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Year : 2018  |  Volume : 21  |  Issue : 2  |  Page : 95-97

Multiple sclerosis in India

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication20-Jul-2018

Correspondence Address:
Dr. Vinay Goyal
Room No 706, Department of Neurology, All India Institute of Medical Sciences, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_296_18

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How to cite this article:
Goyal V. Multiple sclerosis in India. Ann Indian Acad Neurol 2018;21:95-7

How to cite this URL:
Goyal V. Multiple sclerosis in India. Ann Indian Acad Neurol [serial online] 2018 [cited 2021 Jan 28];21:95-7. Available from:

This issue of AIAN has many articles on multiple sclerosis (MS), so I thought of reviewing article published on MS from India. Older belief that MS is rare in India to present setting of suspecting MS in every correct case scenario has been shown by increasing number of publications from India. This article has tried to review publication on MS from Indian authors.

Since the first publication of 6 cases by Singh and Gupta,[1] there has been increasing number of publication from India, due to improving diagnostic facility including pathologically cases by Dastur and Singhal.[2]

Singhal and Wadia, described 30 cases of MS and neuromyelitis optica (NMO), observed over 15 years breaking the myth that MS is uncommon in India.[3] Chopra et al. reported 54 patients with MS from Northwest India with 2 pathologically proven cases and 5 cases with Devic's disease.[4] This study reported more common occurrence of optic neuritis (ON), myelopathy, and higher incidence of classical neuromyelitis optica (NMO). Wadia and Bhatia reported MS in Parsi population with a crude prevalence ratio of 26–58/100,000 from Mumbai/Pune=(age-adjusted prevalence ratio for Mumbai was 24/100,000, with 95% confidence limits of 13.1–40.3, which is same as the rest of the world.[5],[6] Trikannad et al.[7] reported HLA-B12 in Parsi and non-Parsi Indians. Chand and Devi showed the utility of blink reflex and somatosensory-evoked potential in predicting conversion of ON to clinically suspect MS.[8] Jain and Maheshwari complied data of largest case series of 354 cases of MS published from India over the previous three decades and again confirmed higher incidence of ON and NMO.[9] The study also reported that MS might be more common in northern part of India as compared to south based on this data. Singhal [10] reported approximate prevalence rate of 0.17–1.33/100,000 of population in different parts of India based on hospital data record (105 cases of clinical data management systems [CDMS] and 14 cases of NMO from Mumbai region, 1957–1983). The study reported that MS in India is more like other Asian countries as compared to the West with higher incidence of NMO (6%). Common MS was opticospinal form of MS (71.4%) but lesser of cerebellar involvement in the higher socioeconomic group.

Bansil et al. compared the population of India and USA in a case–control study and concluded that involvement of the cerebral hemispheres, cerebellum, spinal cord and brainstem were same including disease progression while ON was more frequent in Indian patients. There were no familial cases.[11] In another publication, Bansil et al. looked at environmental risk factors in Indian patients and reported no difference in prior foreign travel, surgeries, blood transfusions, clinical chicken pox and mumps infections and exposure to cats/farm animals as risk factors. There was more exposure to clinical measles infection and dog exposure in the MS patients.[12]

Singh et al. studied differences in imaging of MS and acute disseminated encephalomyelitis (ADEM). The study included 33 patients with 14 as CDMS and 19 as ADEM.[13] Banerjee et al. first reported pediatric MS.[14] Chopra et al. (2002) evaluated cerebrospinal fluid (CSF) beta-1-globulin in MS and ADEM. It was significantly higher in ADEM (P< 0.05). The negative predictive value (>6.5%) was 100% for diagnosing MS helping in differentiating between MS and ADEM patients. Sahota et al. evaluated the utility of transcranial magnetic stimulation (TMS) as diagnostic utility in MS.[15] The study found TMS to be very useful tool in detecting corticospinal conduction abnormalities in MS that may have no clinical correlate and in monitoring the course of the disease.

Narayan et al. reported MS in Keralite migrated to Middle East in two siblings.[16] At this time, familial MS was not reported from India.

