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Wang M, Liu C, Zou M, Niu Z, Zhu J, Jin T. Recent progress in epidemiology, clinical features, and therapy of multiple sclerosis in China. Ther Adv Neurol Disord 2023; 16:17562864231193816. [PMID: 37719665 PMCID: PMC10504852 DOI: 10.1177/17562864231193816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. It mainly affects young adults, imposing a heavy burden on families and society. The epidemiology, clinical features, and management of MS are distinct among different countries. Although MS is a rare disease in China, there are 1.4 billion people in China, so the total number of MS patients is not small. Because of the lack of specific diagnostic biomarkers for MS, there is a high misdiagnosis rate in China, as in other regions. Due to different genetic backgrounds, the clinical manifestations of MS in Chinese are different from those in the West. Herein, this review aims to summarize the disease comprehensively, including clinical profile and the status of disease-modifying therapies in China based on published population-based observation and cohort studies, and also to compare with data from other countries and regions, thus providing help to develop diagnostic guideline and the novel therapeutic drugs. Meanwhile, we also discuss the problems and challenges we face, specifically for the diagnosis and treatment of MS in the middle- and low-income countries.
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Affiliation(s)
- Meng Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Caiyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meijuan Zou
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zixuan Niu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, No. 1, Xinmin Street, Changchun 130021, China
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm 171 64, Sweden
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, No. 1, Xinmin Street, Changchun 130021, China
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Khedr MA, El Sayed HG, El Wakil A. Perceived stress in multiple sclerosis patients: Relationship with mood states and pain experience. Mult Scler Relat Disord 2022; 59:103650. [DOI: 10.1016/j.msard.2022.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/14/2022] [Accepted: 01/30/2022] [Indexed: 11/17/2022]
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Zeineddine M, Hajje AA, Hussein A, El Ayoubi N, Yamout B. Epidemiology of multiple sclerosis in Lebanon: A rising prevalence in the middle east. Mult Scler Relat Disord 2021; 52:102963. [PMID: 33934011 DOI: 10.1016/j.msard.2021.102963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The epidemiology of multiple sclerosis (MS) has been studied in many countries of the Middle East but the prevalence and incidence of MS in Lebanon is still unknown. OBJECTIVES To determine the incidence and prevalence of MS in Lebanon. METHODS Lebanese patients diagnosed with MS between January 2018 and December 2018 were identified using the database of governmental third-party payers. The crude, age- and sex-specific 2018 prevalence and incidence among Lebanese patients were calculated. RESULTS 2248 MS patients were identified of whom 67.1% were women (female: male ratio 2:1) with a mean age of 41.8 ± 12.96 years. The 2018 prevalence of MS was 62.91 cases per 100,000 persons (95% CI: 60.41 - 65.41). The overall incidence of MS in Lebanon was 8.36 cases per 100,000 (95% CI: 7.45 - 9.27) with a mean age at onset of 34.5 ± 12.5 years. CONCLUSION This is the first study to assess prevalence and incidence of MS in Lebanon, confirming that Lebanon is a moderate to high-risk area for MS. Those high rates are commensurate with recently published studies from the Middle East, pointing to a significant rise in incidence and prevalence of this disease in our region.
