Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Identification of MS patients with a high risk for progression has been a challenge for decades. Objective: To determine the role of neuro-cognitive, genetic and optical coherence tomography (OCT) on multiple sclerosis (MS) disease progression. Subjects and methods: Two groups of definite MS patients, relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), each with 25 patients, were submitted to a battery of neuropsychological tests, OCT and glutamate N-methyl-D-aspartate receptors (NMDARs) gene studies. Results: The best predictor for progressive MS is SDMT (symbol digit modality test) (P value 0.021), that is dependent statistically on the educational level of the MS patient (P value 0.016). The most specific and sensitive test in discrimination between RRMS and SPMS groups is provided through OCT via thickness of average RNFL (retinal nerve fiber layer). Eighty three percent of MS patients with CC genotype reported frequent previous attacks of optic neuritis with significant marked thinning in RNFL and GCC (ganglion cell complex) despite of their higher cognitive performance in comparison to other genotypes. Conclusions: An early deficit in information processing speed measured by SDMT is a good predictor of early transition to SPMS. Thicknesses of RNFL of 83.65om and GCC of 77.47om are indications for induction therapy to prevent transitioning to secondary progressive phase with high sensitivity; 91.7% and 87.5% respectively. Finally, presence of CC genotype of glutamate NMDARs gene predicts frequent optic neuritis episodes with marked visual loss, although the same genotype may preserve cognitive functions

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