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Williams MJ, Orlando C, Akisanya J, Amezcua L. Multiple Sclerosis in Black and Hispanic Populations: Serving the Underserved. Neurol Clin 2024; 42:295-317. [PMID: 37980120 DOI: 10.1016/j.ncl.2023.06.005] [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] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis has historically been characterized as a disease that affects young women of European ancestry, but recent studies indicate that the incidence and prevalence of the disease is much higher in Black and Hispanic populations than previously recognized. There is evidence that there is a more severe disease course in these populations. , but the intersection of genetic underpinnings and social determinants of health (SDOH) is poorly understood due to the lack of diversity in clinical research. Improving health disparities will involve multiple stakeholders in efforts to improve SDOH and raise awareness about research involvement and the importance of developing personalized health care plans to combat this disease.
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Affiliation(s)
- Mitzi J Williams
- Joi Life Wellness Multiple Sclerosis Center, 767 Concord Road, SE, Smyrna, GA 30082, USA.
| | - Christopher Orlando
- Department of Neurology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street, Suite 3000, Los Angeles, CA, USA. https://twitter.com/OrlandoMDMPH
| | - Jemima Akisanya
- Georgetown Department of Neurology, 10401 Hospital Drive, Suite 102, Clinton, MD 20735, USA. https://twitter.com/MimasMyelin
| | - Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street, Suite 3000, Los Angeles, CA, USA
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Alkolfat F, Said S, Mekky J, Eldeeb H. What an adult multiple sclerosis registry can tell us about pediatric onset multiple sclerosis? Mult Scler Relat Disord 2023; 79:104962. [PMID: 37714097 DOI: 10.1016/j.msard.2023.104962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is an immune-mediated, chronic disease of the central nervous system that affects mainly adults. However, it is increasingly recognized that MS may start in childhood resulting in a relentlessly progressive disability and cognitive impairment. Registries across the globe are reporting inconstant data about their Pediatric-Onset Multiple Sclerosis (POMS) patients. Moreover, newer lines of treatments are emerging and showing efficacy in controlling the MS disease regardless of the onset. Therefore, there is a requirement for more research into the clinical profile of POMS in different populations and ethnicities. METHODS This study was a cross-sectional study that included MS patients who visited the MS unit at Alexandria University from January 2019 to January 2021. We analyzed their epidemiological, clinical, radiological data, and cerebrospinal fluid (CSF) results from their updated records as well as follow-up interviews. RESULTS Annual Relapse Rate (ARR) was marginally less in POMS than AOMS (0.72 ± 0.57 vs 1.04 ± 0.78 relapse/year, P =.008). POMS patients had a bigger gap to their first relapse (40.0 ± 47.35 vs 22.71 ± 34.33 months, p= .066). The difference in relapse rate between the two groups was abolished after the exclusion of patients who had a gap of more than 5 years to their first relapse. AOMS patients were significantly more likely to start with a second-line disease-modifying treatment (DMT) than POMS patients (11.5% vs 31%, p= .04), whereas POMS patients were more likely to be escalated to the second line (34.6% vs 19.3%, p= .07). ARR had a positive and significant correlation with expanded disability status scale (EDSS) progression per year (rs(24)= .57 p=.003). A Mann-Whitney test indicated that POMS patients who had infratentorial involvement in the initial MRI brain had higher EDSS (3.08 ± 1.99) than POMS who did not (1.07 ± 0.79) U=24 P =.013. IgG index had a significant and positive correlation with annual EDSS progression rate rs (8) = 0.8 p=.001. CONCLUSION Early disease onset does not mean a higher relapse rate when including the full spectrum of POMS and longer follow-up duration. POMS patients relapsed more on the first-line DMT and escalation should be considered early. Infratentorial involvement in the initial magnetic resonance imaging (MRI) brain and high IgG index are potential predictors for aggressive disease course in POMS.
