FLAIR-hyperintense lesions in anti-MOG-associated encephalitis with seizures (FLAMES) unmasked by withdrawal of immunosuppression for Crohn's disease?

A 31-year-old pregnant woman presented with headache, fever and left-sided focal motor seizures, which progressed to bilateral tonic-clonic seizures. Her medical history included Crohn's disease treated with azathioprine and adalimumab, which were discontinued when she became pregnant. Her cerebro-spinal fluid was entirely normal and viral PCR negative. Extensive testing for infectious, autoimmune or malignant causes of encephalitis were non-revealing. MRI head showed unilateral cortical FLAIR-hyperintensity which on interval scans was seen bilaterally. Anti-myelin-oligodendrocyte glycoprotein (MOG)-IgG was positive leading to a diagnosis of cortical FLAIR-hyperintense lesions in Anti-MOG-associated Encephalitis with seizures (FLAMES)

ETHNICITY AND MULTIPLE SCLEROSIS PREVALENCE IN EAST LONDON

BackgroundThere is a perceived consensus that the incidence and prevalence rates of MS in countries with a White majority are lower in the minority ethnic population than in the White population. Often-cited UK-based studies relevant to this were conducted over twenty years ago. In our study we update the UK-based literature.MethodsElectronic records from GPs in the four innermost east London boroughs were queried for the number of patients with an MS diagnosis, grouped by ethnicity, into 5-year age bands. Compared against total registered GP patients in the area (c.900K), we calculated the age-standardised MS prevalence separately, for White, Black and South Asian populations.ResultsOverall prevalence was 111 per 100K (152 for women, 70 for men). This was 180, 74, and 29 for the White, Black and South Asian populations respectively. The sex ratios (female:male) were 2.2:1, 2.1:1 and 2.8:1 respectively.ConclusionInner east London is an ideal area to study ethnicity-specific prevalence, with a population that is 36% White, 16% Black, 30% South Asian and 18% Other. MS prevalence was considerably lower amongst Black and South Asian populations, compared to the White population, by 59% and 84% respectively. Our findings are consistent with previous studies.</jats:sec