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Mirabella M, Annovazzi P, Brownlee W, Cohen JA, Kleinschnitz C, Wolf C. Treatment Challenges in Multiple Sclerosis – A Continued Role for Glatiramer Acetate? Front Neurol 2022; 13:844873. [PMID: 35493825 PMCID: PMC9051342 DOI: 10.3389/fneur.2022.844873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Earlier diagnosis, access to disease-modifying therapies (DMTs), and improved supportive care have favorably altered the disease course of multiple sclerosis (MS), leading to an improvement in long-term outcomes for people with MS (PwMS). This success has changed the medical characteristics of the population seen in MS clinics. Comorbidities and the accompanying polypharmacy, immune senescence, and the growing number of approved DMTs make selecting the optimal agent for an individual patient more challenging. Glatiramer acetate (GA), a moderately effective DMT, interacts only minimally with comorbidities, other medications, or immune senescence. We describe here several populations in which GA may represent a useful treatment option to overcome challenges due to advanced age or comorbidities (e.g., hepatic or renal disease, cancer). Further, we weigh GA's potential merits in other settings where PwMS and their neurologists must base treatment decisions on factors other than selecting the most effective DMT, e.g., family planning, conception and pregnancy, or the need for vaccination.
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Affiliation(s)
- Massimiliano Mirabella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica, Rome, Italy
- *Correspondence: Massimiliano Mirabella ; orcid.org/0000-0002-7783-114X
| | - Pietro Annovazzi
- MS Center, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Wallace Brownlee
- Queen Square MS Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey A. Cohen
- Department of Neurology, Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States
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2
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Bakirtzis C, Grigoriadou E, Boziki MK, Kesidou E, Siafis S, Moysiadis T, Tsakona D, Thireos E, Nikolaidis I, Pourzitaki C, Kouvelas D, Papazisis G, Tsalikakis D, Grigoriadis N. The Administrative Prevalence of Multiple Sclerosis in Greece on the Basis of a Nationwide Prescription Database. Front Neurol 2020; 11:1012. [PMID: 33132996 PMCID: PMC7550689 DOI: 10.3389/fneur.2020.01012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/31/2020] [Indexed: 12/26/2022] Open
Abstract
Objective: To estimate current prevalence of multiple sclerosis (MS) in Greece using administrative data from the nationwide medicine prescription database. Methods: Prescription records of a 24-month period (June 2017–May 2019) were analyzed in order to identify cases of MS. Sex, age, and place of residence were recorded for each identified case. Prevalence of MS was calculated based on the updated records of the Greek population according to Hellenic Statistical Authority. Results: The 2-year cumulative period prevalence of MS was estimated to 197.8 per 100,000 (95% CI 197.6–198.0). In total, 21,218 patients (65.8% female) were identified. During this period, the prevalence of MS was 138.7 per 100,000 (95% CI 138.4–139.0) in men and 253.6 per 100,000 (95% CI 253.3–254.1) in women. Prevalence was higher in the 45–49 age group in both sexes. Analysis of the place of residence revealed higher prevalence in the Attica region and Western Greece while lower prevalence was observed in Northern Greece. No north–south latitude gradient was detected. Point prevalence on 1 January 2019 was calculated to 188.9 per 100,000 (95% CI 188.7–189.1). Regarding treatment, 73.1% of the identified cases received at least once a Disease Modifying Drug. Conclusions: According to this national-level study conducted in Greece, estimated prevalence of MS was found to be similar to those of other European countries. Heterogeneity of MS prevalence across the country was observed and needs further investigation.