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Affiliation(s)
- Fatma Alkolfat
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Sameh Said
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jaidaa Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany Eldeeb
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Baroncini D, Ghezzi A, Guaschino C, Moiola L, Filippi M, Ianniello A, Pozzilli C, Lanzillo R, Brescia-Morra V, Margoni M, Gallo P, Callari G, Grimaldi L, Lus G, Calabrese M, Simone M, Marfia GA, Rasia S, Cargnelutti D, Comi G, Zaffaroni M, Trojano M, Centonze D, Capra R, Capobianco M, Laroni A, Uccelli A, Gallo A, Patti F, Danni MC, Gasperini C, Coniglio G. Long-term follow-up (up to 11 years) of an Italian pediatric MS cohort treated with Natalizumab: a multicenter, observational study. Neurol Sci 2022; 43:6415-6423. [PMID: 35781765 DOI: 10.1007/s10072-022-06211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Natalizumab (NAT) has a strong impact on disease activity of aggressive pediatric multiple sclerosis (MS), with no difference in safety profile compared to adult MS. However, available data are limited by short follow-up. Our aim was to report long-term follow-up data (up to 11 years) of a large Italian pediatric MS cohort treated with NAT. MATERIALS AND METHODS We retrospectively collected data of pediatric MS patients treated with NAT included in a previous study and prospectively followed in Italian MS centers. We compared disease activity pre, during, and post-NAT and we performed survival analyses of time to evidence of disease activity (EDA) during NAT, time to reach EDA post-NAT, and time to NAT discontinuation. RESULTS Ninety-two patients were included from 19 MS centers in Italy. At NAT initiation, cohort's characteristics were as follows: 55 females; 14.7 ± 2.4 (mean ± SD) years of age; 34 naïve to disease modifying therapies; 1-year pre-NAT annualized relapse rate (ARR): 2.2 ± 1.2; EDSS (median [IQR]): 2.5 [2.0-3.0]; gadolinium-enhancing lesions: 2 [1-5]; 41 JCV positives. During NAT treatment (61.9 ± 35.2 mean infusions), ARR lowered to 0.08 ± 0.23 (p < 0.001), EDSS score to 1.5 [1.0-2.5] at last infusion (p < 0.001), and 51% patients had EDA (21% after 6 months of rebaseline). No serious adverse events were reported. Forty-nine patients discontinued NAT, mainly due to PML concern; the majority (29/49) had disease reactivation in the subsequent 12 months, of which three with a clinical rebound. CONCLUSION NAT treatment maintains its high efficacy for a long time in pediatric MS patients, with no new safety issues.
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Rates and patterns of physical activity among Hispanics with multiple sclerosis in the NARCOMS Registry. Mult Scler Relat Disord 2022; 65:104018. [DOI: 10.1016/j.msard.2022.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
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Menascu S, Khavkin Y, Zilkha‐Falb R, Dolev M, Magalashvili D, Achiron A, Gurevich M. Clinical and transcriptional recovery profiles in pediatric and adult multiple sclerosis patients. Ann Clin Transl Neurol 2021; 8:81-94. [PMID: 33197148 PMCID: PMC7818128 DOI: 10.1002/acn3.51244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/07/2020] [Accepted: 10/18/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To determine whether pediatric-onset multiple sclerosis (POMS) and adults-onset multiple sclerosis (AOMS) patients are different in initial disease severity and recovery and to investigate the associations with peripheral blood mononuclear cells (PBMCs) transcriptional profiles. METHODS Clinical and radiological severity of first and second relapses and 6-month recovery were analyzed in 2153 multiple sclerosis (MS) patients and compared between POMS (onset at 8-18years old) and AOMS (onset at 19-40 years old) patients. PBMCs transcriptomes of 15 POMS and 15 gender-matched AOMS patients were analyzed 6 months after the first relapse and compared to 55 age-matched healthy controls. Differentially Expressed Genes (DEGs) with a false discovery rate ≤ 10% were evaluated using the Partek software. RESULTS POMS had increased Expanded Disability Status Scale (EDSS) score at first and second relapses, higher brain gadolinium-enhancing T1-lesions volume at first relapse, and more complete recovery after both relapses compared to AOMS. POMS patients, who recovered completely from the first relapse, were characterized by 19 DEGs that were mainly related to suppression of antigen presentation. Six upstream regulators of these genes were differentially expressed between pediatric and adult healthy controls. POMS patients, who showed no recovery from the first relapse, were characterized by 28 DEGs that were mainly associated with B-cell activation. Five upstream regulators of these genes were differentially expressed between pediatric and adult healthy controls. INTERPRETATION POMS patients may have more severe first and second relapses than AOMS. However, most often, POMS have better recovery that may be attributed to PBMCs age-related transcriptional profiles associated with antigen presentation and B-cell activation.
