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Gracia F, Ramírez Navarro DA, Ramírez Sánchez NE, Weiser R, Parajeles-Vindas A, Portillo Rivera LI, Torres EL, García Valle LA, Sanabria-Castro A, Abdón López C, Araujo P, Ayerdis Zamora MJ, Balmaceda-Meza A, Benzadon Cohen A, Candelario Cueto A, Castillo D, Castro-Escobar R, Corea Urbina KZ, de Peña Rivas A, Sotelo OD, Enamorado Claros T, Giroud Benítez JL, Gracia K, Larreategui M, Martínez Cerrato JA, Medina Báez JP, Menjivar Samayoa CE, Miranda-Loria G, Monterrey-Alvarez P, Morales Arguello LA, Ortiz M, Pérez Baldioceda CD, Pinilla Aguilar L, Salinas LCR, Rodríguez-Moreno V, Rojas-Chaves S, Román-Garita N, Santos Pujols B, Valderrama C, Van Sijtveld I, Zabala Angeles I, Rivera VM, Armien B. Multiple sclerosis in Central America and Caribbean countries: frequency and clinical characterization of an emergent disease. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1368675. [PMID: 38952354 PMCID: PMC11216161 DOI: 10.3389/fepid.2024.1368675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
Background Multiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population. Methods and results Data from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3-3.5 × 100,000 inhabitants, and the lowest, 0.07-0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies. Conclusion This is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged.
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Affiliation(s)
- Fernando Gracia
- Neurology Service, Hospital Santo Tomás, Panamá, Panama
- Dean of Health Science Faculty, Universidad Interamericana de Panamá, Panamá, Panama
| | | | | | - Roberto Weiser
- Neurology Service, Hospital Horacio Oduber, Oranjestad, Aruba
| | - Alexander Parajeles-Vindas
- Neurology Service, Hospital San Juan de Dios, Caja Costarricense de Seguro Social (CCSS), San Jose, Costa Rica
| | - Ligia I. Portillo Rivera
- Neurology Service, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala
| | | | - Luis A. García Valle
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua, Nicaragua
| | - Alfredo Sanabria-Castro
- Neurology Service, Hospital San Juan de Dios, Caja Costarricense de Seguro Social (CCSS), San Jose, Costa Rica
| | - César Abdón López
- Neurology Service, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Pahola Araujo
- Neurology Service, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama, Panama
| | | | - Andrea Balmaceda-Meza
- Neurology Service, Hospital San Juan de Dios, Caja Costarricense de Seguro Social (CCSS), San Jose, Costa Rica
| | - Aron Benzadon Cohen
- Neurology Service, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama, Panama
| | | | - Diego Castillo
- Neurology Service, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Romy Castro-Escobar
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Karla Z. Corea Urbina
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua, Nicaragua
| | - Anyeri de Peña Rivas
- Neurology Service, Centro de Diagnóstico, Medicina Avanzada Conferencias Médicas, Telemedicina (CEDIMAT), Santo Domingo, Dominican Republic
| | - Octavio Duarte Sotelo
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua, Nicaragua
| | | | | | - Karla Gracia
- Dean of Health Science Faculty, Universidad Interamericana de Panamá, Panamá, Panama
| | - Mario Larreategui
- Neurology Service, Hospital Regional Anita Moreno, Villa de Los Santos, Panama
| | | | | | | | - Gustavo Miranda-Loria
- Neurology Service, Hospital San Rafael de Alajuela, Caja Costarricense de Seguro Social (CCSS), Alajuela, Costa Rica
| | - Priscilla Monterrey-Alvarez
- Neurology Service, Hospital San Rafael de Alajuela, Caja Costarricense de Seguro Social (CCSS), Alajuela, Costa Rica
| | | | | | | | | | | | - Virginia Rodríguez-Moreno
- Neurology Service, Hospital San Carlos, Caja Costarricense de Seguro Social (CCSS), San Carlos, Costa Rica
| | - Sebastián Rojas-Chaves
- Neurology Service, Hospital San Juan de Dios, Caja Costarricense de Seguro Social (CCSS), San Jose, Costa Rica
| | - Norbel Román-Garita
- Neurology Service, Hospital San Juan de Dios, Caja Costarricense de Seguro Social (CCSS), San Jose, Costa Rica
| | - Biany Santos Pujols
- Neurology Service, Hospital Regional Universitario Jose Maria Cabral y Baez, Santiago De Los Caballeros, Dominican Republic
| | - Carlos Valderrama
- Neurology Service, Hospital Regional Rafael Hernández, David, Panama
| | | | - Indhira Zabala Angeles
- Neurology Service, Centro de Diagnóstico, Medicina Avanzada Conferencias Médicas, Telemedicina (CEDIMAT), Santo Domingo, Dominican Republic
| | - Victor M. Rivera
- Neurology Service, Baylor College of Medicine, Houston, TX, United States
| | - Blas Armien
- Directorate of Research and Technological Development, Gorgas Memorial Institute of Health Studies, Panamá, Panama
- Sistema Nacional de Investigación, Secretaria Nacional de Ciencia y Tecnología, Panamá, Panama