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Affiliation(s)
- Maya Zeineddine
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Amal Al Hajje
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Ali Hussein
- Central Military Pharmacy, Lebanese Army Forces, Beirut, Lebanon
| | - Nabil El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
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Bonomi S, Jin S, Culpepper WJ, Wallin MT. MS and Disability Progression in Latin America, Africa, Asia and the Middle East: A Systematic Review. Mult Scler Relat Disord 2021; 51:102885. [PMID: 33773273 DOI: 10.1016/j.msard.2021.102885] [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: 01/06/2021] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is evidence of an increased prevalence and disease burden of Multiple Sclerosis (MS) in parts of the world where the risk was once considered low, such as Latin America (LA), Sub-Saharan Africa, Asia and the Middle East-North Africa (MENA). Despite the growing number of clinical reports, the phenotype and course of MS in these regions remains understudied compared with Europe and North America. We aimed to investigate MS phenotypes and long-term clinical outcomes across these regions. METHOD A Boolean search of the medical literature was conducted between January 1980 and April 30, 2020. PubMed, SCOPUS, Global Health, and the Cochrane databases, were used to identify all relevant citations. Articles were collated and managed on Covidence® software. We independently appraised the articles for meeting study criteria and for quality using the Critical Appraisal Skills Program (CASP) and the Specialist Unit for Review Evidence (SURE) system. RESULTS A total of 1,639 studies were imported for screening. After removing 545 duplicates, two authors assessed 1,094 abstracts and selected 515 for full-text screening. 72 articles met study criteria, including 19 studies from LA, 4 from sub-Saharan Africa, 24 from Asia and 25 from MENA. The overall sex ratio was 2.5:1 (female: male). Disability was assessed using the Expanded Disability Status Scale (EDSS). Longitudinal disability progression and time to standard endpoints was compared by region and with relevant Western reports. Patients with MS living in the MENA region appear to reach disability milestones faster than those in the Western world, although this finding is not uniform. South Asia shows distinct disability features compared with East Asia, more closely resembling those of the West. Disease morbidity in East Asia appears more benign than in the West after careful exclusion of neuromyelitis optica spectrum disorder cases. Populations in LA tend to have similar MS features to the Western world, but some exceptions exist, including African descendants that reach disability milestones earlier. Using all studies with appropriate survival analysis, the mean time to EDSS 6.0 was 16.97 years with a heterogeneity index of 24.59. CONCLUSION The clinical phenotypes and disability progression of MS in LA, Africa, Asia and the MENA region have similarities to Western MS. In some regions and subpopulations there is evidence of a more aggressive course, possibly due to a combination of genetic and environmental factors. More population-based longitudinal data are needed, particularly in Sub-Saharan Africa.
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Affiliation(s)
| | - Shan Jin
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence-East, Baltimore, MD, United States
| | - William J Culpepper
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence-East, Baltimore, MD, United States; University of Maryland School of Medicine, Neurology Department, Baltimore, MD, United States
| | - Mitchell T Wallin
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence-East, Baltimore, MD, United States; George Washington University School of Medicine, Department of Neurology, Washington, DC, United States; University of Maryland School of Medicine, Neurology Department, Baltimore, MD, United States.
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Mateen FJ. Multiple sclerosis in resource-limited settings: Research opportunities in an unequal world. Neurology 2020; 93:176-180. [PMID: 31332086 DOI: 10.1212/wnl.0000000000007837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This position piece is meant to extend the humanitarian argument for assisting people with multiple sclerosis (MS) in resource-limited settings, in this case, through research. It is also meant to highlight areas of strength of some low- and middle-income countries (LMICs), and therefore emphasize how the field of MS could best be served globally by more research with and for resource-limited populations. Possible areas of particular strength include (1) ethnicity, genetic diversity, and migration studies; (2) analysis of possibly emerging environmental and lifestyle-related risk factors; (3) understanding the immune system when exposed to novel pathogens and various infectious agents; (4) reverse innovation to promote better point-of-care diagnostic tests; (5) high participation rates in clinical registries and research; (6) appreciation of MS in special populations including a higher focus on pediatrics and pregnancy; (7) culturally adept means of treatment and rehabilitating disability; (8) models of care delivery for chronic, complex neurologic diseases; and (9) use of off-label, generic, and less commonly implemented disease-modifying therapy sequences. Strategies for strengthening the MS research landscape include (1) creation of centers of research excellence in LMICs and twinning of institutions between high- and low-income countries; (2) standardization of research procedures and reduction of bureaucracies; (3) consensus meetings and network building; (4) opening additional avenues for publications and expanding the types of available publications; (5) identifying and establishing dedicated funding mechanisms; (6) focus on local relevance; and (7) setting expectations to include patients from LMICs in international clinical trials. These underutilized opportunities build an argument that global partnerships for research and knowledge coordination could better reach across populations, geographies, economies, and expertise.
