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Correia I, Cunha C, Bernardes C, Nunes C, Macário C, Sousa L, Batista S. Prevalence, Incidence, and Mortality of Multiple Sclerosis in Coimbra, Portugal. Neuroepidemiology 2023; 58:57-63. [PMID: 38128504 PMCID: PMC10857021 DOI: 10.1159/000535960] [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: 08/29/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system in young adults, representing the leading cause of nontraumatic disability in this population. The rising prevalence of MS worldwide makes it critical to recognize the absolute number of patients with MS, demanding the execution of a sustainable healthcare policy. In Portugal, only six studies evaluating MS rates were published, disclosing a prevalence of 64 cases per 100,000 persons and an incidence of 3.1 cases per 100,000 persons/year, but the mortality rates have not been reported. Thus, this observational, cross-sectional study aimed to assess MS prevalence, incidence, and mortality in the city of Coimbra, a region in the center of Portugal. Patients who fulfilled McDonald's Diagnosis Criteria (2017) for MS were recruited. Inclusion criteria were defined according to prevalence, incidence, and mortality studies. The baseline demographic and clinical characterization of the prevalence study population was performed. The MS prevalence rate in Coimbra was 143.45 cases per 100,000 inhabitants. Between 2018 and 2021, the cumulative incidence was 8.52 new cases per 100,000 persons/year. The mortality rate between 2018 and 2021 was 2.84 deaths per 100,000 inhabitants. MS prevalence and incidence in Coimbra are higher than reported in previous similar studies and comparable to Europe's mean prevalence and incidence.
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Affiliation(s)
- Inês Correia
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carolina Cunha
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Bernardes
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Nunes
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carmo Macário
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lívia Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Sá MJ, Basílio C, Capela C, Cerqueira JJ, Mendes I, Morganho A, Correia de Sá J, Salgado V, Martins Silva A, Vale J, Sousa L. Consensus for the Early Identification of Secondary Progressive Multiple Sclerosis in Portugal: a Delphi Panel. ACTA MEDICA PORT 2023; 36:167-173. [PMID: 36735763 DOI: 10.20344/amp.18543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Multiple sclerosis is a disease with a heterogeneous evolution. The early identification of secondary progressive multiple sclerosis is a clinical challenge, which would benefit from the definition of biomarkers and diagnostic tools applicable in the transition phase from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis. We aimed to reach a Portuguese national consensus on the monitoring of patients with multiple sclerosis and on the more relevant clinical variables for the early identification of its progression. MATERIAL AND METHODS A Delphi panel which included eleven Portuguese Neurologists participated in two rounds of questions between July and August of 2021. In the first round, 39 questions which belonged to the functional, cognitive, imaging, biomarkers and additional evaluations were included. Questions for which no consensus was obtained in the first round (less than 80% of agreement), were appraised by the panel during the second round. RESULTS The response rate was 100% in both rounds and consensus was reached for a total of 33 questions (84.6%). Consensus was reached for monitoring time, evaluation scales and clinical variables such as the degree of brain atrophy and mobility reduction, changes suggestive of secondary progressive multiple sclerosis. Additionally, digital devices were considered tools with potential to identify disease progression. Most questions for which no consensus was obtained referred to the cognitive assessment and the remaining referred to both functional and imaging domains. CONCLUSION Consensus was obtained for the determination of the monitorization interval and for most of the clinical variables. Most questions that did not reach consensus were related with the confirmation of progression taking into account only one test/domain, reinforcing the multifactorial nature of multiple sclerosis.
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Affiliation(s)
- Maria José Sá
- Serviço de Neurologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Carlos Basílio
- Serviço de Neurologia. Centro Hospitalar Universitário do Algarve. Faro. Portugal
| | - Carlos Capela
- Serviço de Neurologia. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | | | - Irene Mendes
- Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal
| | - Armando Morganho
- Serviço de Neurologia. Hospital Dr. Nélio Mendonça. Funchal. Portugal
| | - João Correia de Sá
- Serviço de Neurologia. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Vasco Salgado
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Ana Martins Silva
- Serviço de Neurologia. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - José Vale
- Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal
| | - Lívia Sousa
- Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Moura J, Duarte S, Oliveira V, Pereira D, Costa D, Samões R, Sousa AP, Silva AM, Santos E. Characterization of a late-onset multiple sclerosis Portuguese cohort. Mult Scler Relat Disord 2023; 70:104506. [PMID: 36638770 DOI: 10.1016/j.msard.2023.104506] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Late-onset multiple sclerosis (LOMS) is defined as the onset of symptoms above 50 years, corresponding to an increasingly recognized subset of MS. This study aimed at comparing demographic and clinical data of patients with LOMS to those of early-onset MS (EOMS) from a Portuguese cohort. METHODS Retrospective chart review of an MS cohort from a Portuguese tertiary center. RESULTS From 746 patients with MS (61.7% female), we identified 39 cases with presentation after 50 years of age (22 males and 17 females), corresponding to 5.3%. The mean age at onset was 55.4 (±5.0) for LOMS and 29.5 (±8.9) for EOMS. There was no significant difference in disease duration. The most common type was relapsing-remitting MS, accounting for 51.5% and 83.9% of LOMS and EOMS patients, respectively. Primary-progressive MS (PPMS) was significantly more represented in the LOMS group (41.0%) (p < 0.01). The median EDSS was significantly higher in the LOMS group (4.75, 0.0-7.5) when compared to the EOMS group (2.0, 0.0-9,0). The most frequent presenting feature was myelitis in both LOMS (48.7%) and EOMS patients (47.4%), resulting in significantly higher EDSS (p = 0.003). CONCLUSIONS LOMS is associated with higher EDSS when considering the same disease duration, translating into increased disability.
