SEASONALITY AND MULTIPLE SCLEROSIS
Margoob MA MD, Ab. Majid MBBS, Arshad Hussain MD, Zaid A. Wani MBBS, Aaliya Majeed MBBS, Arshad Pandit MBBS, Jehangir Bakshi MD; Majid Jehangir MD, Omar Shareef MD.
ABSTRACT Multiple sclerosis is a common demylenating disorder with unknown etiology. Psychiatric comorbidity in multiple sclerosis has been studied in detail. Environmental factors as one of the etiological contributors is under debate. We here in discuss the relation of an important environmental factor i.e., Seasonality as one of the contributors to both multiple sclerosis and psychiatric comordibity in the form of seasonal affective disorders.
JK–Practitioner 2004; 11(4):270-271 INTRODUCTION: Multiple sclerosis is by for the most frequent of demyelinating disease. The present consensus is that the disease results from an interplay between genetic and environmental factors, resulting in an immunologicaly mediated inflammatory response within the central nervous system. 1 75% of multiple sclerosis patients suffer from psychiatric morbidity.2 Intellectual deterioration, abnormalities of mood and personality changes are commonest manifestations.2 Seasonal pattern labelling is done to affective disorders when there has been regular temporal relationship between onset of major depressive episode and particular time of year.3 Such pattern of mood disorders is quiet common in our part of world as revealed by pioneering study by Margoob, and Dutta.4 CASE REPORT: A 65 yeas old woman was attending the Department of psyciatry for treatment of Seasonal Affective Disorder from past 4 years. She had recurrent spring-summer depression. The most recent episode of depression was being evaluated by the first author when he noted cognitive decline, with a possibility of Pseudo-dementia. 8 weeks after the treatment for recent episode of depression was started she went into remission for major depressive disorder but her cognitive decline continued and infact became more pronounced. Neuropsychological testing of memory revealed
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Authors’ affiliations: Margoob MA, Arshad Hussain, Ab. Majid, Zaid A. Wani, Aaliya Majeed, Arshad Pandit Department of Psychiatry, GMC, Sgr. Bakhshi Jahangir,Majid Jahangir, Omer Sharief Department of Radio diagonosis and Imaging GMC Sgr. Accepted for publication September 2004 Correspondence to: Dr. Mushtaq A Margoob Associate professor of psychiatry Govt. Medical College Srinagar Post Box No. 701 GPO Srinagar Kashmir
normal digit span testing but severely effected retrieval. Both verbal and nonverbal memory were effected. Concentration, attention and verbal fluency were also impaired. This elderly lady had been well, till few years back, when she during the month of April started remaining low, slept most of time, will not move out of her house and seemed to forget many of the past events. For these complaints she was seen by to a psychiatrist who diagnosed MDD and put her on Imipramine 75mg. She did not improve but improved soon after Fluoxetine 20mg was introduced. She returned to baseline after 3 months with even memory reaching pre-morbid state. These episodes recurred during the same time of year at least thrice before the present episode but all the times she revealed back to her pre-morbid state. But after she went into remission for present episode the memory deficits did not go. LAB FINDINGS: We conducted lab investigation for metabolic profile, renal functions, haematology, liver function tests. They revealed no abnormality. NEUROIMAGING: CT scan brain of the patient was reported as: 1) ? Post-viral effect 2) ? Multiple sclerosis and MRI was suggested to settle the issue. T2 weighted MRI revealed many areas of increased signal intensity particularly periventricular, paraventricular and 270
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Key words: multiple sclerosis,seasonal affective disorders
Figure 1 MRI Scans showing increased signal intensity
callosal, most of them greater than 2mm. DISCUSSION: Effects of seasonality on multiple sclerosis has not been studied systematically. Apart from few case reports on SAD and multiple sclerosis, Pubmed search reveals no systematic study. Epidemiological evidence similarly points to the importance of the environment, and how living in Southern hemisphere is protective and how protective effect of being black is rapidly eliminated when black persons move to geographical areas of high risk. To date, however, no environmental pathogen has been clearly incriminated.1 Seasonal ffects may be one of the long list of environmental factors playing their part in the pathogenesis of multiple
sclerosis and need to be studied. BIBLIOGRAPHY
1. 2. 3. 4. 1. Compston A. Non-infective inflammatory demyelinating and paraneoplastic disease of nervous system. Brains Disease of Nervous System 1993; Chapter 10. Surridge D. An investigation into some psychiatric aspects of multiple slerosis. BJP 1969; 115: 749 - 764. Kaplan and Saddocks. Mood disorder clinical features. 8th Edition 1, 1347. Margoob, MA and Dutta KS. 10 - 15 years retrospective study of 50 patients of MDP for seasonal variation. Indian Journal of Psychiatry 1998; 30 (2): 253 - 256.
Vol. 11, No. 4, October-December 2004