Pandit wrote about the experience of mitoxantrone (MTX) in MS.[17] Singhal et al. same year reported his experience of MTX in 23 patients with MS/NMO and concluded that benefit persisted 2.5 years after completion of therapy with 15% developing neutropenia and 2 patients cardiotoxicity and required discontinuation of MTX. Gupta et al. reported the first experience of beta-interferon in 16 patients.[18]

Santra and Ray reported the first case of Marburg's variant of MS.[19] Dudani et al. studied the relation of Vitamin D and MS and reported that higher Vitamin D level had lower risk of MS.[20] Pandit et al. also had similar observations.[21]

Pandit et al. failed to show any relation between Epstein–Barr virus infection with MS in the study of 140 patients with MS.[22] Patil et al. evaluated the effect of yoga on neurogenic bladder in MS and concluded that doing 2 hours of yoga (various practices) for 21 days improved neurogenic bladder.[23] Nagraj et al. in a case–control study evaluated fatigue in patients with MS and concluded that severe fatigue was significantly more in patients with MS as compared to control [24] and it was also found to be associated with depression and sleep disturbance [25] which was also reported later by Chennadurai et al.[26]

Saxena et al. evaluated retinal nerve fiber layer (RNFL) thinning in MS and found reduced thickness of RNFL which also correlated to visual symptoms [27] and later his group also reported that ganglion cell layer + ganglion cell-inner plexiform layer thickness is a more sensitive clinical structural marker than RNFL in early MS with/without ON.[28]

Jena et al. evaluated the natural study of MS in 157 patients and concluded that there is higher incidence of opticospinal onset, higher cases of relapsing–remitting MS (RRMS) and poor utility of CSF study.[29] Pandit et al. evaluated 109 European-associated variants in a total of 270 patients with MS and 555 controls and showed that two-third of variants overlapped suggesting similarity in etiology irrespective of ethnicity [30] as well as human leukocyte antigen (HLA) (DRB1 × 15:01 and DRB1 × 03 alleles) similarity [31] and also showed CD6 gene polymorphism rs17824933 as seen in European population.[32] Zahoor et al. evaluated Ile587Val polymorphism of the EIF2B5 gene in MS in Kashmir and did not find any polymorphism [33] and also reported the clinical profile of 14 patients of MS from Kashmir.[34]

Pandit et al. reported the usefulness of mycophenolate mofetil in 40 patients with MS used for 2 years. Singhal et al. reported clinical details of 105 patients (68.4% RRMS, 16.8% secondary progressive MS, and 14.8% PPMS) with MS from northern tertiary center with mean disease duration of 6 years, mean expanded disability status scale at presentation of 3.2 and found similarity between published data from western countries.[35] Malli et al. evaluated the risk factors for MS (139 MD and 278 control) and concluded with measles (P< 0.007), vegetarian diet (P< 0.001, higher educational status (P< 0.0001) and urban living (P< 0.0001) as risk factors while Helicobacter pylori infection (P< 0.001) was protective.[36] A study by Chinnadurai et al. suggested cognitive fatigue in patients with MS.[37] Chinnadurai et al. interestingly showed that P13, N10, and P37 latencies strongly predicted falls in patients with MS (134 patient with MS).[38]

Looking at the published literature on MS from India, suggests that there were no have been no studies with, basic science research work which is of groundbreaking research, path changing, or novel ideas. So this, which must stimulates younger researchers to look into the available literature and plan their research work beyond that rather than repeating same in Indian population or just looking for new mutation in India patients. I presume this article might stimulate few researchers to work toward new fields of research in MS.

