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Puthenparampil M, Stivanello C, Bano MC, Tessarin M, Martello T, Rinaldi F, Perini P, Gallo P. Telehealth Feasibility, Interest, and Satisfaction of Patients with Multiple Sclerosis Living in the Veneto Region, Italy, During the COVID-19 Pandemic. Telemed J E Health 2024. [PMID: 39049787 DOI: 10.1089/tmj.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Introduction: Synchronous telehealth (ST) consists of the remote real-time delivery of health services. COVID-19 pandemic has pressed the use of ST and forced neurologists to deliver telehealth services. The aim of this study was to obtain the actual picture of ST accessibility/interest and to evaluate the user satisfaction in patients with multiple sclerosis (MS) during the COVID-19 pandemic. Methods: The study consisted of two phases. First, a hard-copy questionnaire ("Telehealth Identity Card" [TIC]), including only yes/no questions, filled in the presence of a neurologist, and investigating the technical/practical access and the willingness/interest of MS patients to the telehealth services, was obtained from 600 consecutive outpatients, with no time limit for answering. Second, a fully filled "Televisit Satisfaction Questionnaire" (TSQ) was obtained from 100 consecutive patients that underwent a televisit. Statistical analysis applied the t test for normally distributed variables and the Mann-Whitney U test for ordinal. Logistic univariate and multivariate regressions were applied to predict televisit availability on the base of demographic variables. Results: Statistical analysis was performed on 552/600 consecutive TIC (92%). Of them, 464/552 (84%) of the MS patients declared to possess the tools and to be interested in telehealth services. Compared with noninterested patients, they were younger (mean age: 44.0 vs. 49.8, p < 0.001) and with lower disability (mean Expanded Disability Status Scale: 2.5 vs. 3.3, p < 0.01). From TSQ, it emerged that 95% agree or strongly agree that televisit respected timelines, saved time and money, was conducted with respect to privacy, can be a useful tool for monitoring disease and therapy, and expressed their availability for further televisits. Discussion: A great majority of MS patients living in Padua Province were interested in telehealth. High satisfaction and the willingness for further televist were expressed. Telehealth services can help neurologists to manage the increasing number of MS patients and their complex therapeutic monitoring.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Celeste Stivanello
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Maria Chiara Bano
- General, Administrative and Health Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Michele Tessarin
- General, Administrative and Health Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Tiziano Martello
- Hospital Medical Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paola Perini
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
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Haki M, AL-Biati HA, Al-Tameemi ZS, Ali IS, Al-hussaniy HA. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore) 2024; 103:e37297. [PMID: 38394496 PMCID: PMC10883637 DOI: 10.1097/md.0000000000037297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease with demyelination, inflammation, neuronal loss, and gliosis (scarring). Our object to review MS pathophysiology causes and treatment. A Narrative Review article was conducted by searching on Google scholar, PubMed, Research Gate about relevant keywords we exclude any unique cases and case reports. The destruction of myelinated axons in the central nervous system reserves this brunt. This destruction is generated by immunogenic T cells that produce cytokines, copying a proinflammatory T helper cells1-mediated response. Autoreactive cluster of differentiation 4 + cells, particularly the T helper cells1 subtype, are activated outside the system after viral infections. T-helper cells (cluster of differentiation 4+) are the leading initiators of MS myelin destruction. The treatment plan for individuals with MS includes managing acute episodes, using disease-modifying agents to decrease MS biological function of MS, and providing symptom relief. Management of spasticity requires physiotherapy, prescription of initial drugs such as baclofen or gabapentin, secondary drug options such as tizanidine or dantrolene, and third-line treatment such as benzodiazepines. To treat urinary incontinence some options include anticholinergic medications such as oxybutynin hydrochloride, tricyclic antidepressants (such as amitriptyline), and intermittent self-catheterization. When it comes to bowel problems, one can try to implement stool softeners and consume a high roughage diet. The review takes about MS causes Pathophysiology and examines current treatment strategies, emphasizing the advancements in disease-modifying therapies and symptomatic treatments. This comprehensive analysis enhances the understanding of MS and underscores the ongoing need for research to develop more effective treatments.
