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Sechi E, Puci M, Pateri MI, Zara P, Othmani S, Sotgiu S, Saddi MV, Leoni S, Fenu G, Melis M, Sotgiu G, Solla P, Cocco E, Frau J. Epidemiology of aquaporin-4-IgG-positive NMOSD in Sardinia. Mult Scler Relat Disord 2024; 85:105522. [PMID: 38461730 DOI: 10.1016/j.msard.2024.105522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The Italian Island of Sardinia (population, 1,578,146) is recognized for the high risk of multiple sclerosis (MS) but the epidemiological burden of other less common demyelinating diseases of the central nervous system (CNS), such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), is unknown. In this study, we determined the incidence and prevalence of AQP4-IgG+NMOSD in Sardinia over a ten-year study period (2013-2022). METHODS Patients with a diagnosis of AQP4-IgG+NMOSD (per 2015 IPND diagnostic criteria) were retrospectively identified using two sources: (1) Archives of the reference and only laboratory for AQP4-IgG testing in Sardinia; and (2) medical records of the four MS units in the island. Incidence (January 2013-December 2022) and prevalence (December 31, 2022) were calculated. RESULTS A total of 45 cases were included: incident, 31; prevalent, 41. The median age (range) at disease presentation was 51 (6-78) years; female/male ratio was 9:1. The crude (95 % CI) incidence and prevalence were 1.9 (1.3-2.7) per million and 2.6 (1.9-3.5) per 100,000, respectively. Prevalence increased from 2013 (1.1 per 100,000) to 2022 (2.6 per 100,000); p = 0.002. After age-standardization to the world, incidence and prevalence (95 % CI) decreased to 1.3 (0.7-2) per million and 1.8 (1.3-2.3) per 100,000, respectively. Coexisting immune-mediated disorders, mostly autoimmune thyroiditis, were reported in 50 % of patients. CONCLUSIONS The epidemiology of AQP4-IgG+NMOSD in Sardinia is overall in line with other Caucasian populations. The high MS risk in the island seems disease-specific and not associated with an increased risk of other CNS demyelinating disorders, confirming different pathophysiology.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, University Hospital of Sassari, Sassari, Italy.
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Maria Ida Pateri
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Pietro Zara
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Sabrine Othmani
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, University Hospital of Sassari, Sassari, Italy
| | | | - Stefania Leoni
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Giuseppe Fenu
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Paolo Solla
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
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Ptaszek B, Podsiadło S, Adamiak J, Marchewka J, Tota Ł, Teległów A. Effect of Whole-Body Cryotherapy on Oxidant-Antioxidant Imbalance in Women with Multiple Sclerosis. J Clin Med 2023; 12:5958. [PMID: 37762899 PMCID: PMC10532046 DOI: 10.3390/jcm12185958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of the study was to investigate whether 20 whole-body cryotherapy treatments have an effect on oxidative-antioxidant imbalances in women with multiple sclerosis. Fifty women aged 30-55 were examined: study group-15 women with multiple sclerosis, subjected to whole-body cryotherapy; first control group-20 women with multiple sclerosis who did not receive cryotherapy intervention; second control group-15 healthy women who participated in cryotherapy treatments. Blood from the examined women was collected twice (before and after the series of 20 cryotherapy sessions). An insignificant increase in the total antioxidant capacity (study group: p = 0.706; second control group: p = 0.602) was observed after the whole-body cryotherapy intervention. After the series of cryotherapy sessions, the total oxidative status/total oxidative capacity value was insignificantly decreased among the multiple sclerosis patients (decrease by 14.03%, p = 0.495). In women with multiple sclerosis, no significant cryotherapy impact was demonstrated on changes in the oxidant-antioxidant imbalance or concentrations of nitric oxide, uric acid, or matrix metalloproteinase-9.
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Affiliation(s)
- Bartłomiej Ptaszek
- Institute of Applied Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland;
| | - Szymon Podsiadło
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571 Krakow, Poland; (S.P.); (J.M.)
| | - Justyna Adamiak
- Institute of Applied Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland;
| | - Jakub Marchewka
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571 Krakow, Poland; (S.P.); (J.M.)
| | - Łukasz Tota
- Institute of Biomedical Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland;
| | - Aneta Teległów
- Institute of Basic Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland;
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3
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Lane J, Ng HS, Poyser C, Lucas RM, Tremlett H. Multiple sclerosis incidence: A systematic review of change over time by geographical region. Mult Scler Relat Disord 2022; 63:103932. [DOI: 10.1016/j.msard.2022.103932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/25/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
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Puthenparampil M, Perini P, Bergamaschi R, Capobianco M, Filippi M, Gallo P. Multiple sclerosis epidemiological trends in Italy highlight the environmental risk factors. J Neurol 2021; 269:1817-1824. [PMID: 34580756 PMCID: PMC8940874 DOI: 10.1007/s00415-021-10782-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Italy is definitely a high-risk country for multiple sclerosis (MS). Over the last 50 years, several epidemiological studies, including longitudinal surveys, have disclosed that MS incidence and prevalence in Italy mainland and Islands (Sardinia and Sicily) have progressively increased, picturing a semi-parabolic curve. Based on the comprehensive scrutiny of 58 papers, we conclude that the latitude risk gradient does not fit to the Italian map of MS. The genetic heterogeneity of the Italian ethnicities, that likely forms the basis of MS predisposition, does not account for the dramatic increase of MS incidence and prevalence observed in Italy over the last half century that, rather, seems better explained by the effect of environmental factors.
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Affiliation(s)
- M Puthenparampil
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy. .,Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy.
| | - P Perini
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - R Bergamaschi
- Multiple Sclerosis Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - M Capobianco
- Centro di Riferimento Regionale Sclerosi Multipla (CReSM), SCDO Neurologia, AOU S. Luigi Gonzaga, Orbassano, Turin, Italy
| | - M Filippi
- Unit of Neurology, Unit of Neurorehabilitation and Neurophysiology Service, IRCCS San Raffaele Institute, Milan, Italy
| | - P Gallo
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy.,Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
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Talebi M, Sadigh-Eteghad S, Sahraian MA, Fahidi A. Age and sex adjusted prevalence and annual incidence of multiple sclerosis in East-Azerbaijan, Iran. Mult Scler Relat Disord 2021; 50:102839. [PMID: 33592381 DOI: 10.1016/j.msard.2021.102839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incidence and prevalence of multiple sclerosis (MS) is postulated to be rising in recent decades. Therefore, updating and completing the information of patients is essential, especially in high population areas. East-Azerbaijan is the largest and most populous province in the northwest of Iran. This study aimed to determine the prevalence and annual incidence of MS from 2008 to 2017 in East-Azerbaijan. METHODS We evaluated the data of all patients who had registered at the MS center in the university hospital. The data include nearly all MS patients in the East-Azerbaijan region, because it is the only referral site in the area. All of the reported rates were calculated in 100,000 of the total population. RESULTS By the end of 2017, the number of MS patients was 2995 (residing in the, with 769 (25.67%) men and 2226 (74.32%) women. The prevalence rate was 75.72/100,000 (95 % CI: 73.06-78.48), 38.2 in men (95% CI: 35.5-41.0), and 114.61 for women (95% CI: 109.9-119.4), with a female to male (F/M) ratio of 3:1. The mean annual incidence rate was 7.63/100,000 (95% CI: 5.6-9.3), and this rate was higher in women than men. During the nine years, the incidence rate increased. The patients' mean age was 32.33 ± 8.92, with a peak prevalence in 25-29 years for both genders. In this study, 13.9% of patients had a positive MS family history. CONCLUSIONS This study showed a high prevalence of MS in the region. There is a significant increase in the incidence of MS during the nine years in East-Azerbaijan. The increment of incidence was more prominent in women. Also, considering the increasing incidence rate, it is concluded that the risk of MS is increasing in this region.