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Affiliation(s)
- Christos Bakirtzis
- Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Grigoriadou
- Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina Kleopatra Boziki
- Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kesidou
- Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Siafis
- Department of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Tsakona
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Ioannis Nikolaidis
- Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysa Pourzitaki
- Department of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Tsalikakis
- Department of Informatics and Telecommunications Engineering, University of Western Macedonia, Kozani, Greece
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Berriozabalgoitia R, Sanz B, Fraile-Bermúdez AB, Otxoa E, Yeregui I, Bidaurrazaga-Letona I, Duñabeitia I, Antigüedad A, Domercq M, Irazusta J, Rodriguez-Larrad A. An Overground Robotic Gait Training Program for People With Multiple Sclerosis: A Protocol for a Randomized Clinical Trial. Front Med (Lausanne) 2020; 7:238. [PMID: 32582732 PMCID: PMC7295911 DOI: 10.3389/fmed.2020.00238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/06/2020] [Indexed: 12/24/2022] Open
Abstract
Maintaining the ability to walk is one of the significant challenges in people with multiple sclerosis (MS) for keeping a good quality of life as the disease and the aging process progresses. Overground robotic (OR) wearable exoskeletons are promising tools for gait rehabilitation, but currently there is no evidence of their clinical effects on patients with MS. The present study aims to determine the effects of an OR intervention in people with MS and moderate to severe walking disabilities and ascertain if benefits are maintained over a follow-up period of 3 months. This randomized controlled trial will include 36 participants with MS. Inclusion criteria are: older than 18 years, definitive diagnosis of MS, 4.5-7 points on the EDSS (Expanded Disability Status Scale), and needing one or two canes or crutches for walking outdoors. Subjects in the control group will receive conventional physiotherapy sessions at ADEMBI (Asociación de Esclerosis Múltiple de Bizkaia) provided to control spasticity, maintain articular range and exercise balance. Subjects in the intervention group will receive the same physiotherapy but also participate in a progressive OR gait training program assisted by the EksoTM exoskeleton. The program consists of twice a week individually supervised sessions in two setting modalities: PreGait and ProStepPlus. The training parameters (duration, speed, cadence, length of steps) will be set during the first session and the progression and intensity of the intervention will be adapted to the tolerance of each participant. The primary outcome of this study is gait speed. Secondary outcomes will include physical and cognitive performance tests, clinical, fatigue and quality of life assessments, and changes in the plasma levels of inflammatory cytokines. The present trial is the first analyzing the effectiveness of an OR intervention for gait training in patients with MS. It will help clarify the applicability of robotic technologies to clinical practice, extending the functionality and quality of life of people with MS to face a successful aging process. (ACTRN12619000014156; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376548).
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Affiliation(s)
- Rakel Berriozabalgoitia
- ADEMBI, Multiple Sclerosis Association of Bizkaia, Bilbao, Spain.,Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Begoña Sanz
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Belén Fraile-Bermúdez
- Department of Nursing I, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Erika Otxoa
- ADEMBI, Multiple Sclerosis Association of Bizkaia, Bilbao, Spain
| | - Izaskun Yeregui
- ADEMBI, Multiple Sclerosis Association of Bizkaia, Bilbao, Spain.,Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Iraia Bidaurrazaga-Letona
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Iratxe Duñabeitia
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Alfredo Antigüedad
- Biocruces-Bizkaia Research Institute, Department of Neurology, Cruces University Hospital, Osakidetza Basque Health Service, Barakaldo, Spain
| | - Maria Domercq
- Department of Neurosciences, University of the Basque Country, Achucarro Basque Center for Neuroscience-UPV/EHU, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Leioa, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
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Boziki MK, Mentis AFA, Shumilina M, Makshakov G, Evdoshenko E, Grigoriadis N. COVID-19 Immunopathology and the Central Nervous System: Implication for Multiple Sclerosis and Other Autoimmune Diseases with Associated Demyelination. Brain Sci 2020; 10:E345. [PMID: 32512702 PMCID: PMC7349282 DOI: 10.3390/brainsci10060345] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
In the frame of the coronavirus disease 2019 (COVID-19) pandemic, recent reports on SARS-CoV-2 potential neuroinvasion placed neurologists on increased alertness in order to assess early neurological manifestations and their potentially prognostic value for the COVID-19 disease. Moreover, the management of chronic neurological diseases, such as Multiple Sclerosis (MS), underwent guided modifications, such as an Extended Interval Dose (EID) of Disease-Modifying Treatment (DMT) administration, in order to minimize patients' exposure to the health system, thus reducing the risk of SARS-CoV-2 infection. In this review, we summarize existing evidence of key immune pathways that the SARS-CoV-2 modifies during COVID-19 and the relevant implication for MS and other autoimmune diseases with associated demyelination (such as Systemic lupus erythematosus and Antiphospholipid syndrome), including the context of potential neuroinvasion by SARS-Cov-2 and the alterations that DMT induces to the immune system. Moreover we hereby aim to provide an overview of the possible consequences that COVID-19 may carry for the Central Nervous System (CNS) in People with MS (PwMS) and other demyelinating diseases, which are likely to pose challenges for treating Neurologists with respect to the long-term disease management of these diseases.