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Affiliation(s)
- Maha Haki
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
| | - Haeder A. AL-Biati
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
| | - Zahraa Salam Al-Tameemi
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
- Dr. Hany Akeel Institute, Iraqi Medical Research Center, Baghdad, Iraq
| | - Inas Sami Ali
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
| | - Hany A. Al-hussaniy
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
- Dr. Hany Akeel Institute, Iraqi Medical Research Center, Baghdad, Iraq
- Department of Pharmacology, College of Medicine, University of Baghdad, Baghdad, Iraq
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Epidemiology of multiple sclerosis in the Campania Region (Italy): Derivation and validation of an algorithm to calculate the 2015-2020 incidence. Mult Scler Relat Disord 2023; 71:104585. [PMID: 36827873 DOI: 10.1016/j.msard.2023.104585] [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: 10/18/2022] [Revised: 02/01/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE We aim to validate an algorithm based on routinely-collected healthcare data to detect incidence of multiple sclerosis (MS) in the Campania Region (South Italy) and to explore its spatial and temporal variations. METHODS We included individuals resident in the Campania Region who had at least one MS record in administrative datasets (drug prescriptions, hospital discharge, outpatients), from 2015 to 2020. We merged administrative to the clinical datasets to ascertain the actual date of diagnosis, and validated the minimum interval from our study baseline (Jan 1, 2015) to first MS records in administrative datasets to detect incident cases. We used Bayesian approach to explore geographical distribution, also including deprivation index as a covariate in the estimation model. We used the capture-recapture method to estimate the proportion of undetected cases. RESULTS The best performance was achieved by the 12-month interval algorithm, detecting 2,150 incident MS cases, with 74.4% sensitivity (95%CI = 64.1%, 85.9%) and 95.3% specificity (95%CI = 90.7%, 99.8%). The cumulative incidence was 36.68 (95%CI = 35.15, 38.26) per 100,000 from 2016 to 2020. The mean annual incidence was 7.34 (95%CI = 7.03, 7.65) per 100,000 people-year. The geographical distribution of MS relative risk shows a decreasing east-west incidence gradient. The number of expected MS cases was 11% higher than the detected cases. CONCLUSIONS We validated a case-finding algorithm based on administrative data to estimate MS incidence, and its spatial/temporal variations. This algorithm provides up-to-date estimates of MS incidence, and will be used in future studies to evaluate changes in MS incidence in relation to different risk factors.
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Puthenparampil M, Perini P, Bergamaschi R, Capobianco M, Filippi M, Gallo P. Multiple sclerosis epidemiological trends in Italy highlight the environmental risk factors. J Neurol 2021; 269:1817-1824. [PMID: 34580756 PMCID: PMC8940874 DOI: 10.1007/s00415-021-10782-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Italy is definitely a high-risk country for multiple sclerosis (MS). Over the last 50 years, several epidemiological studies, including longitudinal surveys, have disclosed that MS incidence and prevalence in Italy mainland and Islands (Sardinia and Sicily) have progressively increased, picturing a semi-parabolic curve. Based on the comprehensive scrutiny of 58 papers, we conclude that the latitude risk gradient does not fit to the Italian map of MS. The genetic heterogeneity of the Italian ethnicities, that likely forms the basis of MS predisposition, does not account for the dramatic increase of MS incidence and prevalence observed in Italy over the last half century that, rather, seems better explained by the effect of environmental factors.
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Affiliation(s)
- M Puthenparampil
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy. .,Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy.
