Spectrum of Demyelinating Diseases - A Demographic, Clinical and Laboratory Profile.

Birla Pavalam, M (2009) Spectrum of Demyelinating Diseases - A Demographic, Clinical and Laboratory Profile. Masters thesis, Madurai Medical College, Madurai.


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Demyelinating diseases form a class of disorders characterized by loss or attenuation of the myelin sheath in the relative absence of neuronal loss and it can occur in both in peripheral and central nervous systems. The myelin sheath provides a high resistance, low capacitance insulation between the sites of action potential electrogenesis, the node of Raniver. It conducts impulses from one node to another in saltatory manner and therefore its loss is accompanied by significant conduction abnormalities. AIMS AND OBJECTIVES: To study the spectrum of patients with demyelinating illness admitted in Govt. Rajaji Hospital, Madurai during the period of June 2007 to April 2009. To study the demographic profile of the patients with various demyelinating illness. To analyse the antecedent events, clinical profile and etiological factors among them. To evaluate the imaging, CSF and electrophysiological profile and short term outcome among them. SUBJECTS AND METHODS: The study design was prospective one involving patients admitted in Medicine, Obstetrics and Gynaecology, Neuromedicine and all other wards for demyelinating illness. Inclusion Criteria : Patients admitted for neurological symptoms and signs suggestive of demyelinating illness and investigations compatible with them were included in study group. Exclusion Criteria: Patients with equivocal diagnosis or inadequate clinical details or investigations not compatible with demyelinating illness were excluded from study group. Methodology : Patients general information antecedent events, symptoms were recorded in a predesigned proforma one allotted for each patient. Detailed clinical examination finings, pattern of weakness respiratory muscle weakness, requirement of ventilatory assistance were documented in that proforma. CSF analysis results, neuro imaging findings, electro physiological profile including motor nerve conduction of standard limb nerves, F wave responses and Sensory Nerve Action Potential results were all recorded in the proforma. Statistical analysis was done on these data and Chi-Square Test, Student ‘t’ test and p values were applied wherever possible. SUMMARY AND CONCLUSIONS: The spectrum of patients with demyelinating illness admitted comprised of 88% GBS, followed by 9.3% ADEM and 2.7% multiple sclerosis. All cases of ADEM belonged to 10 to 40 year age group and 57% fell into adolescent age group. Non specific infections antedates 43% of ADEM and post viral and post vaccinal shared 29% and 28% respectively. 43% of ADEM were of meningitic form and remaining encephalitic form and CSF pleocytosis was noted in 57% of cases 82% of GBS cases were from Madurai locality. No significant variations between months of occurrence of GBS was made out but trend is of increasing pattern from this current year. The age group of patients with GBS varied from 10 to above 60 and 30% fell into third decade. Males : Female ratio is 1.63 : 1.  Antecedent events occurred in 55% of patients with GBS of which gastro intestinal illnesses constituted 9%, non specific fever 12%, pregnancy 5% and post viral 3% which were statistically significant. Lower limb onset was noted in 94% of cases and ventilator assistance was needed for about 34% of cases. 50% of patients in ventilator for more than 12 days had severe deficits which was 33% and 14% for those who were on ventilator for days between 8 and 12 and 4 and 8 respectively. Of variants, MFS occurred in 3% recurrent GBS, pharygofacial and bifacial occurred 1.5% each. 36% of GBS cases were subjected to CSF study and albumino cytological dissociation was noted in 88%. Of the 38% posted for nerve conduction studies, demyelinating pattern was noted in 48% and axonal in 16%. 83% of patients with demyelinating pattern showed good recovery, whereas 75% of axonal pattern showed severe deficit at the end of 1 month.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Spectrum ; Demyelinating Diseases ; Demographic, Clinical and Laboratory Profile.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 03 Jul 2017 08:22
Last Modified: 03 Jul 2017 08:22
URI: http://repository-tnmgrmu.ac.in/id/eprint/782

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