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Affiliation(s)
- Farrah J Mateen
- From the Department of Neurology, Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
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Hassab AH, Deif AH, Elneely DA, Tawadros IM, Fayad AI. Protective association of VDR gene polymorphisms and haplotypes with multiple sclerosis patients in Egyptian population. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2019. [DOI: 10.1186/s43042-019-0009-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abdelhafeez MA, Zamzam DA, Foad MM, Swelam MS, Abdelnasser A, Aref HA, Ibrahim YA, Khater NH, Darwish EA, Zakaria MF. Magnetic resonance imaging markers of disability in Egyptian multiple sclerosis patients. Mult Scler Relat Disord 2019; 36:101417. [DOI: 10.1016/j.msard.2019.101417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
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Matrix metalloproteases 9 rs3918242 gene polymorphism and serum vit D in MS Egyptian patients. Mult Scler Relat Disord 2019; 32:103-106. [PMID: 31082619 DOI: 10.1016/j.msard.2019.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 11/22/2022]
Abstract
The high frequency of MS, especially among women in the Middle East countries as well as the high cost of caring has become a truly public concern. T-cell trafficking across the interrupted BBB, which constitutes a core immunological feature of the disease, needs activation of matrix metallo-proteinases. MMP-9 (which represents the largest and most complex of MMP family) was a subject for functional polymorphism of rs3918242 gene, but with controversial results among different MS ethnic groups. In this study, we evaluated the role of MMP9 genotypes of rs3918242 (-1562 C/T) in MS susceptibility and disability among patients using PCR-RFLP. Vitamin D assessment using ELISA, as an indirect indicator of MMP activity and proinflammatory status, was also measured to find out its relation to this polymorphism. Results: CT, CT+TT genotypes and T allele carriers were found most among MS patients as compared to healthy controls with a P value of 0.009 CI (1.216- 4.346), suggesting higher susceptibility risk for the disease. Also a significant decrease of Vitamin D in MS group (P < 0.001) were detected. Though this genetic polymorphism was found insignificantly among different clinical measures of MS disease severity, vitamin D level was significantly lower in patients with RRMS and for those with high disabilities. This low level was not influenced by the -1562 C/T polymorphism. In conclusion, MMP9 genotypes of rs3918242 have a role in MS susceptibility, but not with severity. Vitamin D deficiency was also a predominant feature among all MS patients irrespective of their MMP9 genotypes of rs3918242, implying its association with MS activity in different courses of the disease. The gentic susceptibility for MS disease is growing and needs to be studied well in different ethnic groups for their important diagnostic and therapeutic implications.
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Hamdy SM, Abdel-Naseer M, Shalaby NM, Elmazny A, Girgis M, Nada MA, Hassan A, Mourad HS, Hegazy MI, Abdelalim A, Kishk NA, Abokrysha NT, Genedy SA, Essawy EA, Shehata HS. Pediatric-onset multiple sclerosis in Egypt: a multi-center registry of 186 patients. Neuropsychiatr Dis Treat 2018; 14:631-640. [PMID: 29503547 PMCID: PMC5827680 DOI: 10.2147/ndt.s160060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Although the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers. OBJECTIVE To characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS. PATIENTS AND METHODS A retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt. RESULTS Multiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; "early-onset pediatric multiple sclerosis (EOPMS)". The mean age of disease onset was (14.13±2.49 years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS. CONCLUSION The results from this registry - the largest for MS in the Arab region to date - are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children.
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Affiliation(s)
| | | | | | - Alaa Elmazny
- Neurology Department, Cairo University, Cairo, Egypt
| | - Marian Girgis
- Pediatric Department, Cairo University, Cairo, Egypt
| | - Mona A Nada
- Neurology Department, Cairo University, Cairo, Egypt
| | - Amr Hassan
- Neurology Department, Cairo University, Cairo, Egypt
| | | | | | | | | | | | | | - Ehab A Essawy
- Division of Biochemistry, Chemistry Department, Faculty of Science, Helwan University, Helwan, Egypt
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Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks. Mult Scler Int 2016; 2016:1034912. [PMID: 28078140 PMCID: PMC5203912 DOI: 10.1155/2016/1034912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/14/2016] [Indexed: 12/02/2022] Open
Abstract
The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.
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Hawkes C, Lublin F, Giovannoni G, Waubant E. Editors' Welcome. Mult Scler Relat Disord 2016; 10:A1. [PMID: 27919509 DOI: 10.1016/j.msard.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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