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Affiliation(s)
- Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ali Sahraian
- Sina MS Research Center, Sina Hospital, and Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Fahidi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Hosseinzadeh A, Baneshi MR, Sedighi B, Kermanchi J, Haghdoost AA. Incidence of multiple sclerosis in Iran: a nationwide, population-based study. Public Health 2019; 175:138-144. [PMID: 31476710 DOI: 10.1016/j.puhe.2019.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The incidence of multiple sclerosis (MS) is not well known in Iran. This study was conducted to estimate the trends in annual MS incidence in Iran from March 21, 2010, to March 20, 2016. STUDY DESIGN Longitudinal study. METHODS In this longitudinal study, data for all MS patients fulfilling McDonald criteria were obtained from a national registry, coordinated by the Ministry of Health (MOH). In Iran, all MS patients are eligible to receive public care and treatment services based on their records in this registry, and thus nearly all MS patients are registered in this database. The annual incidence rates were calculated based on year of diagnosis and were standardized using the World Health Organization (2000-2025) population as a standard. RESULTS In this registry, 36,287 (8202 [22.6%] males and 28,085 [77.4%] females) confirmed MS cases were registered by the MOH between 2010 and 2016. The female-to-male ratio was 3.11. The mean age of patients was 31.6 ± 0.9 years at the time of diagnosis. It was 31.3 ± 0.8 and 32.3 ± 0.9 for females and males, respectively. Overall incidence rate was 6.7/100,000 population (95% confidence interval [CI]: 6.2-7.2); 10.5 and 3.0 in females and males, respectively. The age-adjusted incidence rates increased significantly from 4.4 (95% CI: 4.3-4.6) in 2010 to 5.8 (95% CI: 5.7-6.0) in 2016, with its peak at 6.5 (95% CI: 6.3-6.6) in 2014. CONCLUSIONS This study revealed that Iran is a high-risk area for MS disease and that MS incidence and female-to-male ratio are more or less comparable with the dominant patterns in developed countries. Also, this study showed that the incidence trend of MS in Iran is similar to regional and global observed patterns.
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Affiliation(s)
- A Hosseinzadeh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - M R Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - B Sedighi
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - J Kermanchi
- Deputy of Curative Affairs, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - A A Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Urru SAM, Antonelli A, Sechi GM. Prevalence of multiple sclerosis in Sardinia: A systematic cross-sectional multi-source survey. Mult Scler 2019; 26:372-380. [DOI: 10.1177/1352458519828600] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Partial surveys in sub-regions of Sardinia have suggested a high prevalence of multiple sclerosis (MS) on the island, relative to other Mediterranean populations. We assessed the island-wide prevalence of MS and its detailed distribution in Sardinia. Methods: The study population consisted of 5677 MS patients, 1735 men and 3942 women, living in Sardinia. Neurologists retrospectively examined electronic and paper-based records of patients with a diagnosis of MS. The data were then linked to the administrative health information systems. Crude, age-, and sex-specific prevalence estimates of disease were calculated. Results: The overall age-adjusted MS prevalence was 330 per 100,000 (95% confidence interval (CI) 321–338) in individuals older than 15 years, 447 in women (95% CI 433–461), and 205 in men (95% CI 195–214). The prevalence was highest in the Ogliastra and Nuoro districts, respectively, 425 (95% CI 372–478) and 419 (95% CI 387–451), and lowest in the Olbia-Tempio district, 217 (95% CI 195–239). Most cases had relapsing–remitting MS (79.3%), 16.3% had secondary-progressive MS, and 4.4% had primary-progressive MS. Conclusion: These prevalence are among the highest reported so far worldwide. They provide estimates for comparative analyses in other populations and are essential for public health interventions.
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Affiliation(s)
- Silvana AM Urru
- Biosciences Sector, CRS4, Science and Technology Park Polaris—Piscina Manna, Pula, Italy
| | - Antonello Antonelli
- Department of Clinical Governance, Sardinia Region Health Service, Cagliari, Italy
| | - Giuseppe M Sechi
- Department of Clinical Governance, Sardinia Region Health Service, Cagliari, Italy
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Boesen MS, Magyari M, Koch-Henriksen N, Thygesen LC, Born AP, Uldall PV, Blinkenberg M. Pediatric-onset multiple sclerosis and other acquired demyelinating syndromes of the central nervous system in Denmark during 1977-2015: A nationwide population-based incidence study. Mult Scler 2017; 24:1077-1086. [PMID: 28608742 DOI: 10.1177/1352458517713669] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The incidence of acquired demyelinating syndromes (ADS) including multiple sclerosis (MS) has never been investigated in a Danish pediatric population. OBJECTIVES We estimated the nationwide age- and sex-specific incidence of pediatric ADS including MS. METHODS Data were sourced from the Danish Multiple Sclerosis Registry, providing cases of pediatric MS for 1977-2015, and the National Patient Register, providing cases of ADS during 2008-2015. All medical records were reviewed to validate the register-based diagnoses. RESULTS We identified 364 cases of pediatric MS occurring during 1977-2015 (incidence rate = 0.79 per 100,000 person-years). MS was exceptionally rare before puberty, but the incidence rose considerably from 9 years in girls and 11 years in boys. The female-to-male ratio was 2.5; the median age at onset was 16 years (range = 7-17 years). The MS incidence rate was relatively stable through the study period. During 2008-2015, we identified 219 ADS cases. The incidence was 2.29 per 100,000 person-years with considerable differences in the age peaks for the separate ADS. CONCLUSION The incidence rates of MS and other ADS in Denmark were higher than those reported for some other European countries. Referral bias and classification differences may account for this disparity, in particular the age-intervals and the definition of onset.
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Affiliation(s)
- Magnus Spangsberg Boesen
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Aarhus, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Alfred Peter Born
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Vilhelm Uldall
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Nielsen NM, Harpsøe M, Simonsen J, Stenager E, Magyari M, Koch-Henriksen N, Baker JL, Hjalgrim H, Frisch M, Bager P. Age at Menarche and Risk of Multiple Sclerosis: A Prospective Cohort Study Based on the Danish National Birth Cohort. Am J Epidemiol 2017; 185:712-719. [PMID: 28369233 DOI: 10.1093/aje/kww160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
Abstract
Few studies have addressed the possible association between age at menarche and multiple sclerosis (MS), and results are conflicting. We studied this issue in a large prospective cohort study. The study cohort comprised 77,330 women included in the Danish National Birth Cohort (1996-2002). Information on menarcheal age was ascertained at the first interview, which took place in the 16th week of pregnancy. Women were followed for MS from the first interview to December 31, 2011. Associations between age at menarche and risk of MS were evaluated with hazard ratios and 95% confidence intervals using Cox proportional hazards regression models. Overall, 226 women developed MS during an average follow-up period of 11.7 years. Age at menarche among women with MS was generally lower than that among women without MS (Wilcoxon rank-sum test; P = 0.002). We observed an inverse association between age at menarche and MS risk. For each 1-year increase in age at menarche, risk of MS was reduced by 13% (hazard ratio = 0.87, 95% confidence interval: 0.79, 0.96). Early age at menarche appears to be associated with an increased risk of MS. The mechanisms behind this association remain to be established.
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Affiliation(s)
- Nete Munk Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Maria Harpsøe
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Jacob Simonsen
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, DK-5000, Odense, Denmark
- Focused Research Unit in Neurology, Hospital of Southern Jutland, DK-6200, Aabenraa, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Aarhus, Denmark
| | - Jennifer L Baker
- Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Frisch
- Department of Biometry and Population Genetics, IFZ Research Centre for Biosystems, Land Use and Nutrition, Justus Liebig University GiessenGiessen, Germany
| | - Peter Bager
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
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Estimated prevalence of multiple sclerosis in Italy in 2015. Neurol Sci 2016; 38:473-479. [PMID: 28040843 DOI: 10.1007/s10072-016-2801-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
Italy is a high risk area for multiple sclerosis (MS) as confirmed by the numerous prevalence and incidence studies conducted in several regions/districts of the country. Nevertheless, there are no recent published epidemiological data, nor studies about the total prevalence of MS in Italy. Our aim was to update as of 2015 the prevalence rates of MS in different geographical areas using already published epidemiological studies, and to estimate the overall prevalence of the disease in Italy. We made a search in MEDLINE database of all published studies on epidemiology of MS in Italy. Then, we applied, to the already published prevalence data, the last published incidence and mortality rates to recalculate, as of 2015, the prevalence of MS. So, we calculated the mean prevalence rate from our extrapolations, and we applied it to the population in 2015 to estimate the number of MS patients in Italy. Our prevalence extrapolations ranged from 122 to 232 cases/100,000 in the mainland and Sicily, with an average of 176/100,000, and from 280 to 317 cases/100,000 in Sardinia with an average of 299/100,000. Applying these media to the Italian population in 2015, we obtained an estimate of more than 109,000 MS patients in Italy. Our estimates were higher than the latest published rates but consistent with the annual increase of prevalence due to incidence that exceeds mortality, with the increase of survival and, maybe, with the probable increase of incidence.