| | - P Perini
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - R Bergamaschi
- Multiple Sclerosis Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - M Capobianco
- Centro di Riferimento Regionale Sclerosi Multipla (CReSM), SCDO Neurologia, AOU S. Luigi Gonzaga, Orbassano, Turin, Italy
| | - M Filippi
- Unit of Neurology, Unit of Neurorehabilitation and Neurophysiology Service, IRCCS San Raffaele Institute, Milan, Italy
| | - P Gallo
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy.,Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
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Scartezzini A, Tateo F, Perini P, Benacchio L, Ermani M, Ferro A, Cadaldini M, Piccinno MG, Colledan L, Freddi N, Gallo P, Puthenparampil M. Association of Multiple Sclerosis with PM 2.5 levels. Further evidence from the highly polluted area of Padua Province, Italy. Mult Scler Relat Disord 2020; 48:102677. [PMID: 33316725 DOI: 10.1016/j.msard.2020.102677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fifty years of epidemiological survey and intra-regional differences in prevalence suggest that environmental factors may be associated with increased multiple sclerosis (MS) risk in Northern Italy. Based on the findings of a previous study carried out in the highly polluted Padan Plain, we further explored the relationship between PM2.5 levels and MS prevalence by comparing bordering areas characterized by quite different environmental conditions, namely the Municipality of Padua and the special protected zone (SPZ) of the Euganean Hills Regional Park, located 15 km from the City. METHODS Three territories were identified; 1) the SPZ, extending over an area of 15.096 hectares and having a total population of 23,980 inhabitants, 2) the urban area of Padua, with a total population of 210,440 inhabitants and repeatedly recognized by the European Invironmental Agency as one of the most polluted Cities of Europe, 3) the Intermediate Zone (IZ), i.e., the area in between the previous two, including part of the urban territories of eight villages adjacent to the SPZ. Demographic and socio-economical data were obtained from official government sources (www.istat.it and www.regione.veneto.it). All Italian MS patients residing in these three areas on December 31, 2018, were registered. PM2.5 concentrations (annual average 1998-2018, μg/m3) were measured by satellite. The correlation between PM2.5 concentrations and MS prevalence was analysed. RESULTS MS prevalence was significantly higher in Padua City (265/100.000) compared to both the SPZ of the Euganean Hills Park (160/100,000; p < 0.0001) and the IZ (194.4/100,000). Prevalence strongly associated with the annual average concentration of PM2.5 (r = 0.89 p < 0.00001). CONCLUSION In the Province of Padua, one of the most polluted areas of Europe, MS prevalence is strongly associated with PM2.5 exposure. Our findings suggest that air pollutants may be one of the possible environmental risk factors for MS in the Veneto Region of Italy.
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Affiliation(s)
- Arianna Scartezzini
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences (DNS), University of Padua, Via Giustinaini 2, 35128, Italy
| | - Fabio Tateo
- Institute of Geosciences and Earth Resources, National Research Council of Italy, Department of Geosciences, University of Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences (DNS), University of Padua, Via Giustinaini 2, 35128, Italy
| | | | - Mario Ermani
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences (DNS), University of Padua, Via Giustinaini 2, 35128, Italy
| | - Antonio Ferro
- Department of Disease Prevention, Public Health Organization of Trento Province, Italy
| | - Morena Cadaldini
- Unit of Neurology, General Hospital of Schiavonia-Monselice, Italy
| | | | | | | | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences (DNS), University of Padua, Via Giustinaini 2, 35128, Italy
| | - Marco Puthenparampil
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences (DNS), University of Padua, Via Giustinaini 2, 35128, Italy.
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Miclea A, Salmen A, Zoehner G, Diem L, Kamm CP, Chaloulos-Iakovidis P, Miclea M, Briner M, Kilidireas K, Stefanis L, Chan A, Evangelopoulos ME, Hoepner R. Age-dependent variation of female preponderance across different phenotypes of multiple sclerosis: A retrospective cross-sectional study. CNS Neurosci Ther 2018; 25:527-531. [PMID: 30411534 PMCID: PMC6488902 DOI: 10.1111/cns.13083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is an autoimmune disease of the CNS, which predominantly affects women. Studies investigating the sex distribution in MS are sparse. We aim to analyze the female‐to‐male ratio (F/M ratio) in different MS phenotypes in association with age at diagnosis and year of birth. Methods We performed a retrospective cross‐sectional analysis by cumulating data (sex, year of birth, age at diagnosis, and MS phenotypes) from unpublished and published studies of the participating centers. Results Datasets of 945 patients were collected. The overall F/M ratio was 1.9:1.0 and female preponderance was present in all phenotypes except for primary progressive MS (PPMS), in which men were predominantly affected (F/M ratio: 0.5:1.0). Female preponderance declined with increasing age at diagnosis and was no longer present in relapsing‐remitting MS (RRMS) patients > 58 years of age. Conclusion Our data demonstrate an age dependency of female preponderance in MS except for PPMS. This could be influenced by the lifecycle of sex hormone secretion in women. In PPMS, a male preponderance was observed in all age‐groups, which might point to pathophysiological mechanisms being less influenced by sex hormones.
