Table 1

Timeline table shows demography, clinical features, investigations, therapeutic intervention and outcome in 3 patients with MS developed after weight loss.

Patient characteristics	Patient 1	Patient 2	Patient 3
Gender	Male	Male	Male
Age at symptoms onset, at diagnosis (years)	18, 18	28, 28	21, 23
Modality of weight loss	Diet	Sleeve surgery	Diet
Weight lost (kg), time (months)	58, 3	87, 6	50, 6
Symptoms at presentation	Bilateral lower limb numbness 5 months after weight loss	Abnormal eye movement, paresthesia in upper and lower limbs, and imbalance 18 months after surgery	Diplopia and right arm and leg paresthesia 2 years after weight loss
Past history	Fatigable ptosis, diplopia, dysarthria, and proximal limb weakness 2 months after weight loss	Upper and lower limb paresthesia and sense of heaviness 10 months after surgery	Bilateral lower limb paresthesia extending to the level of the umbilicus immediately after weight loss
Clinical signs	Normal	Gaze-evoked nystagmus, appendicular ataxia, and impaired tandem gait	Left abducens nerve palsy, right hemisensory loss of pain and temperature, right upper limb dysmetria, and impaired tandem gait
MRI brain	Multiple demyelinating lesions, a few of which were enhancing, located at subcortical and juxtacortical areas, corpus callosum, brainstem, and spinal cord	Multiple supra- and infra-tentorial non-enhancing demyelinating lesions, and enhancing lesions in the brainstem	Extensive white matter demyelinating lesions, a few of which were enhancing
Laboratory workup	ANA titre 1:1,280, low vitamin D level	Low vitamin D elvel	Normal
Therapy for relapse	Pulse methylprednisolone	Pulse methylprednisolone	Pulse methylprednisolone
Disease modifying therapy	Azathioprine and prednisone	Natalizumab	B1a interferon
Follow-up at 1 year	No clinical or radiological relapses	No clinical or radiological relapses	No clinical or radiological relapses

MS - multiple sclerosis, kg - Kilogram, MRI - Magnetic resonance imaging