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Peruzzi A, Zarbo IR, Cereatti A, Della Croce U, Mirelman A. An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis. Disabil Rehabil 2016; 39:1557-1563. [DOI: 10.1080/09638288.2016.1224935] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Agnese Peruzzi
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy
- Interuniversity Center of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ignazio Roberto Zarbo
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Andrea Cereatti
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy
- Interuniversity Center of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy
- Interuniversity Center of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Anat Mirelman
- Laboratory for Gait Analysis & Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Cristiano E, Patrucco L, Miguez J, Giunta D, Correale J, Fiol M, Ysrraelit M, Cáceres F, Liguori NF, Saladino M, Garcea O, Silva B, Alonso R, Carrá A, Curbelo M, Martinez A, Steinberg J, Giachello S, Melcom M, Rojas J. Increasing prevalence of multiple sclerosis in Buenos Aires, Argentina. Mult Scler Relat Disord 2016; 9:91-4. [DOI: 10.1016/j.msard.2016.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022]
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Sotgiu S, Arru G, Mameli G, Serra C, Pugliatti M, Rosati G, Dolei A. Multiple sclerosis-associated retrovirus in early multiple sclerosis: a six-year follow-up of a Sardinian cohort. Mult Scler 2016; 12:698-703. [PMID: 17262996 DOI: 10.1177/1352458506070773] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The human endogenous retroviruses (HERV)-W family contains an extracellular particle detected in multiple sclerosis (MS) patients and designated as MS-associated retrovirus (MSRV). Through nested RT-PCR assays specific for pol MSRV gene, we preliminary reported that its presence in the cerebrospinal fluid (CSF) of early MS patients could be indicative of a poor prognosis upon a three-year follow-up. In the present clinical study, we enlarged our blind observation up to six years. At study entry, 10 MS patients were MSRV- and eight were MSRV+ in the CSF, both groups having a similar mean age and Expanded Disability Status Scale (EDSS) score. After six year follow-up, the mean EDSS significantly differed between the MSRV- and MSRV+ cohorts (4.3 versus 2.2; P = 0.004), as did the annual relapse rate (0.5 in the MSRV- versus 0.3 in the MSRV+; P = 0.01). Finally, two MSRV- patients entered the progressive phase, whilst none of the MSRV+ group entered this phase, and 9/10 MSRV- versus 2/8 MSRV+ patients were treated with immunomodulatory or immunosuppressive drugs (P = 0.009). In conclusion, we found that the presence of MSRV virions in the CSF at the onset of MS is associated, not only with disability accumulation, but also with a higher rate of clinical re-exacerbations. With the known potential pathogenic effects of MSRV given in the literature, further investigations on MSRV are warranted.
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Affiliation(s)
- S Sotgiu
- Institute of Clinical Neurology, University of Sassari, Viale San Pietro 10, 07100, Sassari, Italy.
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Dell'Avvento S, Sotgiu MA, Manca S, Sotgiu G, Sotgiu S. Epidemiology of multiple sclerosis in the pediatric population of Sardinia, Italy. Eur J Pediatr 2016; 175:19-29. [PMID: 26156052 DOI: 10.1007/s00431-015-2588-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Several authors report MS affecting not only young adults but also children and adolescents. Sardinia is one of the regions at the highest risk for MS worldwide in the adult population; to date, no definite data exist on the pediatric population. The aim of this study was to estimate the incidence and prevalence of pediatric MS (pMS) in northern Sardinia. Patients with diagnosis of optic neuritis, myelitis, acute disseminated encephalomyelitis (ADEM), demyelinating disorders, MS, or clinically isolated syndrome (CIS) according to McDonald criteria were enrolled, when disease onset occurred within the range of 0-18 years. From January 1, 2001 to December 31, 2012, 21 cases of pMS and 5 cases of CIS were found in northern Sardinia. The annual mean pMS incidence was 2.85 cases per 100,000 pediatric population, and the annual mean CIS incidence was 0.68 cases per 100,000 pediatric population. The pMS and CIS prevalence computed on 31 December 2012 was 26.92 and 6.41 per 100,000 pediatric population, respectively. CONCLUSION Our pMS data among Sardinians corroborate the epidemiological scenario described in the adult population being the incidence estimates significantly higher than those reported elsewhere. WHAT IS KNOWN Sardinia is one of the regions at the highest risk for MS worldwide in the adult population. To date, no definite data exist on the pediatric population. WHAT IS NEW The pediatric MS incidence in Sardinia is estimated to be significantly higher than those reported elsewhere. The pediatric MS prevalence in Sardinia is among the highest values worldwide.
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Affiliation(s)
- Silvia Dell'Avvento
- Department of Clinical and Experimental Medicine, Section of Child Neuropsychiatry, University of Sassari, Sassari, Italy.
| | | | - Salvatorica Manca
- Unit of Neuropsychiatry for Infants and Adolescents (UONPIA), ASL 1, Sassari, Italy.
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy.
- Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
| | - Stefano Sotgiu
- Department of Clinical and Experimental Medicine, Section of Child Neuropsychiatry, University of Sassari, Sassari, Italy.
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Okuno T, Nakatsuji Y, Kinoshita M, Takata K, Koda T, Yamashita K, Nanba A, Mochizuki H. The role of gut microbiota and diet in experimental autoimmune encephalitis and multiple sclerosis. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cen3.12270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tatsusada Okuno
- Department of Neurology; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Yuji Nakatsuji
- Department of Neurology; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Makoto Kinoshita
- Department of Neurology; Osaka General Medical Center; Osaka Japan
| | - Kazushiro Takata
- Department of Neurology; Osaka General Medical Center; Osaka Japan
| | - Toru Koda
- Department of Neurology; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Kazuya Yamashita
- Department of Neurology; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Akiko Nanba
- Department of Neurology; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Hideki Mochizuki
- Department of Neurology; Graduate School of Medicine; Osaka University; Osaka Japan
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Dunn SE, Gunde E, Lee H. Sex-Based Differences in Multiple Sclerosis (MS): Part II: Rising Incidence of Multiple Sclerosis in Women and the Vulnerability of Men to Progression of this Disease. Curr Top Behav Neurosci 2015; 26:57-86. [PMID: 25690592 DOI: 10.1007/7854_2015_370] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
It is well known that a number of autoimmune diseases including multiple sclerosis (MS) predominantly affect women and there has been much attention directed toward understanding why this is the case. Past research has revealed a number of sex differences in autoimmune responses that can account for the female bias in MS. However, much less is known about why the incidence of MS has increased exclusively in women over the past half century. The recency of this increase suggests that changing environmental or lifestyle factors are interacting with biological sex to increase MS risk predominantly in females. Indeed, a number of recent studies have identified sex-specific differences in the effect of environmental factors on MS incidence. The first part of this chapter will overview this evidence and will discuss the possible scenarios of how the environment may be interacting with autoimmune mechanisms to contribute to the preferential rise in MS incidence in women. Despite the strong female bias in MS incidence, culminating evidence from natural history studies, and imaging and pathology studies suggests that males who develop MS may exhibit a more rapid decline in disability and cognitive functioning than women. Very little is known about the biological basis of this more rapid deterioration, but some insights have been provided by studies in rodent models of demyelination/remyelination. The second part of this chapter will overview the evidence that males with relapsing-onset MS undergo a more rapid progression of disease than females and will discuss potential biological mechanisms that account for this sex difference.
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Affiliation(s)
- Shannon E Dunn
- Department of Immunology, University of Toronto, Toronto, ON, Canada. .,General Research Institute, University Health Network, Women's College Research Institute, Toronto, ON, Canada.
| | - Eva Gunde
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - Hyunwoo Lee
- Montreal Neurological Institute, McGill University, Montreal, Canada.
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The co-occurrence of multiple sclerosis and type 1 diabetes: shared aetiologic features and clinical implication for MS aetiology. J Neurol Sci 2014; 348:126-31. [PMID: 25480016 DOI: 10.1016/j.jns.2014.11.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/21/2014] [Accepted: 11/14/2014] [Indexed: 12/16/2022]
Abstract
We reviewed the evidence for the co-occurrence of type 1 diabetes mellitus (T1D) and multiple sclerosis (MS), and assessed the clinical significance of this association and the shared aetiological features of the two diseases. T1D and MS contribute considerably to the burden of autoimmune diseases in young adults. The co-occurrence of MS and T1D has been reported by a number of studies, suggesting that the two conditions share one or more aetiological components. Both conditions have been associated with distinct human leukocyte antigen (HLA) haplotypes but share a number of similarities in clinical, epidemiological and immunological features, leading to suggestions of possible common mechanisms of development. While underlying genetic factors may be important for the co-occurrence of both conditions, some evidence suggests that environmental factors such as vitamin D deficiency may also modulate an individual's risk for the development of both conditions. Evidence on whether the co-occurrence of the two autoimmune conditions will affect the disease course and severity of MS is merely absent. Further studies need to be conducted to ascertain whether the neuropathology associated with T1D might influence the disease course and contribute to the severity of MS.
