الفهرس 
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Abstract
Multiple sclerosis (MS) is the most common non-traumatic cause of neurological disability in young adults in developed countries .
Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function .
Metabolic syndrome is diagnosed when a patient has at least 3 of the following 5 conditions :
1 -Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia) .
2 -Blood pressure ≥130/85 mm Hg (or receiving drug therapy for hypertension) .
3 -Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia) .
4 -HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for reduced HDL-C) .
5 -Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women .
Metabolic Syndrome is also known as Insulin resistance syndrome. This syndrome is a cluster of disorders like Insulin resistance, impaired glucose intolerance and hyperinsulinemia. Insulin resistance appears to be the primary mediator of metabolic syndrome .
Insulin resistance is important pathophysiological mechanism related to atherosclerosis, but until now, we are not aware of any study that has evaluated the association of IR with disability in patients with MS. Additionally, IR prevalence in individuals with MS, to our knowledge, has not been determined yet.
However, it remains unclear whether or not people with MS are more likely to have the risk factors comprising the metabolic syndrome when compared with healthy controls.
To date, scarce information is available about the association of metabolic comorbidities and disability in individuals with MS .
This study was conducted on fifty Egyptian patients with Multiple Sclerosis disease, fulfilling the Revised McDonald’s criteria for diagnosis of multiple sclerosis 2010 . They was admitted to the Neurology Department in Beni Suef University Hospital (they were enrolled from December 2014 to December 2015) and a control group including 25 healthy volunteers matched for age and sex.
Our aim of work is evaluation of presence of insulin resistance and / or metabolic syndrome in multiple sclerosis patients and how it can affect disease progression and disability. Also the relation of insulin resistance and /or metabolic syndrome on radiological presentation in multiple sclerosis patients.
All patients will be subjected to the following:
• Thorough history taking & examination from sheet currently used in Neurology Department.
• Extended Disability Status Scale.
• Magnetic Resonance Imaging of the Brain and spine with Contrast.
• Laboratory tests include :
a. Serum HDL , LDL.
b. Serum Triglycerides.
c. Fasting blood glucose.
d. Fasting insulin level.
• Measuring the following:
a. Patients Waist Circumference.
b. Blood pressure .
c. Insulin resistance using HOMA IR (insulin fasting x glucose fasting / 22.5).
The results of the study were summarized in the following:
• Results of our study revealed that there was 22% of MS patients had metabolic syndrome and regarding specific components of the MetS , 38% of MS patients had central obesity by waist circumference, , 30% had elevated blood pressure more than 130/85 mmHg , 30% had fasting hyperglycemia 14% had elevated TG level and 34% had low HDL-C.
• Results showed that there was no statistically significant difference between cases with and without metabolic syndromes as regards to disability EDSS.
• Results showed that there is statistically significance increase in fasting blood glucose , Insulin level & Insulin resistance (HOMA-IR) in cases of multiple sclerosis than that of controls.
• Results showed that 46% of cases has high level of HOMA-IR while all control subjects had normal HOMA –IR but that was not associated with disability in MS patients as there is no statistically significant difference in EDSS score among different HOMA-IR results.
• Regarding relation of fasting blood glucose level and disability of MS patients, there was no statistically significant correlation between EDSS score and FBS among multiple sclerosis patients.
• Results showed no statistically significant difference between disability (EDSS) in patients with Fasting glucose ≥100 mg/dL and patients with Fasting glucose < 100 mg/dL .
• Results showed that there is statistically significant difference between cases of multiple sclerosis and control subjects as regards the lipid profile (HDL, LDL, and Triglycerides level) with lower mean of HDL level among cases and significant higher mean among cases with multiple sclerosis for LDL, and triglycerides .
• Results showed no statistically significant correlation between EDSS score and lipid profile (HDL, LDL, and triglycerides) among multiple sclerosis patients which indicated that there is no relation between lipid profile and the disability in MS patients .
• Results showed no statistically significant difference between disability (EDSS) in patients with Triglycerides ≥150 mg/dL and patients with Triglycerides < 150 mg/dL.
• Results showed no statistically significant difference between disability (EDSS) in patients with with HDL-C < 40 mg/dL in men or < 50 mg/dL in women and patients with HDL-C >40 mg/dL in men or > 50 mg/dL in women.
• Results showed that there is statistically significant increase in waist circumference among cases of multiple sclerosis than that of control subjects.
• Results showed that there is no statistically significance correlation between disability of MS patients and their waist circumference.
• Results showed no statistically significant difference between disability (EDSS) in patients with ≥102 cm in men or ≥88 cm in women and patients with <102 cm in men or < 88 cm in women.
• Results showed increase in systolic blood pressure in patients of MS than control subjects and on the other hand there is no statistically significance difference as regards to diastolic blood pressure between cases and control subjects.
• Results showed that there is no statistically significance correlation between disability of MS patients and their systolic , diastolic blood pressure.
• Results showed no statistically significant difference between disability (EDSS) in patients with Systolic blood pr ≥130mm Hg and patients with Systolic blood pr < 130mm Hg.
• Results showed no statistically significant difference between disability (EDSS) in patients with diastolic blood pr ≥ 85mm Hg and patients with diastolic blood pr < 85mm Hg.