title: Natural history of multiple sclerosis from the Indian perspective: Experience from a tertiary care hospital.
abstract: BACKGROUND
  Multiple sclerosis (MS) has a spectrum of heterogeneity, as seen in western and eastern hemispheres, in the clinical features, topography of involvement and differences in natural history.
  
  
  OBJECTIVE
  To study the clinical spectrum, imaging, and electrophysiological as well as cerebrospinal fluid (CSF) characteristics and correlate them with outcome.
  
  
  METHODS
  Retrospective analysis of MS patients during a period of 20 years.
  
  
  METHODS
  Cases were selected according to recent McDonald's criteria (2010), They were managed in the Department of Neurology, Christian Medical College, Vellore.
  
  
  METHODS
  Chi-square and Fisher's exact tests were used for categorical variables. Multiple binary logistic regressions were done to assess significance. Kaplan-Meier curves were drawn to estimate the time to irreversible disability.
  
  
  RESULTS
  A total of 157 patients with female preponderance (55%) were included. The inter quartile range duration of follow-up was 9.1 (8.2, 11) years for 114 patients, who were included for final outcome analysis. Relapsing remitting MS (RRMS) (54.1%) was the most common type of MS seen. RRMS had a significantly better outcome (odds ratio: 0.12, 95% confidence interval: 0.02-0.57, P = 0.008) compared to progressive form of MS (primary progressive, secondary progressive). The Expanded Disability Status Scale score of patients at presentation and at final follow-up was 4.4 ± 1.31 and 4.1 ± 2.31, respectively. During the first presentation, polysymptomatic manifestations like motor and sphincteric involvement, incomplete recovery from the first attack; and, during the disease course, bowel, bladder, cerebellar and pyramidal affliction, predicted a worse outcome.
  
  
  CONCLUSIONS
  A high incidence of optico-spinal presentation, predominance of RRMS and a low yield on cerebrospinal fluid (CSF) studies are the major findings of our study. A notable feature was the analysis of prognostic markers of disability.
authors.forename: Subhransu S
authors.initials: SS
authors.lastname: Jena
authors.affiliation: Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Mathew
authors.initials: M
authors.lastname: Alexander
authors.forename: Sanjith
authors.initials: S
authors.lastname: Aaron
authors.forename: Vivek
authors.initials: V
authors.lastname: Mathew
authors.forename: Maya Mary
authors.initials: MM
authors.lastname: Thomas
authors.forename: Anil K
authors.initials: AK
authors.lastname: Patil
authors.forename: Ajith
authors.initials: A
authors.lastname: Sivadasan
authors.forename: Karthik
authors.initials: K
authors.lastname: Muthusamy
authors.forename: Sunithi
authors.initials: S
authors.lastname: Mani
authors.forename: J Grace
authors.initials: JG
authors.lastname: Rebekah