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Kelland EE, Gilmore W, Hayardeny L, Weiner LP, Lund BT. In vitro assessment of the direct effect of laquinimod on basic functions of human neural stem cells and oligodendrocyte progenitor cells. J Neurol Sci 2014; 346:66-74. [PMID: 25125045 DOI: 10.1016/j.jns.2014.07.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/19/2014] [Accepted: 07/28/2014] [Indexed: 12/21/2022]
Abstract
Laquinimod is an orally active immunomodulatory small molecule that has shown clear clinical benefit in trials for relapsing-remitting multiple sclerosis and in experimental rodent models that emulate multiple sclerosis (MS). Studies in healthy mice, and in mice with experimental autoimmune encephalomyelitis, have demonstrated that laquinimod is capable of entering the central nervous system. It is therefore important to determine if laquinimod is capable of a direct influence on basic functions of neural stem cells (NSC) or oligodendrocyte progenitor cells (OPC)--cells critical for myelin repair in MS. In order to address this question, a series of experiments was conducted to determine the effect of exogenous laquinimod on viability, proliferation, migration and differentiation of human NSC and OPC in vitro. These data show, for the first time in cells of human origin, that direct, short-term interaction between laquinimod and NSC or OPC, in an isolated in vitro setting, is not detrimental to the basic cellular function of these cells.
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Affiliation(s)
- Eve E Kelland
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Wendy Gilmore
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Liat Hayardeny
- Pharmacology Unit, Global Innovative R&D, Teva Pharmaceutical Industries, Netanya, Israel
| | - Leslie P Weiner
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brett T Lund
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Nicoletti A, Bruno E, Nania M, Cicero E, Messina S, Chisari C, Torrisi J, Maimone D, Marziolo R, Lo Fermo S, Patti F, Giammanco S, Zappia M. Multiple Sclerosis in the Mount Etna region: possible role of volcanogenic trace elements. PLoS One 2013; 8:e74259. [PMID: 24348986 PMCID: PMC3859652 DOI: 10.1371/journal.pone.0074259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trace elements have been hypothesised to be involved in the pathogenesis of Multiple Sclerosis and volcanic degassing is the major natural sources of trace elements. Both incidence of Multiple Sclerosis in Catania and volcanic activity of Mount Etna have been significantly increased during the last 30 years. Due to prevailing trade winds direction, volcanic gases from Etna summit craters are mostly blown towards the eastern and southern sectors of the volcano. OBJECTIVE To evaluate the possible association between Multiple Sclerosis and exposure to volcanogenic trace elements. METHODS We evaluated prevalence and incidence of Multiple Sclerosis in four communities (47,234 inhabitants) located in the eastern flank and in two communities (52,210 inhabitants) located in the western flank of Mount Etna, respectively the most and least exposed area to crater gas emissions. RESULTS A higher prevalence was found in the population of the eastern flank compared to the population of the western one (137.6/100,000 versus 94.3/100,000; p-value 0.04). We found a borderline significantly higher incidence risk during the incidence study period (1980-2009) in the population of the eastern flank 4.6/100,000 (95% CI 3.1-5.9), compared with the western population 3.2/100,000 (95% CI 2.4-4.2) with a RR of 1.41 (95% CI 0.97-2.05; p-value 0.06). Incidence risks have increased over the time in both populations reaching a peak of 6.4/100,000 in the eastern flank and of 4.4/100.000 in the western flank during 2000-2009. CONCLUSION We found a higher prevalence and incidence of Multiple Sclerosis among populations living in the eastern flank of Mount Etna. According to our data a possible role of TE cannot be ruled out as possible co-factor in the MS pathogenesis. However larger epidemiological study are needed to confirm this hypothesis.
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Affiliation(s)
- Alessandra Nicoletti
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Elisa Bruno
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Martina Nania
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Edoardo Cicero
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Silvia Messina
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Clara Chisari
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Josita Torrisi
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | | | | | - Salvatore Lo Fermo
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Salvatore Giammanco
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Etneo, Catania, Italy
| | - Mario Zappia
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
- * E-mail:
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Niedziela N, Adamczyk-Sowa M, Pierzchała K. Epidemiology and clinical record of multiple sclerosis in selected countries: a systematic review. Int J Neurosci 2013; 124:322-30. [PMID: 23998938 DOI: 10.3109/00207454.2013.840618] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system mainly affecting young adults. The aim of this paper is to review the literature concentrating the main national MS registries in selected countries of the world. We performed a systematic review to determine the MS epidemiology reported on prevalence, incidence, environmental factors, treatment, social consequences of MS and neurological disability or progression among MS-affected people. We got the information on the high-MS prevalence in Sardinia, Sweden or Sicily and on the effects of MS treatment in United States of America, Italy or Germany. We emphasized environmental factors taking into account as MS risk factors. We concluded that there were many descriptions of MS status in particular countries, but they were often insufficiently detailed and not uniform enough to compare it. The paper indicated an importance of the MS epidemiology in the light of the healthcare or quality of life of the MS patients, but further research is needed to optimize this issue.
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Affiliation(s)
- Natalia Niedziela
- Department of Neurology, Medical University of Silesia , Zabrze , Poland
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Incidence and prevalence of multiple sclerosis in Europe: a systematic review. BMC Neurol 2013; 13:128. [PMID: 24070256 PMCID: PMC3856596 DOI: 10.1186/1471-2377-13-128] [Citation(s) in RCA: 317] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common cause of neurological disability in young adults worldwide and approximately half of those affected are in Europe. The assessment of differential incidence and prevalence across populations can reveal spatial, temporal and demographic patterns which are important for identifying genetic and environmental factors contributing to MS. However, study methodologies vary and the quality of the methods can influence the estimates. This study aimed to systematically review European studies of incidence and prevalence of MS and to provide a quantitative assessment of their methodological quality. METHODS A comprehensive literature search was performed to obtain all original population-based studies of MS incidence and prevalence in European populations conducted and published between January 1985 and January 2011. Only peer-reviewed full-text articles published in English or French were included. All abstracts were screened for eligibility and two trained reviewers abstracted the data and graded the quality of each study using a tool specifically designed for this study. RESULTS There were 123 studies that met the inclusion criteria. The study estimates were highly heterogeneous, even within regions or countries. Quality was generally higher in the more recent studies, which also tended to use current diagnostic criteria. Prevalence and incidence estimates tended to be higher in the more recent studies and were higher in the Nordic countries and in northern regions of the British Isles. With rare exceptions, prevalence and incidence estimates were higher in women with ratios as high as 3:1. Few studies examined ethnicity. Epidemiological data at the national level was uncommon and there were marked geographical disparities in available data, with large areas of Europe unrepresented and other regions well-represented in the literature. Only 37% of the studies provided standardized estimates. CONCLUSIONS Despite the breadth of the literature on the epidemiology of MS in Europe, inter-study comparisons are hampered by the lack of standardization. Further research should focus on regions not yet studied and the evaluation of ethnic differences in MS prevalence and incidence. National-level studies using current diagnostic criteria, validated case definitions and similar age- and sex-standardization would allow better geographical comparisons.
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Alroughani R, Ahmed SF, Behbehani R, Khan R, Thussu A, Alexander KJ, Ashkanani A, Nagarajan V, Al-Hashel J. Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult Scler 2013; 20:543-7. [DOI: 10.1177/1352458513504328] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Kuwait was considered as low to intermediate risk area for MS. Objectives: To determine the prevalence and incidence rates of MS among Kuwaiti nationals based on 2011 population census. Methods: This cross-sectional study was conducted between October 2010 and April 2013 using the newly developed national MS registry in Kuwait. Patients with a diagnosis of MS according to 2010 revised McDonald criteria were identified. The crude, age- and sex-specific prevalence and incidence rates among Kuwaiti patients were calculated. Results: 1176 MS patients were identified of which 927 (78.8%) were Kuwaitis and 249 (21.2%) were expatriates. Among Kuwaiti patients, female to male ratio was 1.8:1 with a mean age of 35.40 ± 10.99 years. The prevalence rate of MS was 85.05 per 100,000 persons (95% CI: 82.80 – 87.04). There was a peak in prevalence among patients aged 30–39 years. The incidence of MS was 6.88 per 100,000 persons (95% CI 5.52–8.55). Between 2003 and 2011, the incidence increased 3.22 and 2.54 times in women and men respectively. Conclusion: Kuwait is considered a high-risk area for MS. The significant increase in prevalence and incidence rates may represent a true increase despite the improvement in case ascertainment and case definition.