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Affiliation(s)
- Shay Menascu
- Multiple Sclerosis Center, Sheba Medical CenterRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Yulia Khavkin
- Multiple Sclerosis Center, Sheba Medical CenterRamat‐GanIsrael
| | | | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical CenterRamat‐GanIsrael
| | | | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical CenterRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Michael Gurevich
- Multiple Sclerosis Center, Sheba Medical CenterRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
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Santoro JD, Saucier LE, Tanna R, Wiegand SE, Pagarkar D, Tempchin AF, Khoshnood M, Ahsan N, Van Haren K. Inadequate Vaccine Responses in Children With Multiple Sclerosis. Front Pediatr 2021; 9:790159. [PMID: 34926358 PMCID: PMC8678906 DOI: 10.3389/fped.2021.790159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/10/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV), are recommended for patients with pediatric onset multiple sclerosis (POMS) and may be required prior to initiation of some disease modifying therapies. However, the efficacy of routine vaccine administration in POMS has never been studied. We sought to assess the humoral mediated vaccine response to HBV and VZV in children with POMS. Methods: A multi-center retrospective chart-based review of 62 patients with POMS was performed. Clinical data and antibody titers against HBV and VZV were collected prior to initiation of disease modifying therapy or steroids and compared to institutional control data, using t-test and chi squared analysis. Results: There were low rates of immunity against both HBV and VZV (33 and 25% respectively) among individuals with POMS. Fifteen individuals (24%) were non-immune to both. Compared to institutional control data, individuals with POMS were significantly less likely to be immune to and HBV (p = 0.003, 95% CI: 0.22-0.75) and VZV (p < 0.001, 95% CI: 0.09-0.39). Interpretation: Individuals with POMS have low rates of antibody-mediated immunity against HBV and VZV, despite receiving the appropriate vaccinations. This suggests an association between POMS and systemic immune dysregulation although further study is needed.
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Affiliation(s)
- Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Laura E Saucier
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Runi Tanna
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sarah E Wiegand
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Dania Pagarkar
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Adam F Tempchin
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mellad Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Nusrat Ahsan
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Keith Van Haren
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, United States
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Characteristics of pediatric multiple sclerosis: A tertiary referral center study. PLoS One 2020; 15:e0243031. [PMID: 33264341 PMCID: PMC7710048 DOI: 10.1371/journal.pone.0243031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The present study represents one of the largest series of pediatric multiple sclerosis (PedMS) in Western Balkan region. This is the first study aimed to evaluate the characteristics of PedMS in the Serbian population. Methods This retrospective study on 54 PedMS, aged 7–17 years, was performed at the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade, Serbia, a tertiary center for the diagnosis and treatment of children with neurological and psychiatric diseases. Results Female to male ratio was 37 (68.5%): 17 (31.5%). Family history of MS was noted in 9.3% and autoimmune diseases in 24.1% patients. Co-occurring migraine was in 7,4%. Monofocal onset of disease was present in 77.8% patients. The most common initial symptoms were optic neuritis (37%), sensory disturbances (31.5%), motor deficit (24.1%), cerebellar (18.5%) and brainstem lesions (16.7%), pain (9.3%), acute disseminated encephalomyelitis like symptoms (1.9%), and hearing loss (3.7%). Visual evoked potentials were pathological in 75.9% of patients. Oligoclonal bands were positive in 68.5% of patients. Magnetic resonance imaging showed periventricular (94.4%), infratentorial (77.8%), juxtacortical and cortical changes (55.6%) and changes in the cervical spinal cord (33.3%). The median EDSS score was 2.0. Conclusion Our cohort significantly differs from the literature data regarding more frequent occurrence of optic neuritis, hearing loss as a first symptom, the relapsing-remitting course of the disease, higher proportion of early onset of disease, presence of co-occurring migraine and the frequent occurrence of epilepsy and other autoimmune diseases in the family.
