Abstract
Background and Objectives Multiple Sclerosis (MS) epidemiology is on the path of globalization mainly due to changing environmental factors. The prevalence of MS is on the rise in the Middle East and Persian Gulf region. Our observations has led us to hypothesize a heavy MRI lesion load at the onset of disease in a relatively younger native population. We aimed to estimate and characterize the onset disease on MRI using McDonald's criteria while applying its terms of “Dissemination in Space (DIS) and Dissemination in Time (DIT)”. Materials and Methods Retrospective review of onset MRI studies of 181 Emirati (native) individuals. Basic demographics were captured. Only 47 patients with Clinically Definite MS (CDMS) were included who had onset diagnostic MRI available. Lesion load was quantified using the specific zones of involvement designated for DIS: (1) Periventricular (PVZ) (I), (2) Juxta-cortical (II) (3) Infra-tentorial (III) and, (4) Spinal cord (IV). PVZ was sub-classified and lesions were quantified. A single enhancing lesion was required for DIT. Results Average age of onset was about 26 years with female dominance of about 2 : 1. About 50% had all 4 zones and about 85% had at least 3 zones involved at the onset. Involvement of only 1 zone was rare. Dissemination in time (DIT) in brain and/or cord was present in approximately 50%. Each of the 4 zones were involved in at least 70% of cases. PVZ was not spared in any case with at least 3 lesions present in approx. 95% and ≥12 lesions in approx. half of the patients. Spinal cord specifically cervical cord was involved in up to 80% with typical patchy lesions. Conclusion Onset disease characterization using MRI in a young Emirati cohort showed a heavy lesion load in the brain and spinal cord at the onset, signifying cumulative disease before presentation. Disseminated disease also facilitated early diagnosis of MS. The findings have significant potential ramifications for local environmental and cultural factors, as well as disease course and disability progression.
Highlights
Introduction e incidence and prevalence ofMultiple Sclerosis (MS) is on the rise globally in nontemperate regions [1,2,3]. is trend is more notable in the Gulf Region of the Middle East, paradoxical to its hot and dry climate
We have observed in this region that most of Multiple Sclerosis International the young patients harbor a much higher load of disease, at the onset. erefore, we hypothesized that MS in the local Emirati population tends to present clinically a er cumulation of considerable load of disease. e terminology and criteria used in 2010 McDonald’s criteria was used i.e Dissemination in Space (DIS) and Dissemination in Time (DIT) [10,11,12]
Dissemination in time (DIT) in brain and/or cord was present in about 50% of patients on the first MRI examination
Summary
Introduction e incidence and prevalence ofMultiple Sclerosis (MS) is on the rise globally in nontemperate regions [1,2,3]. is trend is more notable in the Gulf Region of the Middle East, paradoxical to its hot and dry climate. We have observed in this region that most of Multiple Sclerosis International the young patients harbor a much higher load of disease, at the onset. Erefore, we hypothesized that MS in the local Emirati population tends to present clinically a er cumulation of considerable load of disease. Our observations has led us to hypothesize a heavy MRI lesion load at the onset of disease in a relatively younger native population. We aimed to estimate and characterize the onset disease on MRI using McDonald’s criteria while applying its terms of “Dissemination in Space (DIS) and Dissemination in Time (DIT)”. Onset disease characterization using MRI in a young Emirati cohort showed a heavy lesion load in the brain and spinal cord at the onset, signifying cumulative disease before presentation. Disseminated disease facilitated early diagnosis of MS. e ndings have signi cant potential rami cations for local environmental and cultural factors, as well as disease course and disability progression
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