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Affiliation(s)
- Marina Kleopatra Boziki
- 2nd Neurological University Department, AHEPA General Hospital, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece;
| | - Alexios-Fotios A. Mentis
- Public Health Laboratories, Hellenic Pasteur Institute, 11521 Athens, Greece;
- Laboratory of Microbiology, University Hospital of Larissa, School of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Maria Shumilina
- SPb Multiple Sclerosis Centre, Dinamo pr 11, St. Petersburg 197110, Russia; (M.S.); (G.M.); (E.E.)
| | - Gleb Makshakov
- SPb Multiple Sclerosis Centre, Dinamo pr 11, St. Petersburg 197110, Russia; (M.S.); (G.M.); (E.E.)
| | - Evgeniy Evdoshenko
- SPb Multiple Sclerosis Centre, Dinamo pr 11, St. Petersburg 197110, Russia; (M.S.); (G.M.); (E.E.)
| | - Nikolaos Grigoriadis
- 2nd Neurological University Department, AHEPA General Hospital, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece;
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Bezzini D, Kundisova L, Gori F, Martini A, Giovannetti L, Stoppa G, Chellini E, Ulivelli M, Nante N, Messina G, Battaglia MA. Mortality trend for multiple sclerosis in Italy during the period 1980-2015. Mult Scler Relat Disord 2020; 44:102240. [PMID: 32512288 DOI: 10.1016/j.msard.2020.102240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015. METHODS Mortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs). RESULTS During the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F). CONCLUSION The increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.
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Affiliation(s)
- Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Lucia Kundisova
- Post Graduate School of Public Health, University of Siena, Siena, Italy.
| | - Francesco Gori
- Post Graduate School of Public Health, University of Siena, Siena, Italy.
| | - Andrea Martini
- Institute for Study, Prevention and Cancer Network, Florence, Italy.
| | - Lucia Giovannetti
- Institute for Study, Prevention and Cancer Network, Florence, Italy.
| | - Giorgia Stoppa
- Department of Statistics, Informatics, Applications, University of Florence, Florence, Italy.
| | | | - Monica Ulivelli
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy.
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy; Italian Multiple Sclerosis Foundation, Genoa, Italy.
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Comi G. Preface. Mult Scler 2016; 22:2-3. [DOI: 10.1177/1352458516650745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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7
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Salter A, Tyry T, Wang G, Fox RJ, Cutter G, Marrie RA. Examining the joint effect of disability, health behaviors, and comorbidity on mortality in MS. Neurol Clin Pract 2016; 6:397-408. [PMID: 27847682 DOI: 10.1212/cpj.0000000000000269] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In multiple sclerosis (MS), comorbidities have been associated with disability progression and an increased risk of mortality. We investigated the association between comorbidities and mortality in MS after accounting for disability and health behaviors. METHODS We followed North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants who completed the Fall 2006 survey on comorbidities until death (reported or matched in the National Death Index) or date of last follow-up in 2014. We used proportional hazards regression to investigate the association between comorbidities and mortality, controlling for demographic, clinical, health behavior, and disability factors. RESULTS Of 9,496 participants meeting the inclusion criteria, 502 (5.3%) were deceased. Most participants reported having ≤3 comorbid conditions (70.9% survivors, 76.9% decedents). In individual regression models, vascular, visual, and mental comorbidities were associated with increased mortality risk after adjustment for factors associated with survival. When combined into a single model, vascular (hazard ratio 1.269; 1.041-1.547), visual (1.490; 1.199-1.852), and mental comorbidities (excluding anxiety, 1.239; 1.024-1.499) remained independently associated with an increased risk of mortality. CONCLUSIONS Presence of comorbidities was independently associated with an increased risk of mortality as compared to absence of comorbidities after adjusting for factors associated with survival. Specifically, vascular, visual, and mental comorbidities increased the risk of mortality. This highlights the need for clinicians to attend to these comorbidities, which can be modified by treatments or other interventions, and potentially reduce the risk of mortality in persons with MS who have these conditions.