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Mercado V, Dongarwar D, Fisher K, Salihu HM, Hutton GJ, Cuascut FX. Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis. Biomedicines 2020; 8:biomedicines8120534. [PMID: 33255552 PMCID: PMC7760789 DOI: 10.3390/biomedicines8120534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe similarities and differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. While we found several similarities between the groups regarding mean age, disability severity, and degree of brain atrophy at diagnosis, we also describe a few divergences. Interestingly, we found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) > 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16–0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10–7.10, OR= 2.44, 95% CI: 1.35–6.12, p = 0.01, respectively). Additionally, we observed significant differences in treatment adherence between groups. Assessment of the degree of brain atrophy and progression over time, along with an enumeration of T1, T2, and gadolinium-enhancing brain lesions, did not reveal differences across groups.
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Affiliation(s)
- Vicki Mercado
- Immunology and Microbiology Graduate Program, Baylor College of Medicine, Houston, TX 77030, USA;
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX 77030, USA
- Center of Excellence in Health Equity, Training and Research Program, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research Program, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Kristen Fisher
- Texas Children Hospital, Blue Bird Circle Clinic for Multiple Sclerosis, Houston, TX 77030, USA;
| | - Hamisu M. Salihu
- Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - George J. Hutton
- Baylor College of Medicine, Maxine Mesinger Multiple Sclerosis Center, Houston, TX 77030, USA;
| | - Fernando X. Cuascut
- Center of Excellence in Health Equity, Training and Research Program, Baylor College of Medicine, Houston, TX 77030, USA;
- Baylor College of Medicine, Maxine Mesinger Multiple Sclerosis Center, Houston, TX 77030, USA;
- Correspondence:
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Greenberg B, Kolodny S, Wang M, Deshpande C. Utilization and Treatment Patterns of Disease-Modifying Therapy in Pediatric Patients with Multiple Sclerosis in the United States. Int J MS Care 2020; 23:101-105. [PMID: 34177381 DOI: 10.7224/1537-2073.2019-095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The current landscape and treatment patterns of disease-modifying therapy (DMT) use in pediatric patients with multiple sclerosis (MS) are not yet well understood. This study examined DMT utilization and treatment patterns in pediatric patients newly diagnosed as having MS. Methods Pediatric patients (<18 years old) with two MS diagnosis claims from January 1, 2010, to December 31, 2016, were identified from the MarketScan Commercial Database. The index date was defined as the date of first MS diagnosis, and patients were followed up for 1 year post-index date. Outcomes evaluated included percentage of patients who initiated treatment after MS diagnosis, different DMTs initiated, treatment discontinuation, and switching treatment during follow-up. Results Of 182,057 patients newly diagnosed as having MS, 288 pediatric patients (mean age, 14 years; 61% female) were identified. Within the first year of diagnosis, 188 patients (65.3%) did not receive any DMT. The most common first-initiated treatments were interferons and glatiramer acetate (83%), but 28% of patients switched or discontinued from first-initiated treatment within 6 months of treatment initiation. Conclusions This study suggests that a considerable proportion of pediatric patients with MS remain untreated within 1 year of diagnosis. Patients most commonly initiated injectables as their first DMT. Overall, therapy failed early in approximately one in three patients. Thus, the study warrants urgency in treating these patients with currently approved treatment options.
