Original article
English
Ragae M, Ghada Ben Moussa G, Ben Gafer M
Department of Neurology, Tripoli Medical Centre Tripoli, Libya
JMJ 2009;9(4):258-261
Abstract
Involvement of peripheral nerves in patients with Multiple Sclerosis (MS) is considered a rarity and some neurologists consider the presence of peripheral neuropathy in patients with MS a red flag throwing doubt on the diagnosis of multiple sclerosis. However, there had been several case reports and a number of reports on a small series of patients with MS associated with peripheral polyneuropathy. We have performed detailed neurophysiological studies in 24 consecutive patients with MS. The group consisted of seven males and 17 females. The mean age of the group was 42 years with a range of 21-55 years, and the mean duration of the disease since diagnosis was 10 years (range 1-25 years). The revised criteria of McDonald et al, were used to establish the diagnosis of MS. The disease was considered of the remitting-relapsing type in 15 cases and of progressive type in the remaining 9 patients. Motor nerve conduction studies were carried out on the median, ulnar, peroneal, and tibial nerves as well as sensory nerve conduction studies on median ,ulnar, radial, and sural nerves on both sides. A total of 270 nerves were studied. Conduction abnormalities in at least one peripheral nerve were observed in 33 studies (12%) and in at least 2 nerves in 9 studies (3%). Of the 15 patients with relapsing- remitting disease, six patients (40%) had evidence of peripheral polyneuropathy, as compared to 3 patients (33%) of the nine who had progressive MS, p< 0.2 . The type of peripheral neuropathy was considered sensory-motor and mixed axonal and demyelinating type. Thus the overall prevalence of peripheral polyneuropathy in this group of patients with MS is 37.5% (nine out of 24 patients). Our results indicate that peripheral polyneuropathy is not uncommon in patients with MS and that the involvement is often of the mixed sensory-motor type. Subclinical involvement could only be detected in patients with MS by direct neurophysiological studies Keywords: Multiple Sclerosis, McDonald Criteria, Libyan Link/DOI: http://www.jmj.org.ly/PDF/winter2009/258.pdf