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| Year : 2016 | Volume
: 64
| Issue : 2 | Page : 360-361 |
Arriving at natural history of a disease
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| Date of Web Publication | 3-Mar-2016 |
Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.177665
How to cite this article:
Raina SK. Arriving at natural history of a disease. Neurol India 2016;64:360-1 |
Sir,
I went through with interest the article entitled, “Natural history of multiple sclerosis from the Indian perspective: Experience from a tertiary care hospital” published in Neurology India (2015; 63:866-73),[1] the authors deserve credit for their effort in exploring the natural history of multiple sclerosis. I am of the opinion that research in India should definitely focus on natural history of diseases, as this will generate data specific to the Indian context on how the diseases progress in India; and, on which interventions to plan to obtain maximum benefits for the patients.
However, I have a small concern with the study. The authors have titled the study as “Natural history,” but have not in actual reported on the natural history.
Natural history of disease (multiple sclerosis in this case) would mean the progression of a disease process in an individual over time, in the absence of treatment/intervention. It signifies the way in which a disease evolves over time from the earliest stage of its prepathogenesis phase to its termination as recovery, disability, or death, in the absence of treatment or prevention. Each disease has its own unique natural history, which is not necessarily the same in all individuals. Hence, establishing natural history is not easy. The best way of establishing this is by way of cohort studies. The difficulty with hospital-based studies arises because what a patient generally records is an episode in the natural disease, and once an intervention/treatment is initiated on the basis of this episode, the natural history of the disease changes. Now, this study has entirely been based on hospital data; therefore, all the study participants have undergone an intervention meaning this study is not actually reporting the natural history.
Finally, the authors need to revisit their conclusion wherein they state that a high incidence of opticospinal presentation, predominance of relapsing-remitting multiple sclerosis, and a low yield on cerebrospinal fluid studies are the major findings of our study. The study methodology is inadequate to arrive at incidence. The incidence is basically a “rate” and is the number of new cases per population at risk in a given time period.[2]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Jena SS, Alexander M, Aaron S, Mathew V, Thomas MM, Patil AK, et al. Natural history of multiple sclerosis from the Indian perspective: Experience from a tertiary care hospital. Neurol India 2015;63:866-73.  [ PUBMED]  |
| 2. | Raina SK. Central nervous system lymphoma: Patterns of incidence in Indian population and effect of steroids on stereotactic biopsy yield. Neurol India 2014;62:343-4. [ PUBMED] |
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