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Krch D, Lequerica A, Aguayo Arelis A, Rábago Barajas BV, Arango-Lasprilla JC, Chiaravalloti ND. Efficacy of the Spanish modified Story Memory Technique in Mexicans with multiple sclerosis: A pilot randomized controlled trial. NeuroRehabilitation 2019; 45:349-358. [DOI: 10.3233/nre-192808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anthony Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Adriana Aguayo Arelis
- Departamento de Investigación, Psicología, Universidad Enrique Díaz de León, Guadalajara, Mexico
- Department of Neuropsychology, Mexican Foundation for Multiple Sclerosis, Mexico
| | - Brenda Viridiana Rábago Barajas
- Departamento de Investigación, Psicología, Universidad Enrique Díaz de León, Guadalajara, Mexico
- Department of Neuropsychology, Mexican Foundation for Multiple Sclerosis, Mexico
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Nancy D. Chiaravalloti
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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Amezcua L, Beecham AH, Delgado SR, Chinea A, Burnett M, Manrique CP, Gomez R, Comabella M, Montalban X, Ortega M, Tornes L, Lund BT, Islam T, Conti D, Oksenberg JR, McCauley JL. Native ancestry is associated with optic neuritis and age of onset in hispanics with multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1362-1371. [PMID: 30480030 PMCID: PMC6243381 DOI: 10.1002/acn3.646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background and Objective Hispanics with multiple sclerosis (MS) present younger and more often with optic neuritis (ON) as compared to Whites in the western United States. Regional differences related to Hispanic genetic admixture could be responsible. We investigated the association between global genetic ancestry and ON and age at onset of MS in Hispanics. Methods Data were obtained for 1033 self‐identified Hispanics with MS from four MS‐based registries from four academic institutions across the United States January 2016–April 2017. Multivariate regression models, utilizing genetic ancestry estimates for Native American (NA), African, and European ancestry, were used to assess the relationship between genetic ancestry and ON presentation and age of MS onset, defined as age at first symptom. Results Genetic ancestry and ON proportions varied by region where NA ancestry and ON proportions were highest among Hispanics in the southwestern United States (40% vs. 19% overall for NA and 38% vs. 25% overall for ON). A strong inverse correlation was observed between NA and European ancestry (r = −0.83). ON presentation was associated with younger age of onset (OR: 0.98; 95% CI: 0.96–0.99; P = 7.80 × 10−03) and increased NA ancestry (OR: 2.35 for the highest versus the lowest quartile of NA ancestry; 95% CI: 1.35–4.10; P = 2.60 × 10−03). Younger age of onset was found to be associated with a higher proportion NA (Beta: −5.58; P = 3.49 × 10−02) and African ancestry (Beta: −10.07; P = 1.39 × 10−03). Interpretation Ethnic differences associated with genetic admixture could influence clinical presentation in Hispanics with MS; underscoring the importance of considering genetic substructure in future clinical, genetic, and epigenetic studies in Hispanics.