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Robers MV, Hurtubise B, Roberts MH, Robinson R, Schmidt H, Amezcua L. Multiple sclerosis in indigenous peoples of the Americas: A systematic review of incidence, prevalence, and outcomes. Mult Scler Relat Disord 2023; 72:104612. [PMID: 36917888 DOI: 10.1016/j.msard.2023.104612] [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: 08/09/2022] [Revised: 01/25/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The incidence, prevalence and outcomes of multiple sclerosis (MS) are unclear in Indigenous Peoples (IP) who are more likely to be underrepresented in research. We completed a systematic review of MS in IP of the Americas. METHODS A systematic review was conducted using PubMed, Web of Science, and Cochrane databases as well as references of retrieved papers. Inclusion criteria were: peer-reviewed publications (January 1990- December 2021), incidence, prevalence, or clinical outcome measures of MS in self-identified IP in the Americas. Incidence, prevalence, morbidity and mortality data were summarized and stratified by location and year of publication. Study quality was evaluated by risk of bias or confounding. RESULTS Out of 416 titles, thirteen studies met inclusion criteria. Four studies evaluated incidence, seven prevalence, three clinical outcomes and one mortality. Most studies were completed in Canada or the United States (US). Incidence rates per 100,000 ranged from 0.48 (in US Indian Health Service records) to 8.15 (First Nations Manitoban Canadians). Prevalence ranged from 0 (Lacandonian Mexicans and Panamanians) to 188.5 (First Nations Manitoban Canadians). Incidence and prevalence are consistently lower in IP than comparator White populations. IP with MS were reported to have higher disability and faster disability progression than non-Indigenous comparators. MS-related mortality is low compared to White people. CONCLUSION There is an absence of high-quality studies evaluating MS in IP. Available evidence indicates low, but increasing incidence and prevalence of MS in IP of the Americas. IP with MS may have worse disability than non-Indigenous comparators. Future studies should evaluate the factors influencing the increases in incidence and prevalence as well as better characterize possible disparities in MS care among IP.
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Affiliation(s)
- Michael V Robers
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States of America.
| | - Brigitte Hurtubise
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Melissa H Roberts
- College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
| | - Rheanna Robinson
- Department of First Nations Studies, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Hollie Schmidt
- Accelerated Cure Project, Waltham, MA, United States of America
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
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Guevara C, Villa E, Diaz V, Garrido C, Martinez M, Orellana P, Alarcón P, Silva-Rosas C, Barker GJ, Kempton MJ, de Grazia J. Inclusion of the Symbol Digit Modalities Test in a revised assessment of 'no evidence of disease activity-4 (NEDA-4)' in Latin-American patients with multiple sclerosis. Mult Scler Relat Disord 2020; 42:102076. [PMID: 32361478 DOI: 10.1016/j.msard.2020.102076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/23/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In relapsing-remitting multiple sclerosis (RRMS), no evidence of disease activity-3 (NEDA-3) is defined as the absence of: (1) relapses; (2) disability progression; (3) MRI activity (new/enlarged T2 lesions and/or gadolinium-enhanced T1 lesions). NEDA-4 status is defined as meeting all NEDA-3 criteria plus having an annualized percentage brain volume change (a-PBVC) >-0.4%. In individual patients, brain volume assessment is confounded with normal aging, methodological limitations and fluid-shift related fluctuations in brain volume. Cognitive impairment has been proposed as another component that should be integrated into therapeutic algorithms for RRMS. We aim to determine the proportion of patients failing to meet NEDA-4 criteria and to appraise whether the Symbol Digit Modalities Test (SDMT) is capable of replacing a-PBVC as one of the components of NEDA-4. We hypothesize that NEDA-4 has the potential to capture the impact of DMT therapies in RRMS. METHODS Forty-five patients were prospectively followed 1 and 2 years after their baseline assessment at the University of Chile Hospital. SIENA software was used to assess a-PBVC. RESULTS At baseline, the patients had a mean age of 33.0 years (range 18-57), disease duration of 1.9 years (0.4-4), Expanded Disability Status Scale score of 1.3 (0-4), and 67% were female. The majority had RRMS (91% while 9% had clinically isolated syndrome (CIS)). Seventy-three percent were on the so-called first line DMTs such as interferons (53%), glatiramer acetate (13%), teriflunomide (9%), and 18% were on fingolimod. There was a serial decline in the proportion of NEDA: after 1 and 2 years of follow-up 60% and 47% met NEDA-3 status, and 38% and 27% met NEDA-4, respectively. At the last follow-up 21% remained on interferons, 47% were now on fingolimod, 4% on alemtuzumab and 2% on natalizumab. At year 1 and year 2, with the replacement of a-PBVC by SDMT, 53% and 40% of patients achieved a putative NEDA-4 status, respectively. CONCLUSION Brain volumetric MRI has yet to be translated into clinical practice and SDMT may qualify as the fourth component of NEDA-4 definition. NEDA-4 has the potential to capture the impact of DMT therapies in RRMS earlier in the disease course of RRMS.