   References Top

Singh H, Gupta VK. Multiple sclerosis (clinical study of sixteen cases). J Assoc Physicians India 1964;12:293-7.  Back to cited text no. 1
Dastur DK, Singhal BS. Two unusual neuropathologically proven cases of multiple sclerosis from Bombay. J Neurol Sci 1973;20:397-414.  Back to cited text no. 2
Singhal BS, Wadia NH. Profile of multiple sclerosis in the Bombay region. On the basis of critical clinical appraisal. J Neurol Sci 1975;26:259-70.  Back to cited text no. 3
Chopra JS, Radhakrishnan K, Sawhney BB, Pal SR, Banerjee AK. Multiple sclerosis in North-West India. Acta Neurol Scand 1980;62:312-21.  Back to cited text no. 4
Wadia NH, Bhatia K. Multiple sclerosis is prevalent in the Zoroastrians (Parsis) of India. Ann Neurol 1990;28:177-9.  Back to cited text no. 5
Bharucha NE, Bharucha EP, Wadia NH, Singhal BS, Bharucha AE, Bhise AV. Prevalence of multiple sclerosis in the Parsis of Bombay. Neurology 1988;38:727-9.  Back to cited text no. 6
Trikannad VS, Wadia NH, Krishnaswamy PR. Multiple sclerosis and HLA-B12 in Parsi and non-Parsi Indians. A clarification. Tissue Antigens 1982;19:155-7.  Back to cited text no. 7
Chand RP, Devi MG. The blink reflex and somatosensory evoked potential in optic neuritis in South India. Acta Neurol Scand 1985;71:150-5.  Back to cited text no. 8
Jain S, Maheshwari MC. Multiple sclerosis: Indian experience in the last thirty years. Neuroepidemiology 1985;4:96-107.  Back to cited text no. 9
Singhal BS. Multiple sclerosis – Indian experience. Ann Acad Med Singapore 1985;14:32-6.  Back to cited text no. 10
Bansil S, Singhal BS, Ahuja GK, Ladiwala U, Behari M, Friede R, et al. Comparison between multiple sclerosis in India and the United States: A case-control study. Neurology 1996;46:385-7.  Back to cited text no. 11
Bansil S, Singhal BS, Ahuja GK, Riise T, Ladiwala U, Behari M, et al. Multiple sclerosis in India: A case-control study of environmental exposures. Acta Neurol Scand 1997;95:90-5.  Back to cited text no. 12
Singh S, Prabhakar S, Korah IP, Warade SS, Alexander M. Acute disseminated encephalomyelitis and multiple sclerosis: Magnetic resonance imaging differentiation. Australas Radiol 2000;44:404-11.  Back to cited text no. 13
Banerjee TK, Mukherjee A, Bhargava A. Childhood multiple sclerosis – report of two Indian cases. J Assoc Physicians India 2002;50:1091-2.  Back to cited text no. 14
Sahota P, Prabhakar S, Lal V, Khurana D, Das CP, Singh P. Transcranial magnetic stimulation: Role in the evaluation of disability in multiple sclerosis. Neurol India 2005;53:197-201.  Back to cited text no. 15
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Narayan SK, Kumar S, Prabhakar P, Elangovan S, Baumann N, Verma IC. Multiple sclerosis in keralite siblings after migration to the middle east: Areport of familial multiple sclerosis from India. J Neurol Sci 2007;260:244-8.  Back to cited text no. 16
Pandit L. Invited commentary. Efficacy and safety of mitoxantrone, as an initial therapy, in multiple sclerosis: Experience in an Indian tertiary care setting. Neurol India 2009;57:424-5.  Back to cited text no. 17
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Gupta S, Varadarajulu R, Ganjoo RK. Beta-interferons in multiple sclerosis: A single center experience in India. Ann Indian Acad Neurol 2010;13:132-5.  Back to cited text no. 18
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Santra G, Ray AC. Marburg's variant of multiple sclerosis. J Assoc Physicians India 2009;57:580.  Back to cited text no. 19
Dudani SJ, Kalhan S, Sharma SP. Vitamin D and multiple sclerosis: Potential pathophysiological role and clinical implications. Int J Appl Basic Med Res 2011;1:71-4.  Back to cited text no. 20
Pandit L, Ramagopalan SV, Malli C, D'Cunha A, Kunder R, Shetty R. Association of Vitamin D and multiple sclerosis in India. Mult Scler 2013;19:1592-6.  Back to cited text no. 21
Pandit L, Malli C, D'Cunha A, Shetty R, Singhal B. Association of Epstein-Barr virus infection with multiple sclerosis in India. J Neurol Sci 2013;325:86-9.  Back to cited text no. 22