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Affiliation(s)
- Amber Salter
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Tuula Tyry
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Guoqiao Wang
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Robert J Fox
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Gary Cutter
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
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Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry 2016; 87:324-31. [PMID: 25935887 DOI: 10.1136/jnnp-2015-310361] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There are inconsistent data on mortality in people with multiple sclerosis (MS). We performed a meta-analysis of all-cause, cause-specific and gender-specific crude mortality rates (CMRs), and standardised mortality ratios (SMRs) in MS, and estimated the rate of change of CMR and SMR over the past 50 years. METHODS Medline, Embase and the Cochrane Library were searched. KEYWORDS 'Multiple Sclerosis' and ('standardised mortality' or 'standardized mortality'). INCLUSION CRITERIA availability of data on the number of deaths; mean or median patient follow-up or reports of SMRs; being a longitudinal study. 12 studies were included covering the period 1949-2012 (27 423 patients; 6628 deaths; 437 832 person-years follow-up). CMR was calculated. SMRs were extracted. CMRs and natural logarithm of SMRs were pooled by the method of the inverse of the variance. Meta-regression models were used to investigate the secular trends. RESULTS Pooled CMR was 9.78/1000 person-years (95% CI 6.81 to 14.02). Pooled all-cause SMR was 2.80 (95% CI 2.74 to 2.87). All-cause SMR was 2.56 (95% CI 2.47 to 2.66) in males and 3.06 (95% CI 2.97 to 3.17) in females. SMR due to cancer was 0.89 (95% CI 0.83 to 0.97). SMRs due to cardiovascular diseases, suicide, infection and respiratory diseases were 1.29 (95% CI 1.20 to 1.38), 2.13 (95% CI 1.80 to 2.51) and 2.91 (95% CI 2.60 to 3.26). There was no trend in CMRs, all-cause, and gender-specific SMRs. CONCLUSIONS The excess mortality in MS relative to the general population has not changed over the past 50 years. Female patients with MS have higher survival disadvantage compared to that of males. Death due to cardiovascular diseases, suicide and infection is higher in patients with MS compared to the general population.
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Affiliation(s)
- Ali Manouchehrinia
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Radu Tanasescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy Carol Davila, Colentina Hospital, Bucharest, Romania
| | - Christopher R Tench
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Abstract
ABSTRACTBackground: This study examined mortality due to multiple sclerosis (MS) in Canada, 1975-2009 to determine whether there has been a change in age at death relative to the general population and decrease in MS mortality rates. Methods: Mortality rates/100,000 population for MS and all causes were calculated using data derived from Statistics Canada, age-standardized to the 2006 population. Results: The average annual Canadian MS mortality rate, 1975-2009 was 1.23/100,000. Five-year rates for 1975-79, 1980-84, 1985-89, 1990-94, 1995-99, 2000-04, 2005-09 were: 1.16, 0.94, 1.01, 1.16, 1.30, 1.43, 1.33. Trend analysis showed mortality rates over the entire 35 years were stable (average annual percent change of less than one percent). The average annual 1975-2009 rates for females and males were 1.45 and 0.99. Five-year female rates were always higher than males. Regardless of gender, there was a decrease in MS mortality rates in the 0-39 age group and increases in the 60-69, 70-79, and 80+ groups over time. In contrast, there were decreases in all-cause mortality rates across each age group. The highest MS mortality rates for 1975-2009 were consistently in the 50-59 and 60-69 groups for both genders, while the highest all-cause mortality rates were in the 80+ group. Conclusions: Changes in the age distribution of MS mortality rates indicate a shift to later age at death, possibly due to improved health care. However MS patients remain disadvantaged relative to the general population and changes in age at death are not reflected in decreased mortality rates.