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Affiliation(s)
- João Moura
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal,.
| | - Sara Duarte
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Vanessa Oliveira
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diogo Pereira
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diogo Costa
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Raquel Samões
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal,; Unit of Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health) (ITR), Porto, Portugal
| | - Ana Paula Sousa
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Martins Silva
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal,; Unit of Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health) (ITR), Porto, Portugal
| | - Ernestina Santos
- Department of Neurology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal,; Unit of Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health) (ITR), Porto, Portugal
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Vasanthaprasad V, Khurana V, Vadapalle S, Palace J, Adlard N. Systematic literature review and meta-analysis of the prevalence of secondary progressive multiple sclerosis in the USA, Europe, Canada, Australia, and Brazil. BMC Neurol 2022; 22:301. [PMID: 35978300 PMCID: PMC9382820 DOI: 10.1186/s12883-022-02820-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/01/2022] [Indexed: 03/21/2024] Open
Abstract
Background Secondary progressive multiple sclerosis (SPMS) is a subtype of multiple sclerosis (MS), which is a chronic neurological disease, characterised by inflammation of the central nervous system. Most of MS patients eventually progress to SPMS. This study estimates the prevalence of SPMS in the United States of America, Europe, Canada, Australia, and Brazil. Methods A systematic literature search of the Medline and Embase databases was performed using the OVID™ SP platform to identify MS epidemiological studies published in English from database inception to September 22, 2020. Studies reporting the prevalence of MS and proportion of SPMS patients in the included population were selected. The pooled prevalence of SPMS was calculated based on the proportion of SPMS patients. The Loney quality assessment checklist was used for quality grading. A meta-analysis of the proportions was conducted in RStudio. Results A total of 4754 articles were retrieved, and prevalence was calculated from 97 relevant studies. Overall, 86 medium- and high-quality studies were included in the meta-analysis. Most studies were conducted in European countries (84 studies). The estimated pooled prevalence of SPMS was 22.42 (99% confidence interval: 18.30, 26.95)/100,000. The prevalence of SPMS was more in the North European countries, highest in Sweden and lowest in Brazil. A decline in SPMS prevalence was observed since the availability of oral disease-modifying therapies. We also observed a regional variation of higher SPMS prevalence in urban areas compared with rural areas. Conclusion High variability was observed in the estimated SPMS prevalence, and the quality of the studies conducted. The influence of latitude and other factors known to affect overall MS prevalence did not fully explain the wide range of inter-country and intra-country variability identified in the results. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02820-0.
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Affiliation(s)
| | - Vivek Khurana
- Novartis Corporation (Malaysia) Sdn. Bhd, Kuala Lumpur, Selangor, Malaysia
| | | | - Jackie Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Branco M, Alves I, Martins da Silva A, Pinheiro J, Sá MJ, Correia I, Sousa L, Brandão E, Veira C, Gomes B, Ruano L. The epidemiology of multiple sclerosis in the entre Douro e Vouga region of northern Portugal: a multisource population-based study. BMC Neurol 2020; 20:195. [PMID: 32429866 PMCID: PMC7236954 DOI: 10.1186/s12883-020-01755-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 04/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the north-south gradient of prevalence may be disappearing in the Northern hemisphere. The few previous prevalence studies performed in Portugal have reported a lower prevalence than the average for Western Europe. The aim of this study is to estimate the prevalence of MS in the Entre Douro e Vouga region, in Northern Portugal. METHODS Multiple overlapping sources were used to ascertain all cases from the reference population: records from hospitals in the region and neighbouring regions; diagnostic databases of primary care physicians; and applications for disability benefits. The prevalence date was set at 1 January 2014. The reference population was 274,859 inhabitants. Patients' neurologists were contacted to retrieve clinical information and confirm the diagnosis based. RESULTS A total of 177 patients were identified after eliminating duplicates from different sources. The female to male ratio was 1.9 and the mean age at disease onset was 33.5 (standard deviation: 10.3). Clinically isolated syndrome accounted for 9.0% of patients, relapsing remitting for 58.8%, secondary progressive for 20.3% and primary progressive for 11.8%. The prevalence was estimated in 64.4 patients per 100,000 (95% confidence interval: 54.9;73.9). CONCLUSIONS In this study we report a higher point prevalence of MS than had been previously described in Portugal, but still far from the higher values recently reported in other Southern European countries.
