الفهرس 
multiple sclerosisOnly 14 pages are availabe for public view
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Abstract
Multiple sclerosis (MS) is a progressive and irreversible disease which affects the central nervous system (CNS) and was often followed by neurological dysfunction and difficult to predict. More than two million young individuals worldwide were affected. The etiology of MS is still unclear, and the pathogenesis has not been well defined yet. Complex interactions between environmental and genetic factors are involved in the autoimmune inflammatory process. Vitamin B12, homocysteine and folate have been possible participants in the neurodegenerative process of many chronic diseases including MS. Homocysteine is a neurotoxic amino acid that accumulates in patients with neurodegenerative disorders. Homocysteine exerts direct effects on activation of macrophages and cell damage with a key role in human health. Increased homocysteine levels play an underestimated role in the process of many neurological diseases like MS. Vitamin B12 and folate are needed in the process of methioninesynthase mediating the conversion of homocysteine to methionine. Essential factors for methionine synthesis of homocysteine are 5methyltetrahydro-folate and Vitamin-B12. Increased serum homocysteine levels may be a risk factor for neurological decline in MS and may have a neurodegenerative effect. Not all the studies have demonstrated a relationship between MS progression and elevated serum homocysteine. Thus, current study aimed to verify whether Hyperhomocysteinemia is associated with disability in Multiple Sclerosis. Also, to study the relation between cognitive impairment and homocysteine serum level. This was a case control study and was carried out on 40 MS patient, and 40 controls comparable in age, sex, and socioeconomic status. MS patients diagnosed on revised McDonald criteria 2017 and collected from outpatient clinic in Menofia University hospital during the period from October 2019 to March 2021. These patients were divided into two groups, Cases group: Included 40 patients diagnosed with MS. Patients were diagnosed based on revised McDonald criteria 2017. Control group: Included 40 volunteers healthy subjects, matched for age, sex and socioeconomic status as the control group. Results of the current study can be summarized as follows: A total of 40 patients and 40 controls were included in this study, there was no significant difference between the studied group regarding age and gender (P<0.005). The mean number of attacks in cases was (2.65±1.05), (82%) of patients had less than or equal 3 attacks vs. (17.5%) had 4 attacks. Majority of cases had Relapsing-remitting multiple sclerosis (62.5%), (7.5%) had clinically isolated syndrome, (5%) had primary progressive MS and (25%) had secondary progressive MS. Duration of illness ranged from 6 months up to 32 years, and duration of treatment ranged from 0 to 12 year.. While, 57.5% had EDSS less than 5.5 and 32.5% had cognitive impairment. Also, Brain atrophy was found in 14 cases (35%). Also, (60%) of the studied cases had 3-10 lesions, followed by (22.5%) of them had >10 lesions. 92.31% of the studied subjects had impaired memory, 61.54% had impaired attention, 76.92% had impairment of information processing, 61.54% had impaired verbal fluency, 23.08% had impaired executive functions, 7.69% had impaired visuospatial and 15.38% of them had impairment of language. While, memory and attention found in 38.46%, verbal fluency and executive function found in 38.46% and visuospatial abilities and language represented by 30.77%.
Homocysteine serum level was significantly higher among cases group (18.66±3.93) than control group (9.98±2.71). There were no significant relations between homocysteine serum levels with genders and duration of treatment (P>0.05). While, there was significant relation between homocysteine serum levels with type of MS, number of attacks/ year, cognitive impairment, duration of illness, number of lesions, EDSS and brain atrophy (P=0.001). There were significant relations between homocysteine serum levels with impairment of memory and attention. While there was no significance with either of information processing, verbal fluency, executive functions, visuospatial abilities or language (P>0.05). There was significant positive correlation between cognitive impairment and duration of illness, brain atrophy and number of lesions (P<0.001). While, there were no significant correlations between cognitive impairment with type of MS, EDSS and duration of treatment (p>0.05). Homocysteine serum level had sensitivity of 85% and specificity of 57.5% at best cutoff value ≥13.75, with accuracy of 96.3% for predicting multiple sclerosis disability (P=0.001). The results of logistic regression analysis indicated that, memory (p<0.001), information processing (p<0.001) and verbal fluency (p=0.021) were the most affected cognitive domains in MS patients. While, attention, executive functions, visuospatial abilities and language didn’t show any association for cognitive impairment in MS patients (P> 0.05). There was a significant relation between physical disability assessed with EDSS and type of MS (more in SPMS), duration of illness, duration of treatment, brain atrophy and number of lesions (P=0.031).