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Affiliation(s)
- Andrei Miclea
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Greta Zoehner
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian P Kamm
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Marius Miclea
- Neurological Outpatient Department, Neurocenter Peine, Peine, Germany
| | - Myriam Briner
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Kostas Kilidireas
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Chan
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maria Eleftheria Evangelopoulos
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Hoepner
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Tateo F, Grassivaro F, Ermani M, Puthenparampil M, Gallo P. PM2.5 levels strongly associate with multiple sclerosis prevalence in the Province of Padua, Veneto Region, North-East Italy. Mult Scler 2018; 25:1719-1727. [DOI: 10.1177/1352458518803273] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Incidence and prevalence trends of multiple sclerosis (MS) in the Province of Padua, North-East Italy, suggest that environmental factors may be associated with increased MS risk. Objective: To investigate the association of PM2.5 with MS prevalence in one of the most polluted geographical area of Italy. Methods: In total, 1435 Italian MS patients residing in the Province of Padua were enrolled. The province surface was classified into urban areas, isolated villages, industrialized places, and countryside. Satellite-derived dust-free and sea salt-free PM2.5 concentrations (annual average 1998–2015, μg/m3) allowed the identification of 18 classes of territorial sections with statistically evaluable numbers of inhabitants. Possible correlations between residential locality types, PM2.5 concentrations, and MS prevalence were investigated. Results: MS prevalence was significantly ( p < 0.0001) higher in urban areas (ranging from 219 in Padua City to 169/100,000 in other urban areas) compared to isolated villages (116/100,000) or rural domains (109/100,000) and strongly correlated with the annual average concentration of PM2.5 ( r = 0.81, p < 0.001). Regression analysis further associated MS cases with PM.2.5 average concentration ( β = 0.11, p < 0.001). Conclusion: In the Province of Padua, MS prevalence is strongly associated with PM2.5 exposure suggesting that air pollutants may be one of the possible environmental risk factors for MS.
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Affiliation(s)
- Fabio Tateo
- Institute of Geosciences and Earth Resources, National Research Council of Italy, Department of Geosciences, Università degli Studi di Padova, Padova, Italy
| | - Francesca Grassivaro
- Multiple Sclerosis Centre, Department of Neurosciences (DNS), Università degli Studi di Padova, Padova, Italy
| | - Mario Ermani
- Department of Neurosciences (DNS), Università degli Studi di Padova, Padova, Italy
| | - Marco Puthenparampil
- Multiple Sclerosis Centre, Department of Neurosciences (DNS), Università degli Studi di Padova, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre, Department of Neurosciences (DNS), Università degli Studi di Padova, Padova, Italy
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Bezzini D, Policardo L, Profili F, Meucci G, Ulivelli M, Bartalini S, Francesconi P, Battaglia MA. Multiple sclerosis incidence in Tuscany from administrative data. Neurol Sci 2018; 39:1881-1885. [DOI: 10.1007/s10072-018-3513-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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Koch-Henriksen N, Thygesen LC, Stenager E, Laursen B, Magyari M. Incidence of MS has increased markedly over six decades in Denmark particularly with late onset and in women. Neurology 2018; 90:e1954-e1963. [PMID: 29720546 DOI: 10.1212/wnl.0000000000005612] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/28/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the pattern of development of incidence of multiple sclerosis (MS) over 60 years in Denmark with age-period-cohort analyses and seasonality of birth. METHODS Data on virtually all patients with onset of MS have since 1950 been prospectively recorded and kept in the Danish Multiple Sclerosis Registry with multiple sources of notification. Annualized incidence rates per 100,000 were directly standardized to the European Standard Population. RESULTS We have registered 19,536 cases with clinical onset of confirmed MS in Denmark from 1950 to 2009. From the 1950-1959 to the 2000-2009 onset period, incidence more than doubled in women, with an increase from 5.91 (95% confidence interval [CI]: 5.60-6.24) to 12.33 (95% CI: 11.91-12.75) per 100,000 per year compared with a modest 24% increase in men from 4.52 (95% CI: 4.24-4.81) to 6.08 (95% CI: 5.79-6.38). With age at onset of 50 years and older, incidence increased with a factor 4.30 in women and 2.72 in men. The female/male sex ratio increased over time and with year of birth. Age-period-cohort analysis revealed a significant birth cohort effect in addition to the age and period effect. We found no statistically significant seasonality of births. CONCLUSION The incidence of MS has doubled in women, most pronounced with late onset, and has only modestly increased in men. Lifestyle changes in the female population that could include fewer childbirths, increased occurrence of obesity, and increased cigarette consumption may have a role.