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Affiliation(s)
- Mariana Branco
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ivânia Alves
- Serviço de Neurologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana Martins da Silva
- Serviço de Neurologia Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joaquim Pinheiro
- Serviço de Neurologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Maria José Sá
- Serviço de Neurologia, Centro Hospitalar de São João, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Inês Correia
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lívia Sousa
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eva Brandão
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Carlos Veira
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bernardo Gomes
- Unidade de Saúde Pública, ACES Entre Douro e Vouga I, Santa Maria da Feira, Portugal
| | - Luis Ruano
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal. .,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
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Sá MJ, Nunes CC, da Silva AM, Mota P, Pinto-Marques J. JC virus antibodies in Portuguese multiple sclerosis patients: JUSTIFY study results. J Neurol Sci 2019; 406:116426. [PMID: 31629287 DOI: 10.1016/j.jns.2019.116426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/02/2019] [Accepted: 08/12/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To confirm anti-JC virus (JCV) antibody seroprevalence in Portuguese patients with relapsing-remitting multiple sclerosis (RRMS) and to determine their anti-JCV antibody index. METHODS JUSTIFY was a retrospective, multicentre study that included 655 RRMS patients tested at least once with the anti-JCV antibody assay STRATIFY JCV DxSelect. Demographic data, multiple sclerosis history and results of the anti-JCV antibody test were collected, along with physicians' reasons for requesting the test and the impact of the results. RESULTS Overall anti-JCV antibody seroprevalence was 60.8% (95% confidence interval, 56.9-64.5). Seroprevalence was associated with higher age (P = .030) and was lower in natalizumab-treated patients (P < .001). The mean anti-JCV antibody index of immunosuppressant-naive patients was 1.5 ± 1.3 (n = 378). The main reasons for performing the test were clinical characterization (35.5%) and medication change (26.2%). In patients who switched treatments (n = 109), fingolimod (47.7%) and natalizumab (26.6%) were the most commonly chosen new treatments. CONCLUSIONS The study confirmed the high anti-JCV antibody prevalence in Portuguese RRMS patients and its association with age. These data can be used to better understand the benefit-risk profile of natalizumab treatment in Portuguese patients and to support progressive multifocal leukoencephalopathy risk management strategies.
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Affiliation(s)
- Maria José Sá
- Centro Hospitalar de São João, Hospital de São João, Department of Neurology, Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal.
| | - Carla Cecília Nunes
- Centro Hospitalar e Universitário de Coimbra, Hospitais da Universidade de Coimbra, Department of Neurology, Coimbra, Portugal
| | - Ana Martins da Silva
- Centro Hospitalar do Porto, Hospital de Santo António, Department of Neurology, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - José Pinto-Marques
- Centro Hospitalar de Setúbal, Hospital de São Bernardo, Department of Neurology, Setubal, Portugal
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Using endogenous saccades to characterize fatigue in multiple sclerosis. Mult Scler Relat Disord 2017; 14:16-22. [DOI: 10.1016/j.msard.2017.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/21/2017] [Accepted: 01/27/2017] [Indexed: 11/20/2022]
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Abstract
Multiple sclerosis is characterized by a non-homogeneous distribution around the world. Some authors in past described a latitude gradient, with increasing risk from the equator to North and South Poles, but this theory is still controversial. Regarding Europe, there are many articles in the literature concerning the epidemiology of this disease but, unfortunately, they are not always comparable due to different methodologies, they do not cover all countries in the continent, and most of them reported data of small areas and rarely at a national level. In 2012 there were 20 national registries that could help to describe the epidemiology of the disease and, in addition, there is an European Register for Multiple Sclerosis that collect data from already existing national or regional MS registries and databases. Another valid alternative to obtain epidemiological data, also at national level, in a routinely and cost-saving way is through administrative data that are of increasing interest in the last years.
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Pereira M, Lambrelli D, Ramagopalan SV. Decrease in rate of multiple sclerosis-related hospitalizations in Portugal. F1000Res 2016; 5:1353. [PMID: 27441085 PMCID: PMC4937828 DOI: 10.12688/f1000research.8787.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/27/2022] Open
Abstract
We sought to investigate the rate of multiple sclerosis (MS)-related hospitalizations in Portugal and assess whether there have been temporal changes as described in other countries. Using data from the Portuguese National Discharge Registry, we observed that between 2008 and 2013 the rate of MS-related hospitalizations decreased by 44%, from 15.9/100 person-years (95% confidence interval (CI: 14.9-16.9) in 2008 to 8.9/100 person-years (95% CI: 8.2-9.6) in 2013. The change in hospitalization rates is in accordance with what has been observed in other countries, and coincides with the release of new therapies for MS in Portugal.
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Stawowczyk E, Malinowski KP, Kawalec P, Moćko P. The indirect costs of multiple sclerosis: systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:759-86. [DOI: 10.1586/14737167.2015.1067141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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