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Affiliation(s)
- Carlos Guevara
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile.
| | - Eduardo Villa
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Violeta Diaz
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Cristian Garrido
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Melissa Martinez
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Patricia Orellana
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Pablo Alarcón
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Carlos Silva-Rosas
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
| | - Gareth J Barker
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matthew J Kempton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - José de Grazia
- Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Universidad de Chile, Santos Dumont 999, Santiago, Chile
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Melcon MO, Correale J, Melcon CM. Is it time for a new global classification of multiple sclerosis? J Neurol Sci 2014; 344:171-81. [PMID: 25062946 DOI: 10.1016/j.jns.2014.06.051] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/09/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates. OBJECTIVE The aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys. METHODS We conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012. RESULTS MS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6-36.2). CONCLUSION In the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.
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Affiliation(s)
- Mario O Melcon
- Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina.
| | - Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Carlos M Melcon
- Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina
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Cristiano E, Rojas JI, Romano M, Frider N, Machnicki G, Giunta DH, Calegaro D, Corona T, Flores J, Gracia F, Macias-Islas M, Correale J. The epidemiology of multiple sclerosis in Latin America and the Caribbean: a systematic review. Mult Scler 2012; 19:844-54. [DOI: 10.1177/1352458512462918] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The incidence and prevalence of multiple sclerosis (MS) varies geographically as shown through extensive epidemiological studies performed mainly in developed countries. Nonetheless, scant data is available in Latin America and the Caribbean (LAC). The objective of this review is to assess epidemiological data of MS in LAC. We conducted a systematic review of published articles and gray literature from January 1995 to May 2011. Twenty-two studies met the inclusion criteria after full-text review. Incidence data were found in only three studies and ranged from 0.3 to 1.9 annual cases per 100,000 person-years. Prevalence was reported in 10 studies and ranged from 0.83 to 21.5 cases per 100,000 inhabitants. The most prevalent subtype of MS was the relapsing–remitting form (48% to 91% of the series). No data about mortality were found. This study showed low frequency for MS in LAC compared with North American and European countries. The role of environmental and genetic factors should be well studied, providing new insights about its etiology.
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Affiliation(s)
- E Cristiano
- Department of Neurology, MS Clinic, Hospital Italiano de Buenos Aires, Argentina
| | - JI Rojas
- Department of Neurology, MS Clinic, Hospital Italiano de Buenos Aires, Argentina
| | - M Romano
- Department of Neurocience, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC, Argentina
| | - N Frider
- Regional Medical Director in Neuroscience, Novartis Latinoamerica & Canada
| | - G Machnicki
- Global Health Economics and Outcomes Research, Novartis Latinoamerica & Canada
| | - DH Giunta
- Department of Internal Medicine, Section of Epidemiology, Hospital Italiano de Buenos Aires, Argentina
| | - D Calegaro
- Hospital das Clinicas-Universidade de São Paulo, Brazil
| | - T Corona
- Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico
| | - J Flores
- Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico
| | - F Gracia
- Multiple Sclerosis Clinic, Santo Tomás Hospital, Panamá
| | - M Macias-Islas
- Neurosciences Department, CUCS, Guadalajara University, Mexico
| | - J Correale
- Department of Neurology, Raúl Carrea Institute for Neurological Research, FLENI, Argentina
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