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Affiliation(s)
- Nils Koch-Henriksen
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense.
| | - Lau Caspar Thygesen
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
| | - Egon Stenager
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
| | - Bjarne Laursen
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
| | - Melinda Magyari
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
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Farcomeni A, Cortese A, Sgarlata E, Alunni Fegatelli D, Marfia GA, Buttari F, Mirabella M, De Fino C, Prosperini L, Pozzilli C, Grasso MG, Iasevoli L, Di Battista G, Millefiorini E. The Prevalence of Multiple Sclerosis in the Metropolitan Area of Rome: A Capture-Recapture Analysis. Neuroepidemiology 2018; 50:105-110. [PMID: 29502114 DOI: 10.1159/000487005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limited data are available on the prevalence of multiple sclerosis (MS) in central Italy. The objective of this study is to estimate MS prevalence in the metropolitan area of Rome. METHODS We used the capture-recapture method to calculate prevalence estimates in the study area. The selected prevalence day was December 31, 2015. A total of 1,007 patients, with a definite diagnosis of MS according to the revised McDonald's criteria, were considered for crude, age- and sex-specific prevalence estimation. RESULTS The overall crude prevalence rate was 146.2 cases per 100,000 (95% CI 119.9-172.5). A higher prevalence rate was recorded in females (194.1, 95% CI 149.6-238.6) than in males (93.0, 95% CI 67.2-118.8) with a female to male ratio of 1.8. Age-specific prevalence peaked in the 25-34 , 35-44 and 45-54 years class; moreover, it was found to increase up to the 45-54 years age group in females and the 35-44 years age group in males, decreasing thereafter. CONCLUSION The results confirm that the metropolitan area of Rome is a high-risk area for MS.
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Affiliation(s)
- Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Cortese
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Eleonora Sgarlata
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gerolama Alessandra Marfia
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Fabio Buttari
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Chiara De Fino
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Luca Prosperini
- Multiple Sclerosis Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Luigi Iasevoli
- Multiple Sclerosis Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Enrico Millefiorini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Bezzini D, Pepe P, Profili F, Meucci G, Ulivelli M, Bartalini S, Battaglia MA, Francesconi P. Multiple sclerosis spatial cluster in Tuscany. Neurol Sci 2017; 38:2183-2187. [DOI: 10.1007/s10072-017-3120-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
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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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Estimated prevalence of multiple sclerosis in Italy in 2015. Neurol Sci 2016; 38:473-479. [PMID: 28040843 DOI: 10.1007/s10072-016-2801-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
Italy is a high risk area for multiple sclerosis (MS) as confirmed by the numerous prevalence and incidence studies conducted in several regions/districts of the country. Nevertheless, there are no recent published epidemiological data, nor studies about the total prevalence of MS in Italy. Our aim was to update as of 2015 the prevalence rates of MS in different geographical areas using already published epidemiological studies, and to estimate the overall prevalence of the disease in Italy. We made a search in MEDLINE database of all published studies on epidemiology of MS in Italy. Then, we applied, to the already published prevalence data, the last published incidence and mortality rates to recalculate, as of 2015, the prevalence of MS. So, we calculated the mean prevalence rate from our extrapolations, and we applied it to the population in 2015 to estimate the number of MS patients in Italy. Our prevalence extrapolations ranged from 122 to 232 cases/100,000 in the mainland and Sicily, with an average of 176/100,000, and from 280 to 317 cases/100,000 in Sardinia with an average of 299/100,000. Applying these media to the Italian population in 2015, we obtained an estimate of more than 109,000 MS patients in Italy. Our estimates were higher than the latest published rates but consistent with the annual increase of prevalence due to incidence that exceeds mortality, with the increase of survival and, maybe, with the probable increase of incidence.