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10
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Marrie RA, Elliott L, Marriott J, Cossoy M, Blanchard J, Leung S, Yu N. Effect of comorbidity on mortality in multiple sclerosis. Neurology 2015; 85:240-7. [PMID: 26019190 PMCID: PMC4516290 DOI: 10.1212/wnl.0000000000001718] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/19/2015] [Indexed: 12/03/2022] Open
Abstract
Objective: We aimed to compare survival in the multiple sclerosis (MS) population with a matched cohort from the general population, and to evaluate the association of comorbidity with survival in both populations. Methods: Using population-based administrative data, we identified 5,797 persons with MS and 28,807 controls matched on sex, year of birth, and region. We estimated annual mortality rates. Using Cox proportional hazards regression, we evaluated the association between comorbidity status and mortality, stratifying by birth cohort, and adjusting for sex, socioeconomic status, and region. We compared causes of death between populations. Results: Median survival from birth in the MS population was 75.9 years vs 83.4 years in the matched population. MS was associated with a 2-fold increased risk of death (adjusted hazard ratio 2.40; 95% confidence interval: 2.24–2.58). Several comorbidities were associated with increased hazard of death in both populations, including diabetes, ischemic heart disease, depression, anxiety, and chronic lung disease. The magnitude of the associations of mortality with chronic lung disease, diabetes, hypertension, and ischemic heart disease was lower in the MS population than the matched population. The most common causes of death in the MS population were diseases of the nervous system and diseases of the circulatory system. Mortality rates due to infectious diseases and diseases of the respiratory system were higher in the MS population. Conclusion: In the MS population, survival remained shorter than expected. Within the MS population, comorbidity was associated with increased mortality risk. However, comorbidity did not preferentially increase mortality risk in the MS population as compared with controls.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada.
| | - Lawrence Elliott
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada
| | - James Marriott
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada
| | - Michael Cossoy
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada
| | - James Blanchard
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada
| | - Stella Leung
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada
| | - Nancy Yu
- From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada
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11
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Kaufman D, Reshef S, Golub H, Peucker M, Corwin M, Goodin D, Knappertz V, Pleimes D, Cutter G. Survival in commercially insured multiple sclerosis patients and comparator subjects in the U.S. Mult Scler Relat Disord 2014; 3:364-71. [DOI: 10.1016/j.msard.2013.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022]
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12
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Klewer J. Disease-related conditions in elderly patients with multiple sclerosis. Expert Rev Pharmacoecon Outcomes Res 2014; 5:271-5. [DOI: 10.1586/14737167.5.3.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Scalfari A, Knappertz V, Cutter G, Goodin DS, Ashton R, Ebers GC. Mortality in patients with multiple sclerosis. Neurology 2013; 81:184-92. [PMID: 23836941 DOI: 10.1212/wnl.0b013e31829a3388] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Mortality in patients with multiple sclerosis (MS) is significantly increased compared with the general population. Many questions concerning survival in MS are still unanswered due to the difficulty of comparing information collected at different times and in different geographic areas. The increasing incidence of MS, the improvement in care of the chronically disabled, and different methodologies may explain the lack of coherence among studies' results. Reported times to death from birth and from disease onset/diagnosis are highly variable. Patients older at onset or with primary progressive course have shorter survival; however, data on sex and mortality are contradictory. Changes in sex ratio in MS over time represent one possible explanation. MS is the main cause of death in ≥50% of patients and the incidence of deaths not due to MS varies among countries. Particularly, suicide is substantially increased in patients with MS, and, despite its varying incidence, mainly due to "cultural bias," it should be considered an MS-related cause of death. Recent results of the long-term follow-up study of interferon-β-1b demonstrated a significant reduction of mortality among treated patients. Notwithstanding its long latency, mortality is therefore an unambiguously valid long-term outcome in randomized controlled trials. It usefully combines the net impact of treatment efficacy on longevity and adverse events, which may reduce it.
