The distinctive contrast of multiple sclerosis epidemiology between Persians and Armenian minority community of Isfahan city, Iran.

Abstract

Multiple sclerosis (MS) is a chronic demyelinating disease resulting from the interaction between genetic and environmental components. Epidemiologic surveys on MS in different ethnic groups and justification of their results in light of geographical and racial differences can provide clues to the etiology of the disease. Isfahan province of Iran is a mysterious region for its steep rise of MS prevalence during the current decade [1]. In line with population-based research series performed in the medium of Isfahan MS Society (IMSS) [2, 3], we inspected our database for Armenian patients—the only Christian minority of province—who reside in Isfahan city from April 2003 to January 2014. The estimated population figures in 2011 for Isfahan city and the inquired Armenian population from Vank church— the only Christian center of the city—were used as the denominator populations. Out of the total city population of 2,930,380 (female: male ratio 0.97:1), 2,862 (1,410 females and 1,452 males) individuals were Armenian. Based on Mcdonald criteria [4] among 2,924 (female: male ratio 3.6:1) MS patients, 16 were Armenian. The overall crude prevalence rate of MS among Armenians was 559.04 per 100,000 [95 % confidence interval (CI) 309.92–870.9]. The prevalence rate for females and males was 921.98 (95 % CI 469.93–1499.27) and 206.6 (95 % CI 398.6–636.13), respectively. There was a significant contrast in prevalence of MS between Armenians and Persians of Isfahan; 559.04/100,000 vs. 99.2/100,000 respectively (p = 0.0249). The average age of MS onset was 31.13 years (range 20–58 years) and the gender ratio was 4.3 females to 1 male. Demographic and clinical features of Armenian MS patients are summarized in Table 1. For 3 patients (18.7 %), the onset of disease was polysymptomatic, whereas for the remaining 13 patients (81.3 %), it was monosymptomatic. In the monosymptomatic group, the most common initial presentation was cerebellar involvement (36.1 %) followed by visual disturbances (14.6 %), sensory problems (11 %), and motor deficit (7.8 %). To the best of authors’ knowledge, the reported prevalence of MS in Armenians of Isfahan is among one of the highest rates ever reported, several folds higher than what we had reported in Persians of Isfahan province [1]. Cerebellar sign and symptoms were the most common M. Etemadifar Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran