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Nicoletti A, Rascunà C, Boumediene F, Vasta R, Cicero CE, Lo Fermo S, Ferrante M, Marziolo R, Maimone D, Grimaldi LM, Preux PM, Patti F, Zappia M. Incidence of multiple sclerosis in the province of Catania. A geo-epidemiological study. ENVIRONMENTAL RESEARCH 2020; 182:109022. [PMID: 31883496 DOI: 10.1016/j.envres.2019.109022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND An increasing incidence of MS in the city of Catania was reported during 1975-2004, with a higher incidence along the south-eastern flank of the Mt.Etna. We evaluated the incidence of MS in the entire province of Catania during 2005-2015 and the spatial distribution of MS-cases using a cluster analysis. METHODS Patients were considered as incident MS-cases if they fulfilled the revised McDonald criteria for MS during 2005-2015 and were residents in the province of Catania at the time of disease onset. Cluster analysis was performed using both LISA and Kulldorff's spatial scan statistic. Residence address at disease onset was considered for each case. Communalities were assessed considering the centroid of their inhabited area. RESULTS A total of 973 MS-cases were identified. Mean annual incidence risk was 8.2/100,000 person-years (95%CI 7.7-8.7), significantly higher among women (10.5/100,000 versus 5.7/100,000). LISA identified a spatial aggregation of MS-cases in the eastern side of the province of Catania and Kulldorff's statistics confirmed the existence of a statistically significant spatial cluster in this area (SIR 1.23,95%CI 1.08-1.23, p-value 0.04). CONCLUSIONS Our study confirms a high incidence of MS in the province of Catania and the presence of a spatial cluster along the eastern side of the province. This area is considered the most exposed to volcanogenic ashes due to the prevailing westerly to north-westerly trade winds. Even if such distribution could be related with a greater exposure to volcanogenic metals, further studies are needed to explore possible alternative hypotheses.
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Affiliation(s)
- Alessandra Nicoletti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy.
| | - Cristina Rascunà
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy.
| | - Farid Boumediene
- INSERM, U1094, Tropical Neuroepidemiology, University of Limoges, France.
| | - Rosario Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.
| | | | - Salvatore Lo Fermo
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy.
| | - Margherita Ferrante
- Environmental and Food Hygiene Laboratory LIAA, Department GF Ingrassia, University of Catania, Catania, Italy.
| | | | | | | | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, University of Limoges, France.
| | - Francesco Patti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy.
| | - Mario Zappia
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy.
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Tarlinton RE, Khaibullin T, Granatov E, Martynova E, Rizvanov A, Khaiboullina S. The Interaction between Viral and Environmental Risk Factors in the Pathogenesis of Multiple Sclerosis. Int J Mol Sci 2019; 20:ijms20020303. [PMID: 30646507 PMCID: PMC6359439 DOI: 10.3390/ijms20020303] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic debilitating inflammatory disease of unknown ethology targeting the central nervous system (CNS). MS has a polysymptomatic onset and is usually first diagnosed between the ages of 20–40 years. The pathology of the disease is characterized by immune mediated demyelination in the CNS. Although there is no clinical finding unique to MS, characteristic symptoms include sensory symptoms visual and motor impairment. No definitive trigger for the development of MS has been identified but large-scale population studies have described several epidemiological risk factors for the disease. This list is a confusing one including latitude, vitamin D (vitD) levels, genetics, infection with Epstein Barr Virus (EBV) and endogenous retrovirus (ERV) reactivation. This review will look at the evidence for each of these and the potential links between these disparate risk factors and the known molecular disease pathogenesis to describe potential hypotheses for the triggering of MS pathology.
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Affiliation(s)
| | - Timur Khaibullin
- Republican Clinical Neurological Center, Republic of Tatarstan, Kazan 420021, Russia.
| | - Evgenii Granatov
- Republican Clinical Neurological Center, Republic of Tatarstan, Kazan 420021, Russia.
| | - Ekaterina Martynova
- Department of Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Republic of Tatarstan, Kazan 420021, Russia.
| | - Albert Rizvanov
- Department of Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Republic of Tatarstan, Kazan 420021, Russia.
| | - Svetlana Khaiboullina
- Department of Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Republic of Tatarstan, Kazan 420021, Russia.
- Department of Microbiology and Immunology, University of Nevada, Reno, NV 89557, USA.
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Daltrozzo T, Hapfelmeier A, Donnachie E, Schneider A, Hemmer B. A Systematic Assessment of Prevalence, Incidence and Regional Distribution of Multiple Sclerosis in Bavaria From 2006 to 2015. Front Neurol 2018; 9:871. [PMID: 30425676 PMCID: PMC6218432 DOI: 10.3389/fneur.2018.00871] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Worldwide, incidence and prevalence of multiple sclerosis (MS) have increased over the last decades. We present a systematic epidemiological study with recent prevalence and incidence rates of MS in Bavaria. Methods: Incidence and prevalence of MS stratified by gender, age groups and region were analyzed by data records from 2006 to 2015 of more than 10 million people insured by the Bavarian Association of Statutory Health Insurance Physicians. Official statistics of the German Federal Ministry of Health provided the size of the general population. Future prevalence was estimated with a predictive model. Results: From 2006 to 2015 prevalence of MS in Bavaria increased from 171 per 100,000 to 277 per 100,000, while incidence rates remained relatively stable (range 16-18 per 100,000 inhabitants with a female to male ratio between 2.4:1 and 2:1). Incidence and prevalence were higher in urban than urbanized and rural areas. The prevalence is expected to increase to 374 per 100,000 in 2040 with the highest prevalence rates between 50 and 65 years. Conclusion: The prevalence of MS in Bavaria is among the highest worldwide and will further rise over the next two decades. This demonstrates a need to strengthen healthcare provision systems due to the increasing numbers of particularly older patients with MS in the future.
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Affiliation(s)
- Tanja Daltrozzo
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Ewan Donnachie
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Kearns PKA, Casey HA, Leach JP. Hypothesis: Multiple sclerosis is caused by three-hits, strictly in order, in genetically susceptible persons. Mult Scler Relat Disord 2018; 24:157-174. [PMID: 30015080 DOI: 10.1016/j.msard.2018.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
Multiple Sclerosis is a chronic, progressive and debilitating neurological disease which, despite extensive study for over 100 years, remains of enigmatic aetiology. Drawn from the epidemiological evidence, there exists a consensus that there are environmental (possibly infectious) factors that contribute to disease pathogenesis that have not yet been fully elucidated. Here we propose a three-tiered hypothesis: 1) a clinic-epidemiological model of multiple sclerosis as a rare late complication of two sequential infections (with the temporal sequence of infections being important); 2) a proposal that the first event is helminthic infection with Enterobius Vermicularis, and the second is Epstein Barr Virus infection; and 3) a proposal for a testable biological mechanism, involving T-Cell exhaustion for Epstein-Barr Virus protein LMP2A. We believe that this model satisfies some of the as-yet unexplained features of multiple sclerosis epidemiology, is consistent with the clinical and neuropathological features of the disease and is potentially testable by experiment. This model may be generalizable to other autoimmune diseases.
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Nicoletti A, Messina S, Bruno E, Mostile G, Quattrocchi G, Raciti L, Dibilio V, Cappellani R, D'Amico E, Sciacca G, Lo Fermo S, Paradisi V, Patti F, Zappia M. Risk factors in multiple sclerosis: a population-based case-control study in Sicily. Background and methods. Neurol Sci 2016; 37:1931-1937. [PMID: 27488302 DOI: 10.1007/s10072-016-2685-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 07/25/2016] [Indexed: 01/01/2023]
Abstract
Incidence of multiple sclerosis (MS) has steeply increased over time during the last 30 years in the city of Catania. We carried out a population-based case-control study to evaluate the possible role of both environmental and genetic factors. From 1975 to 2004 in Catania, 367 MS patients diagnosed according to the Poser's criteria had the onset of disease. A sample of MS patients was randomly selected from this incident cohort. Three controls matched by age and sex were randomly selected from the rosters of 14 GPs. Controls were proportionally selected according to the distribution by municipality of the target population using a multistage sampling methods. All cases and controls underwent a face-to-face interview to record information concerning environmental factors and a blood sample was taken for serological and genetic analysis. 164 MS patients (64 % women; mean age of 46.4 ± 10.7) and 481 controls (69 % women; mean age of 47.7 ± 14.8) were enrolled in the study. The distribution of the whole population and the selected controls by municipalities was similar. A blood sample was taken from 150 MS cases and from 337 controls. At the end of the enrolment, we obtained a representative sample of the MS cases and population controls avoiding possible selection bias. Participation rate was very high also concerning the collection of biological specimens.
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Affiliation(s)
- Alessandra Nicoletti
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Silvia Messina
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Elisa Bruno
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Mostile
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Graziella Quattrocchi
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Loredana Raciti
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Valeria Dibilio
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Roberto Cappellani
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Emanuele D'Amico
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giorgia Sciacca
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Salvatore Lo Fermo
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Vincenza Paradisi
- Italian Society of General Medicine (SIMG)-Catania Municipality Section, Catania, Italy
| | - Francesco Patti
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Mario Zappia
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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Bagos PG, Nikolopoulos G, Ioannidis A. Chlamydia pneumoniae infection and the risk of multiple sclerosis: a meta-analysis. Mult Scler 2016; 12:397-411. [PMID: 16900753 DOI: 10.1191/1352458506ms1291oa] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We conducted a meta-analysis of studies comparing the presence of Chlamydia pneumoniae (Cpn) between multiple sclerosis (MS) patients and other neurological diseases patients or healthy controls. We identified 26 studies with 1332 MS patients and 1464 controls. Using random-effects methods, MS patients were found more likely to have detectable levels of Cpn DNA (OR = 3.216; 95% CI: 1.204, 8.585) in their cerebrospinal fluid, and intrathecally synthesized immunoglobulins (OR = 3.842; 95% CI: 1.317, 11.212), compared to other patients with neurological diseases. There is no evidence for increased levels of serum immunoglobulins (OR = 1.068; 95% CI: 0.745, 1.530), even though this result is confounded by the presence of studies using normal subjects as controls. Similarly, there is no evidence for association of immunoglobulins against Cpn in the cerebrospinal fluid (OR = 3.815; 95% CI: 0.715, 20.369). Up to 59.7% of the between-studies variability could be explained by the inappropriate matching of cases and controls for gender. In random-effects meta-regressions, adjusting for the confounding effect of gender differences results in stronger and statistically significant associations of MS with detectable levels of Cpn DNA, intrathecally synthesized immunoglobulins and immunoglobulins in the cerebrospinal fluid. Even though the presence of Cpn is clearly more likely in MS patients, these findings are insufficient to establish an etiologic relation.
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Affiliation(s)
- P G Bagos
- Department of Cell Biology and Biophysics, Faculty of Biology, University of Athens, Panepistimiopolis, Athens, 15701, Greece.