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Affiliation(s)
- Antonio Scalfari
- Centre of Neuroscience, Division of Experimental Medicine, Department of Medicine, Imperial College, Hammersmith Hospital, London, UK
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Chung SE, Cheong HK, Park JH, Kim HJ. Burden of disease of multiple sclerosis in Korea. Epidemiol Health 2012; 34:e2012008. [PMID: 23251838 PMCID: PMC3521103 DOI: 10.4178/epih/e2012008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/31/2012] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. There are few reports on the burden of disease of MS, worldwide. The authors aim to estimate burden of disease and estimate the epidemiologic indexes of MS in Korea using available epidemiologic data. METHODS Epidemiologic indexes were computed using DISMOD II software based on prevalence from nationwide survey, incidence estimated from extrapolation, mortality from National Statistics Office, and duration of disease from literature as input indexes. We calculated disability-adjusted life year (DALY) as a measure of premature mortality and disability, equivalent to years of healthy life lost due to a given condition. RESULTS The incidence of MS in Korea was 0.1 per 100,000, higher in female than in male. The highest incidence was estimated in the age group between 35 and 44 years in male and age group between 25 and 29 years in female. Total burden of disease of MS was 1,394 DALY, comprised of 292 (21%) years of life lost and 1,101 (79%) years lived with disability. The mean age at onset of MS was 33 years old in men and 32 years old in female. Estimated duration of disease was 35 years in men and 40 years in female. Most of the DALY of MS occurred in the adult population between 25 and 54 years of age. CONCLUSION Although MS is a rare disease in Korea, most of the DALY arises from young people, which results in a major financial burden on the patient, family, health system and society.
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Affiliation(s)
- Soo-Eun Chung
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea. ; Center for Molecular Medicine, Samsung Biomedical Research Institute, Seoul, Korea
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15
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Goodin DS, Ebers GC, Cutter G, Cook SD, O'Donnell T, Reder AT, Kremenchutzky M, Oger J, Rametta M, Beckmann K, Knappertz V. Cause of death in MS: long-term follow-up of a randomised cohort, 21 years after the start of the pivotal IFNβ-1b study. BMJ Open 2012; 2:e001972. [PMID: 23204140 PMCID: PMC3533062 DOI: 10.1136/bmjopen-2012-001972] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Compared with controls, multiple sclerosis (MS) patients die, on average, 7-14 years prematurely. Previously, we reported that, 21 years after their participation in the pivotal randomised, controlled trial (RCT) of interferon β-1b, mortality was reduced by 46-47% in the two groups who received active therapy during the RCT. To determine whether the excessive deaths observed in placebo-treated patients was due to MS-related causes, we analysed the causes-of-death (CODs) in these three, randomised, patient cohorts. DESIGN Long-term follow-up (LTF) of the pivotal RCT of interferon β-1b. SETTING Eleven North American MS-centres participated. PARTICIPANTS In the original RCT, 372 patients participated, of whom 366 (98.4%) were identified after a median of 21.1 years from RCT enrolment. INTERVENTIONS Using multiple information sources, we attempted to establish COD and its relationship to MS in deceased patients. PRIMARY OUTCOME An independent adjudication committee, masked to treatment assignment and using prespecified criteria, determined the likely CODs and their MS relationships. RESULTS Among the 366 MS patients included in this LTF study, 81 deaths were recorded. Mean age-at-death was 51.7 (±8.7) years. COD, MS relationship, or both were determined for 88% of deaths (71/81). Patients were assigned to one of nine COD categories: cardiovascular disease/stroke; cancer; pulmonary infections; sepsis; accidents; suicide; death due to MS; other known CODs; and unknown COD. Of the 69 patients for whom information on the relationship of death to MS was available, 78.3% (54/69) were adjudicated to be MS related. Patients randomised to receive placebo during the RCT (compared with patients receiving active treatment) experienced an excessive number of MS-related deaths. CONCLUSIONS In this long-term, randomised, cohort study, MS patients receiving placebo during the RCT experienced greater all-cause mortality compared to those on active treatment. The excessive mortality in the original placebo group was largely from MS-related causes, especially, MS-related pulmonary infections.