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Affiliation(s)
- R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - SF Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Neurology and Psychiatry, Al-Minia Hospital, Egypt
| | - R Behbehani
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
- Department of Ophthalmology, Al-Bahar Eye Center, Kuwait
| | - R Khan
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - A Thussu
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - KJ Alexander
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - A Ashkanani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
| | - V Nagarajan
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - J Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Medicine, Kuwait University, Kuwait
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Bellantonio P, Iuliano G, Di Blasio F, Ruggieri S. Prevalence and incidence of Multiple Sclerosis in Campobasso (Molise region chieftown, southern Italy). Clin Neurol Neurosurg 2013; 115:1806-8. [DOI: 10.1016/j.clineuro.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 02/08/2013] [Accepted: 05/02/2013] [Indexed: 11/29/2022]
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Concentration of 25(OH)D₃ and calcium and phosphorus metabolism in patients suffering from relapsing-remitting multiple sclerosis. A pilot study. Neurol Neurochir Pol 2013; 47:126-30. [PMID: 23650000 DOI: 10.5114/ninp.2013.34730] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate the concentration of 25(OH)D₃ and the indices of calcium and phosphorus metabolism at different times of relapsing-remitting multiple sclerosis (MS). The relationships between the concentrations of 25(OH)D₃ and the indices of calcium-phosphate metabolism were determined, depending on the duration of disease and vitamin and unsaturated fatty acids supplementation. MATERIAL AND METHODS Thirty patients (15 at the early stage and 15 at the advanced stage of MS) were enrolled. Each patient underwent neurological examination; neurological motor disability was defined according to the Expanded Disability Status Scale (EDSS). The results were compared to the values obtained in the control group (15 individuals) selected according to the age of subjects, their residence, ethnicity and gender. RESULTS Significantly lower serum concentrations of 25(OH)D₃ in MS patients compared to the control group were found. MS patients at the advanced stage of the disease (duration of 5-6 years) had lower 25(OH)D₃ concentrations than patients at the early stage of MS. Among patients in an advanced stage of MS, significantly lower levels of 25(OH)D₃ were found in women compared to men with a similar level of physical disability. CONCLUSIONS Lower serum concentrations of 25(OH)D₃ in MS patients compared to the control group were found. The lowest concentrations of 25(OH)D₃ were found in female patients aged 20-40 and in patients with a longer disease duration without substantial impairment of calcium-phosphate metabolism.
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Romano M, Machnicki G, Rojas JI, Frider N, Correale J. There is much to be learnt about the costs of multiple sclerosis in Latin America. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:549-55. [DOI: 10.1590/0004-282x20130082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/03/2013] [Indexed: 11/22/2022]
Abstract
METHOD: A systematic review of the literature from 1990 to 2011 was conducted. Outcome measures included: mean cost of disease modifying therapies (DMTs), mean cost of treatment of relapses and mean cost of disease by stage stratification measured by the expanded disability status scale (EDSS). RESULTS: Seven studies from three countries (Brazil, Argentina and Colombia) were included. In 2004, in Argentina, the mean cost of DMT treatment was reported to be USD 35,000 per patient treated. In Brazil, the total MS expenditure of DMTs rose from USD 14,011,700 in 2006 to USD 122,575,000 in 2009. Patient costs ranged between USD 10,543 (EDSS 8-9.5) and USD 25,713 (EDSS 3-5.5). Indirect costs markedly increased for the EDSS 8-9.5 patients. CONCLUSION: Further research assessing the economic burden of MS in LA is warranted.
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Affiliation(s)
- Marina Romano
- Centro de Educacion Medica e Investigaciones Clinicas, Argentina
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Alcalde-Cabero E, Almazán-Isla J, García-Merino A, de Sá J, de Pedro-Cuesta J. Incidence of multiple sclerosis among European Economic Area populations, 1985-2009: the framework for monitoring. BMC Neurol 2013; 13:58. [PMID: 23758972 PMCID: PMC3686603 DOI: 10.1186/1471-2377-13-58] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/04/2013] [Indexed: 11/15/2022] Open
Abstract
Background A debate surrounding multiple sclerosis epidemiology has centred on time-related incidence increases and the need of monitoring. The purpose of this study is to reassess multiple sclerosis incidence in the European Economic Area. Methods We conducted a systematic review of literature from 1965 onwards and integrated elements of original research, including requested or completed data by surveys authors and specific analyses. Results The review of 5323 documents yielded ten studies for age- and sex-specific analyses, and 21 studies for time-trend analysis of single data sets. After 1985, the incidence of multiple sclerosis ranged from 1.12 to 6.96 per 100,000 population, was higher in females, tripled with latitude, and doubled with study midpoint year. The north registered increasing trends from the 1960s and 1970s, with a historic drop in the Faroe Islands, and fairly stable data in the period 1980-2000; incidence rose in Italian and French populations in the period 1970-2000, in Evros (Greece) in the 1980s, and in the French West Indies in around 2000. Conclusions We conclude that the increase in multiple sclerosis incidence is only apparent, and that it is not specific to women. Monitoring of multiple sclerosis incidence might be appropriate for the European Economic Area.
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Affiliation(s)
- Enrique Alcalde-Cabero
- National Centre for Epidemiology, Carlos III Institute of Health, and Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Av Monforte de Lemos 5, Madrid 28029, Spain
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29
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Cristiano E, Rojas JI, Romano M, Frider N, Machnicki G, Giunta DH, Calegaro D, Corona T, Flores J, Gracia F, Macias-Islas M, Correale J. The epidemiology of multiple sclerosis in Latin America and the Caribbean: a systematic review. Mult Scler 2012; 19:844-54. [DOI: 10.1177/1352458512462918] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The incidence and prevalence of multiple sclerosis (MS) varies geographically as shown through extensive epidemiological studies performed mainly in developed countries. Nonetheless, scant data is available in Latin America and the Caribbean (LAC). The objective of this review is to assess epidemiological data of MS in LAC. We conducted a systematic review of published articles and gray literature from January 1995 to May 2011. Twenty-two studies met the inclusion criteria after full-text review. Incidence data were found in only three studies and ranged from 0.3 to 1.9 annual cases per 100,000 person-years. Prevalence was reported in 10 studies and ranged from 0.83 to 21.5 cases per 100,000 inhabitants. The most prevalent subtype of MS was the relapsing–remitting form (48% to 91% of the series). No data about mortality were found. This study showed low frequency for MS in LAC compared with North American and European countries. The role of environmental and genetic factors should be well studied, providing new insights about its etiology.