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Affiliation(s)
- Lilyana Amezcua
- Department of Neurology Keck School of Medicine University of Southern California Los Angeles California
| | - Ashley H Beecham
- Dr. John T. Macdonald Department of Human Genetics Miller School of Medicine University of Miami Miami Florida.,John P. Hussman Institute of Human Genomics Miller School of Medicine University of Miami Miami Florida
| | - Silvia R Delgado
- Multiple Sclerosis Division Department of Neurology Miller School of Medicine University of Miami Miami Florida
| | - Angel Chinea
- San Juan Multiple Sclerosis Center San Juan Puerto Rico
| | - Margaret Burnett
- Department of Neurology Keck School of Medicine University of Southern California Los Angeles California
| | - Clara Patricia Manrique
- John P. Hussman Institute of Human Genomics Miller School of Medicine University of Miami Miami Florida
| | - Refujia Gomez
- Department of Preventive Medicine Keck School of Medicine University of Southern California Los Angeles California
| | - Manuel Comabella
- Department of Neurology University of San Francisco School of Medicine Los Angeles California
| | - Xavier Montalban
- Department of Neurology University of San Francisco School of Medicine Los Angeles California
| | - Melissa Ortega
- Multiple Sclerosis Division Department of Neurology Miller School of Medicine University of Miami Miami Florida
| | - Leticia Tornes
- Multiple Sclerosis Division Department of Neurology Miller School of Medicine University of Miami Miami Florida
| | - Brett T Lund
- Department of Neurology Keck School of Medicine University of Southern California Los Angeles California
| | - Talat Islam
- Department de Neurología-Neuroinmunología Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Institut de Recerca Vall d'Hebron Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - David Conti
- Department de Neurología-Neuroinmunología Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Institut de Recerca Vall d'Hebron Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - Jorge R Oksenberg
- Department of Preventive Medicine Keck School of Medicine University of Southern California Los Angeles California
| | - Jacob L McCauley
- Dr. John T. Macdonald Department of Human Genetics Miller School of Medicine University of Miami Miami Florida.,John P. Hussman Institute of Human Genomics Miller School of Medicine University of Miami Miami Florida
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Rivas-Rodríguez E, Amezcua L. Ethnic Considerations and Multiple Sclerosis Disease Variability in the United States. Neurol Clin 2018; 36:151-162. [DOI: 10.1016/j.ncl.2017.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hamdy SM, Abdel-Naseer M, Shalaby NM, Elmazny A, Girgis M, Nada MA, Hassan A, Mourad HS, Hegazy MI, Abdelalim A, Kishk NA, Abokrysha NT, Genedy SA, Essawy EA, Shehata HS. Pediatric-onset multiple sclerosis in Egypt: a multi-center registry of 186 patients. Neuropsychiatr Dis Treat 2018; 14:631-640. [PMID: 29503547 PMCID: PMC5827680 DOI: 10.2147/ndt.s160060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Although the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers. OBJECTIVE To characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS. PATIENTS AND METHODS A retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt. RESULTS Multiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; "early-onset pediatric multiple sclerosis (EOPMS)". The mean age of disease onset was (14.13±2.49 years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS. CONCLUSION The results from this registry - the largest for MS in the Arab region to date - are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children.
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Affiliation(s)
| | | | | | - Alaa Elmazny
- Neurology Department, Cairo University, Cairo, Egypt
| | - Marian Girgis
- Pediatric Department, Cairo University, Cairo, Egypt
| | - Mona A Nada
- Neurology Department, Cairo University, Cairo, Egypt
| | - Amr Hassan
- Neurology Department, Cairo University, Cairo, Egypt
| | | | | | | | | | | | | | - Ehab A Essawy
- Division of Biochemistry, Chemistry Department, Faculty of Science, Helwan University, Helwan, Egypt