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Affiliation(s)
- Douglas S Goodin
- Department of Neurology, University of California, San Francisco, California, USA
| | - George C Ebers
- University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Gary Cutter
- Department of Biostatistics, UAB School of Public Health, Birmingham, Alabama, USA
| | - Stuart D Cook
- Department of Neurosciences, UMD New Jersey Medical School, Newark, New Jersey, USA
| | | | - Anthony T Reder
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Marcelo Kremenchutzky
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Joel Oger
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Rametta
- Bayer HealthCare Pharmaceuticals, Wayne, New Jersey, USA
- Bayer HealthCare Pharmaceuticals, Berlin, Germany
- Bayer HealthCare Pharmaceuticals, Montville, New Jersey, USA
| | - Karola Beckmann
- Bayer HealthCare Pharmaceuticals, Wayne, New Jersey, USA
- Bayer HealthCare Pharmaceuticals, Berlin, Germany
- Bayer HealthCare Pharmaceuticals, Montville, New Jersey, USA
| | - Volker Knappertz
- Bayer HealthCare Pharmaceuticals, Wayne, New Jersey, USA
- Bayer HealthCare Pharmaceuticals, Berlin, Germany
- Bayer HealthCare Pharmaceuticals, Montville, New Jersey, USA
- Heinrich-Heine-Universität, Düsseldorf, Germany
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16
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Ragonese P, Aridon P, Mazzola MA, Callari G, Palmeri B, Famoso G, Terruso V, Salemi G, D’Amelio M, Savettieri G. Multiple sclerosis survival: a population-based study in Sicily. Eur J Neurol 2009; 17:391-7. [DOI: 10.1111/j.1468-1331.2009.02814.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Putnam M, Tang F. Long-term care planning and preparation among persons with multiple sclerosis. Home Health Care Serv Q 2008; 27:143-65. [PMID: 18928209 DOI: 10.1080/01621420802022613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Individuals with multiple sclerosis (MS) primarily rely on informal supports such as family members and assistive technology to meet their daily needs. As they age, formal supports may become important to compliment these supports and sustain community-based living. No previous research exists exploring plans and preparations of persons with MS for future independent living and long-term care needs. We analyzed data from a random sample survey (N = 580) to assess knowledge and perceptions of future service needs using ANOVA, chi-square, correlations, and MANOVA procedures. Results indicate that overall, most respondents are not well informed and have not planned or prepared for future care needs. Persons reporting severe MS were more likely to plan and prepare. Key "entry points" for making preparations include receiving specific education and planning information, discussions with family and professional service providers, and increased age, education, and income. We recommend greater infusion of long-term care planning into these existing entry points and creation of new entry points including healthcare provides and insurers.
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Affiliation(s)
- Michelle Putnam
- George Warren School of Social Work, Washington University, St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA.