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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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Goodman M, LaKind JS, Fagliano JA, Lash TL, Wiemels JL, Winn DM, Patel C, Van Eenwyk J, Kohler BA, Schisterman EF, Albert P, Mattison DR. Cancer cluster investigations: review of the past and proposals for the future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1479-99. [PMID: 24477211 PMCID: PMC3945549 DOI: 10.3390/ijerph110201479] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 12/18/2022]
Abstract
Residential clusters of non-communicable diseases are a source of enduring public concern, and at times, controversy. Many clusters reported to public health agencies by concerned citizens are accompanied by expectations that investigations will uncover a cause of disease. While goals, methods and conclusions of cluster studies are debated in the scientific literature and popular press, investigations of reported residential clusters rarely provide definitive answers about disease etiology. Further, it is inherently difficult to study a cluster for diseases with complex etiology and long latency (e.g., most cancers). Regardless, cluster investigations remain an important function of local, state and federal public health agencies. Challenges limiting the ability of cluster investigations to uncover causes for disease include the need to consider long latency, low statistical power of most analyses, uncertain definitions of cluster boundaries and population of interest, and in- and out-migration. A multi-disciplinary Workshop was held to discuss innovative and/or under-explored approaches to investigate cancer clusters. Several potentially fruitful paths forward are described, including modern methods of reconstructing residential history, improved approaches to analyzing spatial data, improved utilization of electronic data sources, advances using biomarkers of carcinogenesis, novel concepts for grouping cases, investigations of infectious etiology of cancer, and "omics" approaches.
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Affiliation(s)
- Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Judy S LaKind
- LaKind Associates, LLC, 106 Oakdale Avenue, Catonsville, MD 21228, USA.
| | - Jerald A Fagliano
- Division of Epidemiology, Environmental and Occupational Health, New Jersey Department of Health, P.O. Box 369, Trenton, NJ 08625, USA.
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Joseph L Wiemels
- Division of Cancer Epidemiology, Department of Epidemiology & Biostatistics, School of Medicine, University of California, Helen Diller Family Cancer Research Building, HD 274 1450 3rd Street, San Francisco, MC 0520, San Francisco, CA 94158, USA.
| | - Deborah M Winn
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
| | - Chirag Patel
- School of Medicine, Stanford University, 1265 Welch Road, Stanford, CA 94305, USA.
| | - Juliet Van Eenwyk
- Washington State Department of Health, P.O. Box 47812, Olympia, WA 98504, USA.
| | - Betsy A Kohler
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Enrique F Schisterman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Paul Albert
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Donald R Mattison
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, 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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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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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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Abstract
BACKGROUND Multiple sclerosis (MS) is a disease with purported environmental causes. Consistent correlations have been found in various settings for latitude, smoking exposure, sunlight, and vitamin D deficiency. We analysed the contribution of various environmental factors to the risk of developing MS from a population perspective. METHODS We collated global data of MS prevalence from 54 studies over the previous ten years and calculated the degree of risk contributed by latitude, longitude, ultraviolet radiation (from NASA satellite data and formulae for available sunlight hours), population smoking rates (from WHO data), gender, study date, study demographics, and several socioeconomic factors. We report a very significant negative correlation between MS prevalence and available ultraviolet (UV) radiation. RESULTS The lack of available UV radiation outweighs other factors by at least 20 fold (p < 10⁻⁸) from single variate regression analysis. Multiple regression analysis revealed that latitude and longitude are also significant factors; smoking may also provide a very minimal role. The eight prevalence studies from Scandinavia produced prevalences that were lower than expected, given their global geospatial positioning. CONCLUSIONS The available ultraviolet radiation is a significant environmental factor, more so than all the other factors examined.
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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: 768] [Impact Index Per Article: 54.9] [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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Nicoletti A, Patti F, Lo Fermo S, Messina S, Bruno E, Raciti L, Zappia M. A possible spatial and temporal cluster of multiple sclerosis in the town of Linguaglossa, Sicily: an update. Mult Scler 2009; 15:129-30. [DOI: 10.1177/1352458508096873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Nicoletti
- Department of Neurosciences, University of Catania, Catania, Italy
| | - F Patti
- Department of Neurosciences, University of Catania, Catania, Italy
| | - S Lo Fermo
- Department of Neurosciences, University of Catania, Catania, Italy
| | - S Messina
- Department of Neurosciences, University of Catania, Catania, Italy
| | - E Bruno
- Department of Neurosciences, University of Catania, Catania, Italy
| | - L Raciti
- Department of Neurosciences, University of Catania, Catania, Italy
| | - M Zappia
- Department of Neurosciences, University of Catania, Catania, Italy
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15
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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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