P008 - A prospective study on the prognosis of multiple sclerosis in Tunisia: Do we really have a distinct disease course in North Africa?

Abstract

Introduction Few epidemiological data on multiple sclerosis (MS) patients are available in North Africa (NA). Studies of immigrants from NA showed a more aggressive course of MS in NA than in European patients. Objective To describe clinical, long term course characteristics and prognostic factors of MS in a Tunisian population. Methods We performed a prospective multicentric study of 437 MS patients in Tunisia between 2010 and 2012. We considered as endpoints the time to reach non-reversible disability levels corresponding to EDSS scores of 3.0, 4.0 and 6.0, and the beginning of a secondary progressive phase. We used Kaplan–Meier analyses and Cox regression models to determine the influence of the clinical variables on the time to disability onset. Results Sex ratio was 2.34. Mean age of onset was 30.3±9.5 years and the duration of illness was 8.4±6.7 years. The course was relapsing-remitting (RR) in 77% of patients, secondary progressive (SP) in 15.5% and primary progressive (PP) in 8.5%. Median time to secondary progressive onset was 19.1 years. Median times from onset of multiple sclerosis to assignment of a score of 3, 4 and 6 were 8, 10.7 and 15 years respectively. A greater number of functional systems involved at onset, progressive from as well as late age, motor, cerebellar and sphincter symptoms at onset were factors predictive of a poor outcome. A longer first inter-attack interval was associated with a better prognosis. Once EDSS 4 was reached, the time course of progressive disability was similar in patients with progressive onset and those with RR MS. Conclusion This is the first multicentric study in our country. The present study showed a similar course of MS in a North African population compared to European cohorts. Similar long term prognosis factors were found.