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Ragonese P, Aridon P, Salemi G, D'Amelio M, Savettieri G. Mortality in multiple sclerosis: a review. Eur J Neurol 2008; 15:123-7. [PMID: 18217882 DOI: 10.1111/j.1468-1331.2007.02019.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This work was undertaken to evaluate studies on mortality caused by multiple sclerosis (MS), to evaluate if useful inferences can be drawn from survival studies that can be applied to clinical practice. A literature search was carried out to find epidemiological studies on MS prognosis, survival, mortality and causes of death relevant to our aim. The World Health Organization (WHO) reports on worldwide cause-specific mortality were also considered. Studies were evaluated according to the duration of the follow-up study, the year of publication and the methodology used. We evaluated MS survival from a methodological point of view and considered if time trends could be drawn from study results. We conclude that mortality is only slightly higher in MS patients when compared with that in the general population. Mortality is higher particularly for older patients and those with longer disease duration.
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Affiliation(s)
- P Ragonese
- Dipartimento Universitario di Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
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Alves-Leon SV, Malfetano FR, Pimentel MLV, Estrada CLD, Pereira VCSR, Liem AM, Novis SAP. Multiple sclerosis outcome and morbi-mortality of a Brazilian cohort patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:671-7. [DOI: 10.1590/s0004-282x2008000500012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 07/25/2008] [Indexed: 11/21/2022]
Abstract
We studied the clinical and evolution characteristics of multiple sclerosis (MS) patients followed since the onset of HUCFF/UFRJ in 1978. The diagnosis of MS was based on Poser's et al. and MC Donald's et al. criteria. From 188 patients, 122 were included. Eighty-five were females. The mean age onset was 32.2 years-old (range 6.0 to 61.0±10.3), mainly Caucasians (82/67%). The relapsing-remitting course (MSRR) was more frequent (106/86.8%). Monosymptomatic onset was significantly more frequent in Caucasians than in Afro-Brazilians (p<0.05). Seventeen patients had benign form of MS and these patients presented association with MSRR when compared with severe form (p=0.01). The mortality rate was 2.12% (4 patients died). This study was similar to other Brazilian series with regard to sex and age, and lack of correlation between EDSS and number of relapses; it confirmed south-southeast African-descendants gradient distribution and association between first mono-symptomatic relapses and Caucasian; we found lower frequency of benign forms.
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Affiliation(s)
- Soniza Vieira Alves-Leon
- Universidade Federal do Estado do Rio de Janeiro; UNIRIO; Universidade Federal do Rio de Janeiro, Brazil; UFRJ
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Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vécsei L, Milanov I. The epidemiology of multiple sclerosis in Europe. Eur J Neurol 2006; 13:700-22. [PMID: 16834700 DOI: 10.1111/j.1468-1331.2006.01342.x] [Citation(s) in RCA: 370] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Multiple sclerosis (MS) is a chronic and potentially highly disabling disorder with considerable social impact and economic consequences. It is the major cause of non-traumatic disability in young adults. The social costs associated with MS are high because of its long duration, the early loss of productivity, the need for assistance in activities of daily living and the use of immunomodulatory treatments and multidisciplinary health care. Available MS epidemiological estimates are aimed at providing a measure of the disease burden in Europe. The total estimated prevalence rate of MS for the past three decades is 83 per 100,000 with higher rates in northern countries and a female:male ratio around 2.0. Prevalence rates are higher for women for all countries considered. The highest prevalence rates have been estimated for the age group 35-64 years for both sexes and for all countries. The estimated European mean annual MS incidence rate is 4.3 cases per 100,000. The mean distribution by disease course and by disability is also reported. Despite the wealth of epidemiological data on MS, comparing epidemiological indices among European countries is a hard task and often leads only to approximate estimates. This represents a major methodological concern when evaluating the MS burden in Europe and when implementing specific cost-of-illness studies.
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Affiliation(s)
- M Pugliatti
- Ist. Clinica Neurologica, Facoltà di Medicina e Chirurgia, Università di Sassari, Viale San Pietro 10, 07100 Sassari, Italy.
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Atkins H, Freedman M. Immunoablative therapy as a treatment aggressive multiple sclerosis. Neurol Clin 2005; 23:273-300, ix. [PMID: 15661098 DOI: 10.1016/j.ncl.2004.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Harold Atkins
- Ottawa Hospital Blood and Marrow Transplant Program, General Campus, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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