Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Clinical characteristics and dynamics of disability progression in a cohort of patients with multiple sclerosis in Latvians

There is wide variation in the time from the onset to secondary progressive multiple sclerosis (MS) and some controversy regarding the clinical characteristics of the courses (phenotypes) of MS. The present study aimed to characterize demographic and clinical factors that potentially influence long-term disability progression in the cohort of Latvian MS patients. A descriptive longitudinal incidence study was conducted using a cohort of 288 MS patients beginning in 2011 (disease duration from 1 to 51 years). Socio-demographic and clinical information from the first visit to 15/20 years was analysed in groups stratified by gender and visits at five-time points (the first visit; after a year or 2; after 5 ± 1 year; after 10 ± 2 years; after 15-20 years). Our study was dominated by patients from urban areas and non-smokers. The female/male ratio was 2.4:1; the distribution of clinical courses at the first visit was consistent with most European studies. The most common symptom at presentation in our study was optic manifestations, followed by sensory disturbances and motor deficits. In the Latvian study, gender was not a significant influencing factor on the rate of disease progression; however, patient age was statistically significantly associated with EDSS (Expanded Disability Status Scale) value at the first visit. Early clinical features of MS are important in predicting the disability accumulation of patients. Despite the small differences regarding the first MS symptoms, the disability outcomes in the cohort of Latvian patients are similar to other regions of the world.

Ethnic disparities in the epidemiological and clinical characteristics of multiple sclerosis

BACKGROUND

Multiple Sclerosis (MS) is a neuroinflammatory disorder which affects 2.8 million people world-wide. A growing body of evidence shows ethnic disparities in MS. This review aims to evaluate differences, based upon ethnic background, in the incidence, prevalence, disease course, and efficacy of disease-modifying therapies (DMTs) among people with MS (PwMS).

METHOD

Ethnicities were classified as White, Black, Hispanic, Asian, and Middle Eastern and North African (MENA). A literature search was conducted using the PubMed search engine to identify articles on MS and ethnicity that were published in the English language between 01/01/2005 and 31/05/2022.

RESULTS

101 studies met all inclusion criteria. Although the incidence and prevalence of MS varied among ethnicities, findings were inconsistent and depended on the continent of the study. Ethnicity may have an impact on the disease course. PwMS from Black, Hispanic, and MENA, but not Asian ethnicities, appeared to accumulate physical disability at a faster rate than those from White ethnicity. Although there was a lack of studies evaluating the relative safety and efficacy of DMTs among various ethnicities, interferon-beta was found to be less efficacious in PwMS from Black ethnicity.

CONCLUSIONS

Further studies, with more uniform definitions of ethnicity are required to comprehensively understand ethnic disparities in MS, in particular to identify underlying causes, to facilitate the delivery of personalised medical care and avoid inequity.

Preliminary race-ethnicity-based analyses of fall risk among people with multiple sclerosis

BACKGROUND

Mounting evidence suggests differences in the disease characteristics of multiple sclerosis (MS) across ethnic and racial groups. Although it is widely recognized that falls are a significant concern for people with MS (PwMS), no study has explored if the fall risk is related to race/ethnicity in PwMS. The primary purpose of this pilot study was to examine whether the risk of falls is different between age-matched White, Black, and Latinx PwMS.

METHODS

Fifteen White, 16 Black, and 22 Latinx, age-matched ambulatory PwMS were selected from previous studies. Demographic and disease information, the fall risk (annual fall prevalence, proportion of recurrent fallers, and the number of falls) in the preceding year, and a battery of fall risk factors (including the disability level, gait speed, and cognition) were compared between race/ethnicity groups. The fall history was gathered using the valid fall questionnaire. The disability level was assessed by the Patient Determined Disease Steps score. Gait speed was measured using the Timed 25-Foot Walk test. The short Blessed Orientation-Memory-Concentration test evaluates participants' cognitive function. SPSS 28.0 was used for all statistical analyses and a significance level of 0.05 was applied.

RESULTS

Among the demographic measurements, age (p = 0.052), sex (p = 0.17), body mass (p = 0.338), age at diagnosis (p = 0.623), and disease duration (p = 0.280) were comparable across groups while the body height was significantly different between racial groups (p < 0.001). Binary logistic regression analysis did not detect a significant relationship between the faller status and racial/ethnic group (p = 0.571) after controlling the body height and age. Similarly, the recurrent faller status was not associated with our participants' race/ethnicity (p = 0.519). There was no difference in the number of falls in the past year between racial groups (p = 0.477). The fall risk factors of disability level (p = 0.931) and gait speed (p = 0.252) were similar among the groups. However, the White group had a significantly better Blessed Orientation-Memory-Concentration score than the Black (p = 0.037) and Latinx (p = 0.036) groups. No significant difference in the Blessed Orientation-Memory-Concentration score was observed between the Black and Latinx groups (p = 0.857).

CONCLUSION

As the initial attempt, our preliminary study suggests that the annual risk of being a faller or recurrent faller may not be affected by PwMS' race/ethnicity. Similarly, the physical functions (quantified by the Patient Determined Disease Steps and the gait speed) are comparable between racial/ethnic groups. However, the cognitive function may differ among age-matched racial groups of PwMS. Given the small sample size, caution is warranted when interpreting our findings. Despite the limitations, our study provides pilot knowledge about how race/ethnicity affects the fall risk in PwMS. Due to the limited sample size, it is too soon to definitively conclude that race/ethnicity has ignorable impacts on fall risk in PwMS. Further studies with larger sample sizes and more fall risk metrics are needed to clarify the effects of race/ethnicity on fall risk in this population.

Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities?

Those of African American or Latin American descent have been demonstrated to have more severe clinical presentations of multiple sclerosis (MS) than non-Latin American White people with MS. Concurrently, radiological burden of disease on magnetic resonance imaging (MRI) in African Americans with MS has also been described as being more aggressive. Here, we review MRI studies in diverse racial and ethnic groups (adult and pediatric) investigating lesion burden, inflammation, neurodegeneration, and imaging response to disease modifying therapy. We also discuss why such disparities may exist beyond biology, and how future studies may provide greater insights into underlying differences.

Editorial of Special Issue "Multiple Sclerosis: Diagnosis and Treatment II"

The special issue on Multiple Sclerosis: Diagnosis and Treatment II, reflects advances and discoveries in the molecular and cellular mechanisms of disease, and novel laboratory techniques providing more sensitivity to diagnostic techninques and the understanding of neuroinflammation. Mitochondrial-mediated apoptosis in isolated peripheral blood mononuclear cells and the role of reactive oxygen species are studied as indicators of activity of MS. In these cells, downregulation of circular and linera RNAs are reported as markers of highly active disease in MS. Progress and importance of Neurofilaments determinations in early diagnosis and as a marker of disease activity, and the analysis of the complex mechanisms and therapeutic potential of Sphingosine-1-phosphate receptor modulator are discussed. Epidemiologic observations from a highly diversified area of the world provide more insights into this important aspect of MS; discussions on the clinical challenges posed by spinal cord involvement in demyelinatind disorders and the latest aspects of pediatric onset MS, complement this fine collection of scientific papers.