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Affiliation(s)
- E Cristiano
- Department of Neurology, MS Clinic, Hospital Italiano de Buenos Aires, Argentina
| | - JI Rojas
- Department of Neurology, MS Clinic, Hospital Italiano de Buenos Aires, Argentina
| | - M Romano
- Department of Neurocience, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC, Argentina
| | - N Frider
- Regional Medical Director in Neuroscience, Novartis Latinoamerica & Canada
| | - G Machnicki
- Global Health Economics and Outcomes Research, Novartis Latinoamerica & Canada
| | - DH Giunta
- Department of Internal Medicine, Section of Epidemiology, Hospital Italiano de Buenos Aires, Argentina
| | - D Calegaro
- Hospital das Clinicas-Universidade de São Paulo, Brazil
| | - T Corona
- Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico
| | - J Flores
- Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico
| | - F Gracia
- Multiple Sclerosis Clinic, Santo Tomás Hospital, Panamá
| | - M Macias-Islas
- Neurosciences Department, CUCS, Guadalajara University, Mexico
| | - J Correale
- Department of Neurology, Raúl Carrea Institute for Neurological Research, FLENI, Argentina
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Houzen H, Niino M, Hirotani M, Fukazawa T, Kikuchi S, Tanaka K, Sasaki H. Increased prevalence, incidence, and female predominance of multiple sclerosis in northern Japan. J Neurol Sci 2012; 323:117-22. [PMID: 22995683 DOI: 10.1016/j.jns.2012.08.032] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To carry out the third epidemiologic surveillance of multiple sclerosis (MS) in Tokachi province, on the northernmost island of Japan, and to compare the results of the present survey on the prevalence, incidence, and characteristics of MS and neuromyelitis optica (NMO) with those of previous surveys performed in 2001 and 2006. METHODS A data processing sheet was sent to all MS-related institutions in Tokachi province, and all sheets were collected in March 2011. The criteria of Poser were used for diagnosing MS and the criteria proposed by Wingerchuk for diagnosing NMO. We then compared the results of the present survey with those of previous surveys performed in 2001 and 2006 in the same community. RESULTS Fifty-seven patients diagnosed with MS according to the criteria of Poser were identified. The prevalence was 16.2/100,000 in 2011, which was higher than in the previous studies. The female/male ratio of MS was 2.63, 2.75, and 3.38 in 2001, 2006, and 2011, respectively. Three patients fulfilled the criteria for diagnosis of NMO in 2011; the prevalence of NMO was 0.9/100,000. CONCLUSIONS The results of this study suggest that the prevalence and the female predominance of MS have been increasing, due to an increase in the incidence after 1990, and that the prevalence of NMO is relatively low in northern Japan.
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Affiliation(s)
- Hideki Houzen
- Department of Neurology, Obihiro Kosei General Hospital, Obihiro, Japan
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Conradi S, Malzahn U, Schröter F, Paul F, Quill S, Spruth E, Harms L, Bergh FT, Ditzenbach A, Georgi T, Heuschmann P, Rosche B. Environmental factors in early childhood are associated with multiple sclerosis: a case-control study. BMC Neurol 2011; 11:123. [PMID: 21978074 PMCID: PMC3203040 DOI: 10.1186/1471-2377-11-123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 10/06/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) with increasing incidence mainly in high-income countries. One explanation of this phenomenon may be a higher prevalence of allergic and autoimmune diseases in industrialized countries as a consequence of otherwise beneficial advances in sanitation (hygiene hypothesis). We investigated environmental factors in early childhood associated with MS. METHODS A case-control study was performed of 245 MS patients and 296 population-based controls in Berlin. The study participants completed a standardized questionnaire on environmental factors in childhood and youth, including aspects of personal and community hygiene. Multivariable logistic regression analysis was performed to investigate factors in childhood and youth associated with the occurrence of MS. RESULTS Mean age was 46 years (range, 20-80) in the MS group and 42 years (range 18-80) in the control group, of which 73.9% in the MS and 61.5% in the control group were female. The multivariable analysis showed that having at least two older siblings (OR 0.54; p = 0.05, for individuals with two older siblings compared to individuals without older siblings), attending a day-care center (OR 0.5; p = 0.004) and growing up in an urban center with more than 100, 000 inhabitants (OR 0.43; p = 0.009) were factors independently associated with a lower chance for MS. CONCLUSIONS The hygiene hypothesis may play a role in the occurrence of MS and could explain disease distribution and increasing incidence.
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Affiliation(s)
- Silja Conradi
- Department of Neurology & Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neurology, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
| | - Uwe Malzahn
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Franziska Schröter
- Department of Neurology & Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Sabine Quill
- Department of Neurology & Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Eike Spruth
- Department of Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité -Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Lutz Harms
- Department of Neurology & Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Florian Then Bergh
- Department of Neurology, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
| | - Anna Ditzenbach
- General Practitioner, Berliner Straße 14b, Berlin, 14169, Germany
| | - Thomas Georgi
- General Practitioner, Prenzlauer Allee 90, Berlin, 10409, Germany
| | - Peter Heuschmann
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Berit Rosche
- Department of Neurology & Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
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Cocco E, Sardu C, Massa R, Mamusa E, Musu L, Ferrigno P, Melis M, Montomoli C, Ferretti V, Coghe G, Fenu G, Frau J, Lorefice L, Carboni N, Contu P, Marrosu MG. Epidemiology of multiple sclerosis in south-western Sardinia. Mult Scler 2011; 17:1282-9. [PMID: 21652610 DOI: 10.1177/1352458511408754] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sardinia is a known high-risk area for multiple sclerosis (MS), but no data for south-western Sardinia (SWS) are available. SWS has a genetically homogeneous population, apart from St Peter Island, and represents a peculiar environment related to the industrial, mineralogical and military economy. OBJECTIVE To estimate prevalence and incidence and to evaluate temporal trends and geographical distribution of MS in SWS. METHODS MS prevalence was evaluated on 31 December 2007 and crude mean annual incidence rate was defined between 2003 and 2007. Temporal trend in MS incidence was assessed using the Armitage test. To identify MS clusters, Standard Morbidity Ratio (SMR) was calculated for each village and geographical distribution prevalence by means of a Bayesian hierarchical model. RESULTS Total crude prevalence rate was 210.4 (95% CI 186.3-234.5): 280.3 (95% CI 241.4-319.3) for females, 138 (95% CI 110.1-165.8) for males. The crude mean annual incidence rate was 9.7/100,000 (95% CI 3.4-13.2): 4.7/100,000 (95% CI 2.4-17.0) and 14.6/100,000 (95% CI 11.8-34.8) for males and females respectively. MS incidence has increased over the last 50 years. Cluster analysis showed an SMR of 0.2 (95% CI 0.05-0.68, p = 0.002) on the island of San Pietro, and 2.0 (95% CI 1.35-2.95, p = 0.001) in Domusnovas. Spatial distribution of MS was confirmed by Bayesian geographical analysis. CONCLUSIONS Our data confirm Sardinia as a high-risk area for MS and support the relevance of genetic factors in MS, as evidenced in St Peter Island. However, we found an unexpectedly high MS prevalence in one village, in particular in males, suggesting an environmental influence on MS occurrence.
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Affiliation(s)
- Eleonora Cocco
- Department of Cardiovascular and Neurological Science, University of Cagliari, Italy.
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Madeddu R, Forte G, Bocca B, Tolu P, Sotgiu MA, Sotgiu G, Marchal JA, Sotgiu S, Montella A. Heavy Metals and Multiple Sclerosis in Sardinian Population (Italy). ANAL LETT 2011. [DOI: 10.1080/00032719.2010.520396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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34
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Elhami SR, Mohammad K, Sahraian MA, Eftekhar H. A 20-Year Incidence Trend (1989–2008) and Point Prevalence (March 20, 2009) of Multiple Sclerosis in Tehran, Iran: A Population-Based Study. Neuroepidemiology 2011; 36:141-7. [DOI: 10.1159/000324708] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 01/27/2011] [Indexed: 11/19/2022] Open
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Nicoletti A, Patti F, Lo Fermo S, Messina S, Bruno E, Quattrocchi G, Laisa P, Cilia S, Mostile G, Marziolo R, Scillieri R, Maimone D, Zappia M. Increasing frequency of multiple sclerosis in Catania, Sicily: a 30-year survey. Mult Scler 2010; 17:273-80. [DOI: 10.1177/1352458510386995] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objective: The objective of this study was to determine the prevalence and incidence of multiple sclerosis (MS) and its temporal profiles from 1975 to 2005 in the city of Catania. Methods: The incidence of MS from 1975 to 31 December 1999 had been previously investigated by the same group. The frequency of MS in the community of Catania from 1 January 2000 to 31 December 2004 was studied in a population of 313,110 inhabitants (2001 census). All patients who satisfied Poser’s criteria were considered as prevalent and incident cases. Results: Three hundred and ninety-eight patients with MS who had experienced the clinical onset of the disease before 31 December 2004 were found in a population of 313,110 inhabitants. The prevalence rate was 127.1/100,000 [95% confidence interval (CI) 115.1–140.4]. From 2000 to 2004, 108 patients with MS had clinical onset of the disease . The mean annual incidence was 7.0/100,000 (95% CI 5.7–13.7) and was higher in women (8.4/100,000; 95% CI 6.4–10.5) than in men (5.3/100,000; 95% CI 3.7–7.2). The mean length of time between the date of clinical onset and the date of the diagnosis was 1.4 ± 1.7 years. During the last 30 years the incidence of MS in this population increased from 1.3/100,000 during the first quinquennium (1975–9) to 7.0/100,000 during 2000–4. Conclusions: Incidence rates have further increased in this population, suggesting that the risk of MS is still increasing.