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Bargagli AM, Colais P, Agabiti N, Mayer F, Buttari F, Centonze D, Di Folco M, Filippini G, Francia A, Galgani S, Gasperini C, Giuliani M, Mirabella M, Nociti V, Pozzilli C, Davoli M. Prevalence of multiple sclerosis in the Lazio region, Italy: use of an algorithm based on health information systems. J Neurol 2016; 263:751-9. [PMID: 26886201 PMCID: PMC4826660 DOI: 10.1007/s00415-016-8049-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/22/2022]
Abstract
Compared with other areas of the country, very limited data are available on multiple sclerosis (MS) prevalence in Central Italy. We aimed to estimate MS prevalence in the Lazio region and its geographical distribution using regional health information systems (HIS). To identify MS cases we used data from drug prescription, hospital discharge and ticket exemption registries. Crude, age- and gender-specific prevalence estimates on December 31, 2011 were calculated. To compare MS prevalence between different areas within the region, we calculated age- and gender-adjusted prevalence and prevalence ratios using a multivariate Poisson regression model. Crude prevalence rate was 130.5/100,000 (95 % CI 127.5–133.5): 89.7/100,000 for males and 167.9/100,000 for females. The overall prevalence rate standardized to the European Standard Population was 119.6/100,000 (95 % CI 116.8–122.4). We observed significant differences in MS prevalence within the region, with estimates ranging from 96.3 (95 % CI 86.4–107.3) for Latina to 169.6 (95 % CI 147.6–194.9) for Rieti. Most districts close to the coast showed lower prevalence estimates compared to those situated in the eastern mountainous area of the region. In conclusion, this study produced a MS prevalence estimate at regional level using population-based health administrative databases. Our results showed the Lazio region is a high-risk area for MS, although with an uneven geographical distribution. While some limitations must be considered including possible prevalence underestimation, HIS represent a valuable source of information to measure the burden of SM, useful for epidemiological surveillance and healthcare planning.
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Affiliation(s)
- Anna Maria Bargagli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy.
| | - Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Fabio Buttari
- MS Clinical and Research Center, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077, Pozzilli, Isernia, Italy
| | - Diego Centonze
- MS Clinical and Research Center, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077, Pozzilli, Isernia, Italy
| | - Marta Di Folco
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185, Rome, Italy
| | - Graziella Filippini
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Besta, Via Celoria 11, 20133, Milan, Italy
| | - Ada Francia
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185, Rome, Italy
| | - Simonetta Galgani
- Department of Neurosciences, S Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Manuela Giuliani
- Multiple Sclerosis Center, S Andrea Hospital, Sapienza University, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Institute of Neurorehabilitation, Don C Gnocchi Foundation, Via Pier Alessandro Paravia 71, 20148, Milan, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S Andrea Hospital, Sapienza University, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
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Bezzini D, Policardo L, Meucci G, Ulivelli M, Bartalini S, Profili F, Battaglia MA, Francesconi P. Prevalence of Multiple Sclerosis in Tuscany (Central Italy): A Study Based on Validated Administrative Data. Neuroepidemiology 2015; 46:37-42. [PMID: 26618996 DOI: 10.1159/000441567] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) epidemiology in Italy is mainly based on population-based prevalence studies. Administrative data are an additional source of information, when available, in prevalence studies of chronic diseases such as MS. The aim of our study is to update the prevalence rate of MS in Tuscany (central Italy) as at 2011 using a validated case-finding algorithm based on administrative data. METHODS The prevalence was calculated using an algorithm based on the following administrative data: hospital discharge records, drug-dispensing records, disease-specific exemptions from copayment to health care, home and residential long-term care and inhabitant registry. To test algorithm sensitivity, we used a true-positive reference cohort of MS patients from the Tuscan MS register. To test algorithm specificity, we used another cohort of individuals who were presumably not affected by MS. RESULTS As at December 31, 2011, we identified 6,890 cases (4,738 females and 2,152 males) with a prevalence of 187.9 per 100,000. The sensitivity of algorithm was 98% and the specificity was 99.99%. CONCLUSIONS We found a prevalence higher than the rates present in literature. Our algorithm, based on administrative data, can accurately identify MS patients; moreover, the resulting cohort is suitable to monitor disease care pathways.