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Yılmaz Ü, Anlar B, Gücüyener K, Cansu A, Ünalp A, Aksoy A, Bayram AK, Kartal A, Tosun A, Serdaroğlu A, Konuşkan B, Sarıoğlu B, Yüzbaşı BK, Kılıç B, Taşkın BD, Bulut C, Yılmaz C, Yarar C, Okuyaz Ç, Gençsel Ç, Yüksel D, Arslan EA, Gürkaş E, Faruk incecik, Serdaroğlu G, Deda G, Gürbüz G, Gümüş H, Acer H, Tekgül H, Çaksen H, Per H, Erol İ, Çarman KB, Canpolat M, Özkan M, Direk MÇ, Kutluk MG, Arslan M, Sönmez FM, Dündar NO, Koçak O, Aydın ÖF, Toptaş Ö, Duman Ö, Hergüner Ö, Bozkurt Ö, Arıcan P, Yılmaz S, Gökben S, Işıkay S, Kumandaş S, Edizer S, Kurul SH, Saygı S, Teber S, Güngör S, Altunbaşak Ş, Haspolat Ş, Sezer T, Yılmaz TS, Yiş U, Öztoprak Ü, Aydoğmuş Ü, Topçu Y, Öztürk Z, Karalök ZS. Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database. Eur J Paediatr Neurol 2017; 21:864-872. [PMID: 28694135 DOI: 10.1016/j.ejpn.2017.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 05/26/2017] [Accepted: 06/20/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To document the clinical and paraclinical features of pediatric multiple sclerosis (MS) in Turkey. METHODS Data of MS patients with onset before age 18 years (n = 193) were collected from 27 pediatric neurology centers throughout Turkey. Earlier-onset (<12 years) and later-onset (≥12 years) groups were compared. RESULTS There were 123 (63.7%) girls and 70 (36.3%) boys aged 4-17 years, median 14 years at disease onset. Family history of MS was 6.5%. The first presentation was polysymptomatic in 55.4% of patients, with brainstem syndromes (50.3%), sensory disturbances (44%), motor symptoms (33.2%), and optic neuritis (26.4%) as common initial manifestations. Nineteen children had facial paralysis and 10 had epileptic seizures at first attack; 21 (11%) were initially diagnosed with acute disseminated encephalomyelitis (ADEM). Oligoclonal bands were identified in 68% of patients. Magnetic resonance imaging revealed periventricular (96%), cortical/juxtacortical (64.2%), brainstem (63%), cerebellum (51.4%), and spinal cord (67%) involvement. Visual evoked potentials (VEP) were abnormal in 52%; serum 25-hydroxyvitamin D levels were low in 68.5% of patients. The earlier-onset group had a higher rate of infection/vaccination preceding initial attack, initial diagnosis of ADEM, longer interval between first 2 attacks, and more disability accumulating in the first 3 years of the disease. CONCLUSION Brainstem and cerebellum are common sites of clinical and radiological involvement in pediatric-onset MS. VEP abnormalities are frequent even in patients without history of optic neuropathy. Vitamin D status does not appear to affect the course in early disease. MS beginning before 12 years of age has certain characteristics in history and course.
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Affiliation(s)
- Ünsal Yılmaz
- Department of Pediatric Neurology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
| | - Banu Anlar
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kıvılcım Gücüyener
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
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Amezcua L. MS in self-identified Hispanic/Latino individuals living in the US. Mult Scler J Exp Transl Clin 2017; 3:2055217317725103. [PMID: 28979795 PMCID: PMC5617095 DOI: 10.1177/2055217317725103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/07/2017] [Indexed: 12/26/2022] Open
Abstract
Self-identified Hispanic/Latino individuals living with multiple sclerosis (MS) in the continental United States (US) are a diverse group that represents different cultural and ancestral backgrounds. A marked variability in the way MS affects various subgroups of Hispanics in the US has been observed. We reviewed and synthesized available data about MS in Hispanics in the US. There are likely a host of multifactorial elements contributing to these observations that could be explained by genetic, environmental, and social underpinnings. Barriers to adequate MS care in Hispanics are likely to include delivery of culturally competent care and social and economic disadvantages. Considerable efforts, including the formation of a national consortium known as the Alliance for Research in Hispanic Multiple Sclerosis (ARHMS), are underway to help further explore these various factors.
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Affiliation(s)
- Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, USA
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Ghezzi A, Baroncini D, Zaffaroni M, Comi G. Pediatric versus adult MS: similar or different? ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40893-017-0022-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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