Long-term follow-up of patients with multiple sclerosis treated with a cost-effective protocol from a rural medical center in India: a retrospective case series

Background and objectives: Multiple sclerosis affects young adults resulting in dependency after 15 years of disease. Treatments are time-consuming, expensive and do not provide full protection. The purpose of this study is to assess the therapeutic effects of rational therapy on multiple sclerosis in patients from a tertiary centre, India. Subjects and methods: This retrospective case series study included 23 patients treated with a very cost-effective protocol that was practiced for three decades in a government medical college setting in a population of 250 patients. All rational options were explained to the patients who were diagnosed with multiple sclerosis according to modified Mc Donald criteria. The patients who were willing to undergo the scheduled regime were followed up. Multiple sclerosis relapse, lesion load, and Expanded Disability Status scale (EDSS) scores were evaluated at 1 and 3 years and thereafter in a need based way. This study was approved by the Institutional Review Board, National Institute of Mental Health And Neurosciences (NIMHANS), India. Results: The mean duration of illness of 23 patients with multiple sclerosis was 6.8 ± 5.23 years and the mean remission period was 4.09 ± 3.5 years. The mean EDSS score was 3.83 ± 0.78 at onset and it was 1.15 ± 0.5 after treatment. Thirteen (22%) patients had replaces during the above period of illness but were managed well with a pulse of 5 g methyl prednisolone. Conclusion: The treatment protocol for multiple sclerosis designed for patients from an Indian rural medical center is cost-effective and has very good effects on the control of relapse and progression.