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Affiliation(s)
| | | | | | - Silvia Messina
- Department of Neurosciences, University of Catania, Italy
| | - Elisa Bruno
- Department of Neurosciences, University of Catania, Italy
| | | | - Patrizia Laisa
- Department of Neurosciences, University of Catania, Italy
| | - Sabina Cilia
- Department of Neurosciences, University of Catania, Italy
| | | | | | | | | | - Mario Zappia
- Department of Neurosciences, University of Catania, Italy
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Koch-Henriksen N, Sørensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010; 9:520-32. [PMID: 20398859 DOI: 10.1016/s1474-4422(10)70064-8] [Citation(s) in RCA: 749] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The uneven distribution of multiple sclerosis (MS) across populations can be attributed to differences in genes and the environment and their interaction. Prevalence and incidence surveys could be affected by inaccuracy of diagnosis and ascertainment, and prevalence also depends on survival. These sources of error might play a part in the geographical and temporal variations. Our literature search and meta-regression analyses indicated an almost universal increase in prevalence and incidence of MS over time; they challenge the well accepted theory of a latitudinal gradient of incidence of MS in Europe and North America, while this gradient is still apparent for Australia and New Zealand; and suggest a general, although not ubiquitous, increase in incidence of MS in females. The latter observation should prompt epidemiological studies to focus on changes in lifestyle in females. New insights into gene-environment and gene-gene interactions complicate interpretations of demographic epidemiology and have made obsolete the idea of simple causative associations between genes or the environment and MS.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Neurology, Aarhus University Hospital in Aalborg, Aalborg, Denmark.
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Kingwell E, Leung AL, Roger E, Duquette P, Rieckmann P, Tremlett H. Factors associated with delay to medical recognition in two Canadian multiple sclerosis cohorts. J Neurol Sci 2010; 292:57-62. [PMID: 20202651 DOI: 10.1016/j.jns.2010.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/02/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
Long referral and diagnostic delays can impact both the opportunity for early therapeutic intervention and estimates of MS incidence and prevalence. We investigated factors associated with diagnostic or referral delays within two geographically distinct MS Canadian cohorts and the association between referral delay and disability at first clinic visit. Adult-onset MS patients were selected from the population-based British Columbian MS (BCMS) (n=5705) and the clinic-based Hôpital Notre-Dame, Quebec (CHUM) (n=1489) databases. Referral delay (BCMS) and diagnostic delay (CHUM) were examined by sex, onset age, disease course (primary progressive (PPMS) vs. relapsing at onset), onset symptoms (BCMS only) and year of first clinic visit/diagnosis. Cohorts were analyzed separately by stratified analyses and multivariable linear modeling. The relationship between referral delay and initial disability was examined by multiple ordinal regression in the BCMS cohort. Younger at onset patients or those with PPMS exhibited significantly longer delays (p<0.001). Delays decreased over the 20+ year period, but reductions varied by clinical course, onset age and sex. Long referral delays were associated with greater disability at first clinic visit (p<0.001). If early intervention at mild disability levels is warranted in MS, then the extended delays to medical recognition for young adult-onset and PPMS patients must be addressed.
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Affiliation(s)
- Elaine Kingwell
- Faculty of Medicine (Neurology), Multiple Sclerosis Program, UBC Hospital, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
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Sagnes-Raffy C, Gourraud PA, Hannon V, Bourrel R, Laffontan MA, Gaulene MC, Viala F, Clanet M. La SEP en Haute-Garonne : une sous-estimation importante du nombre de cas. Rev Epidemiol Sante Publique 2010; 58:23-31. [DOI: 10.1016/j.respe.2009.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 08/05/2009] [Accepted: 08/24/2009] [Indexed: 11/27/2022] Open
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Pugliatti M, Cossu P, Sotgiu S, Rosati G, Riise T. Clustering of multiple sclerosis, age of onset and gender in Sardinia. J Neurol Sci 2009; 286:6-13. [DOI: 10.1016/j.jns.2009.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 06/23/2009] [Accepted: 07/16/2009] [Indexed: 11/27/2022]
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40
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Debouverie M. Gender as a prognostic factor and its impact on the incidence of multiple sclerosis in Lorraine, France. J Neurol Sci 2009; 286:14-7. [DOI: 10.1016/j.jns.2009.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 07/09/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
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Sadovnick AD, Yee IM, Guimond C, Reis J, Dyment DA, Ebers GC. Age of onset in concordant twins and other relative pairs with multiple sclerosis. Am J Epidemiol 2009; 170:289-96. [PMID: 19546151 PMCID: PMC2714951 DOI: 10.1093/aje/kwp143] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The ages of onset in multiple sclerosis cases span more than 7 decades. Data are presented for affected relative pairs from a Canadian population base of 30,000 multiple sclerosis index cases (1993–2008). The effects of genetic sharing, parent of origin, intergenerational versus collinear differences, and gender on the ages of onset were evaluated in the following concordant pairs: monozygotic twins (n = 29), dizygotic twins (n = 10), siblings (n = 614), first cousins (n = 405), half siblings (n = 29), parent/child (n = 285), and aunt/uncle/niece/nephew (avunculars) (n = 289). Fisher's z test assessed intraclass correlation (r) for ages of onset. Correlations for monozygotic twins, dizygotic twins, full siblings, and first cousins were 0.60, 0.54, 0.20, and 0.10, respectively. Dizygotic twins resembled monozygotic twins more than siblings. The age-of-onset correlation for maternal half siblings (r = 0.37) was higher than that for paternal half siblings (r = 0.26), consistent with other observations suggesting an intrauterine environmental effect on multiple sclerosis risk. Intergenerational comparisons are complicated by substantial increases of multiple sclerosis incidence over time. Genetic loading (familial vs. sporadic cases) did not generally influence the age of onset, but correlation of age of onset in multiple sclerosis relative pairs was proportional to genetic sharing. A maternal parent-of-origin effect on the age of onset in collinear generations was suggested.
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Affiliation(s)
- A Dessa Sadovnick
- Department of Medical Genetics, Vancouver Coastal Health Authority-University of British Columbia Hospital, G-920 Detwiller Pavilion, Vancouver, British Columbia, Canada.
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Fromont A, Binquet C, Clerc L, Moreau T. Épidémiologie de la sclérose en plaques : la particularité française. Rev Neurol (Paris) 2009; 165:671-5. [DOI: 10.1016/j.neurol.2009.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 02/13/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
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Mameli G, Poddighe L, Astone V, Delogu G, Arru G, Sotgiu S, Serra C, Dolei A. Novel reliable real-time PCR for differential detection of MSRVenv and syncytin-1 in RNA and DNA from patients with multiple sclerosis. J Virol Methods 2009; 161:98-106. [PMID: 19505508 DOI: 10.1016/j.jviromet.2009.05.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/20/2009] [Accepted: 05/28/2009] [Indexed: 01/01/2023]
Abstract
Two components of the HERV-W family of human endogenous retroviruses are activated during multiple sclerosis (MS) and proposed immunopathogenic co-factors: MSRV (MS-associated retrovirus), and ERVWE1 (whose env protein, syncytin-1, reaches the plasma membrane). MSRVenv and syncytin-1 are closely related, and difficult to distinguish each other. The sequences of extracellular MSRVenv and of syncytin-1 available in GenBank were compared with those found in MS patients and controls of the cohort under study. With respect to syncytin-1, MSRVenv sequences have a 12-nucleotide insertion in the trans-membrane moiety. Based on this insertion, discriminatory real-time PCR assays were developed, that can amplify selectively either MSRVenv or syncytin-1. The data of MS patients and controls indicated that MSRV and ERVWE1 are both expressed in the brain of MS patients, while only MSRV is present in the blood; MSRV was released in culture by PBMCs of MSRV-producer individuals. These cells expressed the complete MSRVenv gene in the absence of syncytin-1 expression, up to the final, fully glycosylated envelope protein product, since western blot staining with anti-HERV-Wenv antibody detected two bands of the same molecular weight (73 and 61kDa) of the fully glycosylated and partially glycosylated HERV-Wenv uncleaved proteins. Beyond MSRVenv DNA copy numbers were more abundant in MS patients than in healthy humans, while syncytin-1 were unchanged. These findings reinforce the link between MSRV and MS.