Patil NJ, Nagaratna R, Garner C, Raghuram NV, Crisan R. Effect of integrated Yoga on neurogenic bladder dysfunction in patients with multiple sclerosis – A prospective observational case series. Complement Ther Med 2012;20:424-30.  Back to cited text no. 23
Nagaraj K, Taly AB, Gupta A, Prasad C, Christopher R. Prevalence of fatigue in patients with multiple sclerosis and its effect on the quality of life. J Neurosci Rural Pract 2013;4:278-82.  Back to cited text no. 24
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Nagaraj K, Taly AB, Gupta A, Prasad C, Christopher R. Depression and sleep disturbances in patients with multiple sclerosis and correlation with associated fatigue. J Neurosci Rural Pract 2013;4:387-91.  Back to cited text no. 25
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Chinnadurai SA, Gandhirajan D, Pamidimukala V, Kesavamurthy B, Venkatesan SA. Analysing the relationship between polysomnographic measures of sleep with measures of physical and cognitive fatigue in people with multiple sclerosis. Mult Scler Relat Disord 2018;24:32-7.  Back to cited text no. 26
Saxena R, Bandyopadhyay G, Singh D, Singh S, Sharma P, Menon V. Evaluation of changes in retinal nerve fiber layer thickness and visual functions in cases of optic neuritis and multiple sclerosis. Indian J Ophthalmol 2013;61:562-6.  Back to cited text no. 27
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Pillay G, Ganger A, Singh D, Bhatia R, Sharma P, Menon V, et al. Retinal nerve fiber layer and ganglion cell layer changes on optical coherence tomography in early multiple sclerosis and optic neuritis cases. Indian J Ophthalmol 2018;66:114-9.  Back to cited text no. 28
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Jena SS, Alexander M, Aaron S, Mathew V, Thomas MM, Patil AK, et al. Natural history of multiple sclerosis from the Indian perspective: Experience from a tertiary care hospital. Neurol India 2015;63:866-73.  Back to cited text no. 29
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Pandit L, Ban M, Beecham AH, McCauley JL, Sawcer S, D'Cunha A, et al. European multiple sclerosis risk variants in the South Asian population. Mult Scler 2016;22:1536-40.  Back to cited text no. 30
Pandit L, Malli C, Singhal B, Wason J, Malik O, Sawcer S, et al. HLA associations in South Asian multiple sclerosis. Mult Scler 2016;22:19-24.  Back to cited text no. 31
D'Cunha MA, Pandit L, Malli C. CD6 gene polymorphism rs17824933 is associated with multiple sclerosis in Indian population. Ann Indian Acad Neurol 2016;19:491-4.  Back to cited text no. 32
Zahoor I, Asimi R, Haq E. No evidence for a role of Ile587Val polymorphism of EIF2B5 gene in multiple sclerosis in Kashmir valley of India. J Neurol Sci 2015;359:172-6.  Back to cited text no. 33
Zahoor I, Asimi R, Haq E, Yousuf Wani I. Demographic and clinical profile of multiple sclerosis in Kashmir: A short report. Mult Scler Relat Disord 2017;13:103-6.  Back to cited text no. 34
Singhal A, Bhatia R, Srivastava MV, Prasad K, Singh MB. Multiple sclerosis in India: An institutional study. Mult Scler Relat Disord 2015;4:250-7.  Back to cited text no. 35
Malli C, Pandit L, D'Cunha A, Mustafa S. Environmental factors related to multiple sclerosis in Indian population. PLoS One 2015;10:e0124064.  Back to cited text no. 36
Chinnadurai SA, Venkatesan SA, Shankar G, Samivel B, Ranganathan LN. A study of cognitive fatigue in multiple sclerosis with novel clinical and electrophysiological parameters utilizing the event related potential P300. Mult Scler Relat Disord 2016;10:1-6.  Back to cited text no. 37
Chinnadurai SA, Gandhirajan D, Srinivasan AV, Kesavamurthy B, Ranganathan LN, Pamidimukkala V. Predicting falls in multiple sclerosis: Do electrophysiological measures have a better predictive accuracy compared to clinical measures? Mult Scler Relat Disord 2018;20:199-203.  Back to cited text no. 38


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