Profile of multiple sclerosis in the bombay region. On the basis of critical clinical appraisal.

Using internationally accepted strict clinical criteria, 30 patients with probable multiple sclerosis (MS) fron the Bombay region have been described. They were personally studied and followed up over a period of 15 years. In addition, 9 patients with neuromyelitis optica and 6 with a mixed neurological picture of MS and neuromyelitis optica have been described. As in Japan, the neuromyelitis optica type of presentation was relatively more frequent in our material than in the West. In this small series MS was more frequent in patients with a better socio-economic status, in the Parsee community and in patients with a fair complexion, whereas neuromyelitis optica was more frequent in patients with poor socio-economic status. A relatively high proportion of patients (nearly half of the MS patients with optic nerve involvement and two-thirds of the MS--neuromyelitis optica group) had bilateral optic nerve involvement. Except in 2 patients, the tempo and course of the disease in our patients with MS was comparable to that seen in the West. In 3 patients with MS the initiation of symptoms or appearance of fresh symptoms was related to vaccination. In addition to the above 45 patients, 29 other cases of possible demyelination have been reviewed. Nine of these had one or more remission and relapse but in the same site as the first episode. Seventeen had a solitary episode of spinal cord or brainstem disturbance with some remission and 3 had multiple lesions but without remission or clear dissemination in time. In the absence of a specific diagnostic test or autopsy, such atypical cases will remain unclassified. To conclude, MS does occur in the Bombya region and elsewhere in India but the incidence is much less than in the West. Further studies and especially careful follow-up of atypical cases may show that the prevalence is higher than it seems today.