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Affiliation(s)
- Giuseppe Mameli
- Section of Microbiology, Department of Biomedical Sciences, Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Viale San Pietro 43B, Sassari, Italy
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Murgia C, Berria R, Minerba L, Sulis S, Murenu M, Portoghese E, Garau N, Zedda P, Melis GB. Risk assessment does not explain high prevalence of gestational diabetes mellitus in a large group of Sardinian women. Reprod Biol Endocrinol 2008; 6:26. [PMID: 18593483 PMCID: PMC2459178 DOI: 10.1186/1477-7827-6-26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 07/02/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A very high prevalence (22.3%) of gestational diabetes mellitus (GDM) was recently reported following our study on a large group of Sardinian women. In order to explain such a high prevalence we sought to characterise our obstetric population through the analysis of risk factors and their association with the development of GDM. METHODS The prevalence of risk factors and their association with the development of GDM were evaluated in 1103 pregnancies (247 GDM and 856 control women). The association of risk factors with GDM was calculated according to logistic regression. Sensitivity and specificity of risk assessment strategy were also calculated. RESULTS None of the risk factors evaluated showed an elevated frequency in our population. The high risk patients were 231 (20.9%). Factors with a stronger association with GDM development were obesity (OR 3.7, 95% CI 2.08-6.8), prior GDM (OR 3.1, 95% CI 1.69-5.69), and family history of Type 2 diabetes (OR 2.6, 95% CI 1.81-3.86). Only patients over 35 years of age were more represented in the GDM group (38.2% vs 22.6% in the non-GDM cases, P < 0.001). Type 2 diabetes in second-degree relatives was equally represented in GDM and non-GDM subjects, while prior poor obstetrical outcomes mostly characterized non-GDM women (17.5% vs 10.6%, P < 0.001). The "average risk" assessment better characterized non-GDM patients (76.8% vs 57.8%, P < 0.001). The logistic regression analysis confirmed that Type 2 diabetes in second-degree relatives, prior poor obstetrical outcomes and the "average risk" definition did not predict the development of GDM. CONCLUSION Such a high prevalence of GDM in our population does not seem to be related to the abnormal presence of some known risk factors, and appears in contrast with the prevalence of Type 2 diabetes in Sardinia. Further studies are needed to explain the cause such a high prevalence of GDM in Sardinia. The "average risk" definition is not adequate to predict GDM in our population.
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Affiliation(s)
- Cinzia Murgia
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Rachele Berria
- Department of Obstetrics and Gynecology, Case Western Reserve University, 44109, Cleveland, Ohio, USA
| | - Luigi Minerba
- Dipartimento di Sanità Pubblica, Universita' degli Studi di Cagliari, Italy
| | - Simonetta Sulis
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Michela Murenu
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Elaine Portoghese
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Nicoletta Garau
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Pierina Zedda
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Gian Benedetto Melis
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
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Houzen H, Niino M, Hata D, Nakano F, Kikuchi S, Fukazawa T, Sasaki H. Increasing prevalence and incidence of multiple sclerosis in northern Japan. Mult Scler 2008; 14:887-92. [PMID: 18573833 DOI: 10.1177/1352458508090226] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We previously reported that prevalence of multiple sclerosis (MS) in Japan was 8.6/100,000 individuals in 2001. This was much higher than prevalence previously reported from Asian countries. A second epidemiologic survey was conducted to assess changes in MS prevalence and incidence over the last 30 years in Tokachi province of Hokkaido, the northernmost island of Japan. METHODS The authors studied the frequency of MS in the community of Tokachi Province, where the population has stabilized between 350,000 and 360,000 over the last 30 years. The survey was conducted at the same institutions using the same methods as the first survey in 2001. RESULTS On March 31, 2006, 47 subjects satisfied Poser's criteria for MS. The prevalence rate increased from 8.6 to 13.1/100,000 individuals between 2001 and 2006. The prevalence of conventional MS (C-MS) increased in five years although the prevalence of optic-spinal MS (OS-MS) did not increase. The mean annual incidence increased from 0.15 (1975-1989) to 0.68 (1990-2004). CONCLUSIONS The results show the highest MS prevalence in Asia; the increase in MS prevalence in Tokachi Province may be due to increased incidence after 1990.
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Affiliation(s)
- H Houzen
- Department of Neurology, Obihiro Kosei General Hospital, Obihiro, Japan
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46
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Pugliatti M, Harbo HF, Holmøy T, Kampman MT, Myhr KM, Riise T, Wolfson C. Environmental risk factors in multiple sclerosis. Acta Neurol Scand 2008; 188:34-40. [PMID: 18439219 DOI: 10.1111/j.1600-0404.2008.01029.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Multiple sclerosis (MS) likely results from an interaction between genetic and exogenous factors. While genetics shapes the overall population MS susceptibility, observed epidemiological patterns strongly suggest a role for the environment in disease initiation and modulation. RESULTS Findings from studies on seasonality in MS patients' birth, disease onset and exacerbations, as well as apparent temporal trends in incidence and gender ratio support an influential effect of viruses, metabolic and lifestyle factors on MS risk. Epstein-Barr virus, vitamin D status, and smoking are factors that may explain such epidemiological patterns. CONCLUSIONS Further epidemiological investigations are encouraged and opportunities to use data from existing cohort studies as well as the design of new studies should be pursued. In particular, the development of new large multicentre population-based case-control studies which incorporate the study of the role of environment and genetics, including epigenetic mechanisms, in determining MS risk is proposed.
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Affiliation(s)
- M Pugliatti
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Mameli G, Serra C, Astone V, Castellazzi M, Poddighe L, Fainardi E, Neri W, Granieri E, Dolei A. Inhibition of multiple-sclerosis-associated retrovirus as biomarker of interferon therapy. J Neurovirol 2008; 14:73-7. [PMID: 18300077 DOI: 10.1080/13550280701801107] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors performed a longitudinal evaluation of multiple sclerosis (MS) patients, during 1 year of therapy with interferon-beta (IFN-beta), by clinical examination and detection of presence in the blood and viral load of MS-associated retrovirus (MSRV), by MSRVenv-specific, fully quantitative, real time reverse transcriptase-polymerase chain reaction (RT-PCR). MSRV load in the blood was directly related to MS duration and fell below detection limits within 3 months of IFN therapy; one patient had strong progression, accompanied by total MSRV rescue. These findings suggest that evaluation of plasmatic MSRV could be considered the first prognostic marker for the individual patient, to monitor disease progression and therapy outcome.
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Affiliation(s)
- Giuseppe Mameli
- Section of Microbiology, Department of Biomedical Sciences and Center of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
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48
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Self-perceived physical functioning and health status among fully ambulatory multiple sclerosis patients. J Neurol 2008; 255:157-62. [DOI: 10.1007/s00415-008-0543-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 12/24/2006] [Accepted: 01/05/2007] [Indexed: 10/22/2022]
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49
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Kampman MT, Brustad M. Vitamin D: A Candidate for the Environmental Effect in Multiple Sclerosis – Observations from Norway. Neuroepidemiology 2008; 30:140-6. [DOI: 10.1159/000122330] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 01/23/2008] [Indexed: 11/19/2022] Open
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Iuliano G, Napoletano R. Prevalence and incidence of multiple sclerosis in Salerno (southern Italy) and its province. Eur J Neurol 2007; 15:73-6. [PMID: 18042236 DOI: 10.1111/j.1468-1331.2007.02006.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Many multiple sclerosis (MS) prevalence studies in Italian northern and central areas, since 1980, have put Italy in a high risk zone; none concerns southern Italy. The MS registry of Salerno Center was reviewed, including the city and 16 towns at different distances (9-149 km) better connected to our Center. Population screened: 259 681 persons (Salerno = 136 678; province = 123 003). Prevalence day was December 31, 2005. Data on 186 patients were collected of which 55 were males, 131 females; crude total prevalence = 71.6263 (62.03-82.303, ranging from 50.1128 (Oliveto Citra) to 431.499 (Controne). Salerno prevalence rate is 70.9697 (57.41-86.583); standardized = 72.02. Incidence rate ranges from 2.38585 (1.6-3.39) (1991-95) to 4.31997 (3.24-5.6) (2001-05). Our data can be underestimated because some patients could have skipped the local center. This emphasizes that the results, except for Sardinia, are comparable to Italian literature data. They confirm that this territory is a high risk area for MS. There is also an indirect indication against a latitude gradient for MS.
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Affiliation(s)
- G Iuliano
- Ospedali Riuniti di Salerno, U.O. Neurologia, Centro Sclerosi Multipla, Via S. Leonardo, Salerno, Italy.
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