Fulminant variants of multiple sclerosis: Local experience at shifa international hospital, Islamabad, Pakistan

Objective: To report a series of patients with fulminant variants of multiple sclerosis (MS) based on their clinical and radiological features Methodology: This retrospective study consists of series of four patients with fulminant variants of MS seen between January 2008 and February 2011 at Shifa International Hospital, Islamabad, Pakistan. Results: Out of Four patients, three were females, with mean age of 27 (range 13-40) years. Onset was acute with significant progression over 2 weeks in all cases. Presenting symptoms were hemiparesis and speech difficulty in all patients, 3 had visual impairment, and 2 had headache. CSF pleocytosis and raised CSF protein was seen in 3 patients. Visual evoked potentials were abnormal in one patient. Based on the characteristic MRI findings, 3 patients were diagnosed as Balo's concentric sclerosis and one patient with Marburg's variant of MS. All patients were initially treated with intravenous methylprednisolone followed by immunomodulatory therapy. Two patients received intravenous immunoglobulins (IVIG) and mitoxantrone, one received IVIG only and one received mitoxantrone only. On follow up, all 4 patients had shown marked improvement with independence in activities of daily living. Conclusion: Aggressive treatment with IVIG and mitoxantrone resulted in significant improvement in this small case series. Early and aggressive immunosuppression should be considered in patients with fulminant variants of MS.