Background. Multiple sclerosis (MS) is an uncommon disease in multiracial Malaysia. Diagnosing patients with idiopathic inflammatory demyelinating diseases has been greatly aided by the evolution in diagnostic criterion, the identification of new biomarkers, and improved accessibility to neuroimaging in the country. Objectives. To investigate the spectrum of multiple sclerosis in Malaysia. Methods. Retrospective analysis with longitudinal follow-up of patients referred to a single tertiary medical center with neurology services in Malaysia. Results. Out of 245 patients with idiopathic inflammatory demyelinating disease, 104 patients had multiple sclerosis. Female to male ratio was 5？:？1. Mean age at onset was 28.6？±？9.9 years. The Malays were the predominant racial group affected followed by the Chinese, Indians, and other indigenous groups. Subgroup analysis revealed more Chinese having neuromyelitis optica and its spectrum disorders rather than multiple sclerosis. Positive family history was reported in 5%. Optic neuritis and myelitis were the commonest presentations at onset of disease, and relapsing remitting course was the commonest disease pattern observed. Oligoclonal band positivity was 57.6%. At disease onset, 61.5% and 66.4% fulfilled the 2005 and 2010 McDonald’s criteria for dissemination in space. Mean cord lesion length was 1.86？±？1.65 vertebral segments in the relapsing remitting group as opposed to 6.25？±？5.18 vertebral segments in patients with neuromyelitis optica and its spectrum disorders. Conclusion. The spectrum of multiple sclerosis in Malaysia has changed over the years. Further advancement in diagnostic criteria will no doubt continue to contribute to the evolution of this disease here. 1. Introduction Multiple Sclerosis (MS) is an uncommon disease with an estimated prevalence of one to two per 100,000 population in multiracial Malaysia with its Malay, Chinese, Indian, and indigenous racial groups [1–3]. Previous studies have highlighted several features such as rare familial inheritance and higher prevalence amongst females and those of Chinese descent. Clinically, these studies also reported optico-spinal preponderance, paroxysmal tonic spasms, early blindness, severe disability, and low incidence of oligoclonal bands and cord lesions of more than 3 vertebral segments (VS) on the magnetic resonance imaging (MRI) of the spine [1–3]. Since 1988, very little has been published on the demographics and clinical characteristics of patients with classical western type multiple sclerosis (MS) in Malaysia. There have been a number of
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