Masoud Hojjati (MD) 2 * 1. Student Research Committee, Babol University of Medical Sciences, Babol, Iran. 2. Department of Neurology, Babol University of Medical Sciences, Babol, Iran.

 Multiple sclerosis (MS) is an inflammatory and neurodegenerative demyelinating disease of central nervous system (CNS).  Geographic variation in the incidence of MS supports the probability that environmental factors are involved in the etiology besides genetics.  Classic signs and symptoms of MS are as follows: sensory disturbance (paresthesis etc.), spinal cord symptoms(motor and autonomic such as spasticity, bladder or sexual dysfunction etc.), cerebellar symptoms(tremor, dysarthria etc.), optic neuritis, brain stem disorders and etc. Introduction:

The aim of this study was to review the frequency of presenting symptoms and related demographic findings of the most prevalent presenting symptom in MS patients in Babol, Northern Iran. Objectives:  Concerning the sites of involvement, there have been several reports that eastern MS patients, more commonly represent clinical evidence of more involvement of the optic nerves and spinal cord than Caucasians ( Kalanie H et al. 2009).

Patients & Methods Study type: retrospective cross-sectional Duration:2002 to 2012 Place: Multiple Sclerosis Center in Babol, north of Iran Diagnosis: The McDonald criteria applied in the present study and data confirmed by a neurologist in order to diagnose MS in all the consecutive patients Variables: Demographic information and clinical variables, such as the age at onset of disease, family history, initiation symptoms, etc. retrieved in order to assess factors associated with initial symptom in patients with MS.

 In a total of 263 consecutive patients with MS 28.5% were men and 71.5% women [female to male ratio was 2.5]  The mean age of participants was 34.28± 9.47 (age range,17 to 61 yr).  Optic neuritis with the incidence of 46.8% was the most prevalent initial presenting symptoms in our patients with MS.  Monosymptomatic initiation pattern was seen in (161/263) 61.2% of the cases. Results:

Figure 1:Frequency of initial symptoms in 263 MS patients Results(cont.):

Table 1: Demographic and clinical profile of 263 patients with Multiple Sclerosis with or without optic neuritis Results(cont.) Patients Variables Optic neuritis Odds Ratio 95% Confidence interval P value With (n=160) Without (n=103) LowerUpper GenderMale39(24.4%)36(35%) Female121(75.6%)67(65%) Marital status*single47(29.7%)22(21.4%) married111(70.3%)81(78.6%) Place of liveUrban93(58.1%)52(50.5%) Rural67(41.9%)51(49.5%) EducationLower diploma98(61.3%66(64.1%) Higher diploma62(38.8%)37(35.9%) Age at onset≤30130(81.3%)63(61.2%) <0.001 >3030(18.8%)40(38.8%) Initiation patternMonosymptomatic101(63.1%)60(58.3%) Polysymptomatic59(36.9%)43(41.7%)

Discussion  Optic neuritis was observed as the most prevalent initial presenting symptom in our study population. But in contrast to similar studies in other part of the world, our data placed in the row of high frequencies [Saadatnia et al :47%].  Reports from several Arab and Latin countries revealed that motor dysfunction was the most prevalent feature. Studies from China and Japan were revealed controversial frequencies of sensory disturbance, visual loss and optic neuritis.  It is assumed that in different populations with different social and individual characteristics, the distribution of MS might differ which leads to various reasons like genetic, environment and geographical location (Ebers GC et al. Lancet Neurol. 2008)

Conclusion & Prospectives:  Optic neuritis was the most common initial symptoms in our study population and monosymptomatic pattern was the most frequent pattern.  Practitioners should be pay extra attention to such a manifestation particularly in young adults in this region.  The discrepancy with similar studies in neighboring countries and other continents, may be a matter of designing meta-analysis for achieving precise epidemiologic documentation.

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