Spectrum of Demyelinating Diseases in Pakistan: A multicenter cross-sectional study

Zainab Memon; Safia  Awan; Haris Majid  Rajput; Qamar Un Nisa; Muhammad  Subhan; Lal Chand; Muhammad Wazir Ali Khan

doi:10.56310/pjns.v20i01.429

Zainab Memon Aga Khan University Hospital, Karachi
Safia Awan Aga Khan University Hospital, Karachi
Haris Majid Rajput Pakistan Institute of Medical Sciences, Islamabad
Qamar Un Nisa Dow University of Health Sciences, Karachi
Muhammad Subhan Kuwait Teaching Hospital, Peshawar
Lal Chand Mehar Medical College, Sukkur
Muhammad Wazir Ali Khan Sheikh Zayed Hospital, Rahimyar Khan

DOI: https://doi.org/10.56310/pjns.v20i01.429

Keywords: Demyelinating diseases, Multiple sclerosis, Neuromyelitis optica, Acute disseminated encephalomyelitis, Disability

Abstract

Background and Objective:
Demyelinating diseases are a heterogeneous group of disorders of the central nervous system, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). Data from South Asia remain scarce, despite potential regional variations in disease spectrum and outcomes. The objective of this study was to characterize the demographic, clinical, and disability profile of patients with demyelinating disorders across Pakistan.

Methods:
This multicenter cross-sectional study was conducted between August 2017 and December 2019 across 39 neurology centers in Pakistan. Adult patients (≥18 years) diagnosed with demyelinating disorders using standardized criteria were included. Data on demographics, education, comorbidities, and disability (modified Rankin Scale) were collected. Statistical analyses were performed using t-tests and chi-square tests, with significance set at p<0.05.

Results:
A total of 373 patients were analyzed (59.5% female; mean age 37.2 ± 11.7 years). MS was the most frequent diagnosis (79.1%), followed by NMOSD (11.8%), ADEM (5.1%), and leukodystrophy (4.0%). Females had higher MS prevalence (82.9% vs. 73.5%, p=0.02) and higher rates of illiteracy. Hypertension (9.4%) and diabetes (6.7%) were more common in older and male patients. While 33.5% were fully functional, 16.7% had moderate-to-severe disability, including 6.7% who were bedridden.

Conclusion:
Demyelinating diseases in Pakistan predominantly affect young adults, with MS as the leading disorder but NMOSD comprising a notable proportion. Female predominance, education disparities, and significant disability highlight the need for improved diagnostic access, equitable treatment, and targeted rehabilitation strategies in South Asia.