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Affiliation(s)
- Daiana Bezzini
- Department of Life Science, University of Siena, Siena, Italy
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Hoepner R, Faissner S, Salmen A, Gold R, Chan A. Efficacy and side effects of natalizumab therapy in patients with multiple sclerosis. J Cent Nerv Syst Dis 2014; 6:41-9. [PMID: 24855407 PMCID: PMC4011812 DOI: 10.4137/jcnsd.s14049] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/19/2014] [Accepted: 02/25/2014] [Indexed: 12/24/2022] Open
Abstract
Natalizumab (Nat) is a humanized monoclonal antibody used for the treatment of relapsing multiple sclerosis (MS). Nat inhibits lymphocyte migration via the blood brain barrier (BBB) by blockage of an integrin adhesion molecule, very late antigen 4. During the phase III clinical trials, it was shown that Nat reduces disease activity and prevents disability progression. In addition, several smaller studies indicate a positive influence of Nat on cognition, depression, fatigue, and quality of life (Qol). Therapeutic efficacy has to be weighed against the risk of developing potentially fatal progressive multifocal leukoencephalopathy (PML), an opportunistic infection by JC-virus (JCV) with an incidence of 3.4/1000 (95% CI 3.08–3.74) in Nat treated MS patients. In this review article, we will review data on the presumed mechanism of Nat action, clinical and paraclinical efficacy parameters, and adverse drug reactions with a special focus on PML.
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Affiliation(s)
- Robert Hoepner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Simon Faissner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Anke Salmen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Andrew Chan
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
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Nicoletti A, Bruno E, Nania M, Cicero E, Messina S, Chisari C, Torrisi J, Maimone D, Marziolo R, Lo Fermo S, Patti F, Giammanco S, Zappia M. Multiple Sclerosis in the Mount Etna region: possible role of volcanogenic trace elements. PLoS One 2013; 8:e74259. [PMID: 24348986 PMCID: PMC3859652 DOI: 10.1371/journal.pone.0074259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trace elements have been hypothesised to be involved in the pathogenesis of Multiple Sclerosis and volcanic degassing is the major natural sources of trace elements. Both incidence of Multiple Sclerosis in Catania and volcanic activity of Mount Etna have been significantly increased during the last 30 years. Due to prevailing trade winds direction, volcanic gases from Etna summit craters are mostly blown towards the eastern and southern sectors of the volcano. OBJECTIVE To evaluate the possible association between Multiple Sclerosis and exposure to volcanogenic trace elements. METHODS We evaluated prevalence and incidence of Multiple Sclerosis in four communities (47,234 inhabitants) located in the eastern flank and in two communities (52,210 inhabitants) located in the western flank of Mount Etna, respectively the most and least exposed area to crater gas emissions. RESULTS A higher prevalence was found in the population of the eastern flank compared to the population of the western one (137.6/100,000 versus 94.3/100,000; p-value 0.04). We found a borderline significantly higher incidence risk during the incidence study period (1980-2009) in the population of the eastern flank 4.6/100,000 (95% CI 3.1-5.9), compared with the western population 3.2/100,000 (95% CI 2.4-4.2) with a RR of 1.41 (95% CI 0.97-2.05; p-value 0.06). Incidence risks have increased over the time in both populations reaching a peak of 6.4/100,000 in the eastern flank and of 4.4/100.000 in the western flank during 2000-2009. CONCLUSION We found a higher prevalence and incidence of Multiple Sclerosis among populations living in the eastern flank of Mount Etna. According to our data a possible role of TE cannot be ruled out as possible co-factor in the MS pathogenesis. However larger epidemiological study are needed to confirm this hypothesis.
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Affiliation(s)
- Alessandra Nicoletti
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Elisa Bruno
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Martina Nania
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Edoardo Cicero
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Silvia Messina
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Clara Chisari
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Josita Torrisi
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | | | | | - Salvatore Lo Fermo
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Salvatore Giammanco
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Etneo, Catania, Italy
| | - Mario Zappia
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
- * E-mail:
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Infodemiology and infoveillance of multiple sclerosis in Italy. Mult Scler Int 2013; 2013:924029. [PMID: 24027636 PMCID: PMC3762202 DOI: 10.1155/2013/924029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 11/17/2022] Open
Abstract
Multiple Sclerosis (MS) is a chronic debilitating disease of probable autoimmune inflammatory nature, whose aetiology is not fully understood, despite the many efforts and investigations. In this manuscript, we review the concept of “Multiple Sclerosis 2.0”, that is to say the Internet usage by MS patients, for seeking health and disease-related material for self-care and self-management purposes, and we introduce a Google Trends-based approach for monitoring MS-related Google queries and searches, called MS infodemiology and infoveillance. Google Trends has already proven to be reliable for infectious diseases monitoring, and here we extend its application and potentiality in the field of neurological disorders.
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