Frequency Of Multiple Sclerosis Research Articles

FREQUENCY AND PREDICTORS OF LHERMITTE PHENOMENON IN MULTIPLE SCLEROSIS (2-YEAR PROSPECTIVE STUDY)

Neuropathic pain in multiple sclerosis can manifest itself in the form of the Lhermitte phenomenon, short-term unpleasant sensations along the spine that occur when the head is bent. The purpose of this study is to investigate the factors that act as predictors of the Lhermitte phenomenon and their frequency in multiple sclerosis. 308 patients with multiple sclerosis were involved in the study, 258 of them agreed to follow-up, of them there were 67 men (26.0%) and 191 women (74.0%), aged 21 to 60 years. Out of the total cases, 187 (72.5%) patient had the relapsing-remitting type of multiple sclerosis, 2 (0.8%) had primary progressive type, and 69 (26.7%) showed secondary progressive type. Among the 258 patients who initially agreed to participate in the study at the Centre, 18 (7.0%) individuals discontinued their involvement during the first year, and 13 (5.0%) individuals prematurely withdrew from the study during the second year due to various reasons.
 Among the characteristics of multiple sclerosis, the age of the patient when diagnosed, the duration and the type of course, and the overall assessment of neurological deficit were determined. Psychopathological and cognitive states, socio-demographic factors, and comorbid pathology were assessed using appropriate scales. Statistical research methods were employed to analyze the collected data.
 The results indicate that the risk of developing the Lhermitte phenomenon remains relatively consistent over a two-year period: 2.5% in the first year and 2.3% in the second year. Pain associated with the Lhermitte phenomenon is most commonly experienced in the neck (63.6%), followed by the upper back (54.6%), lower back (72.7%), and least frequently in the upper limbs (18.2%) and lower limbs (36.4%). The Lhermitte phenomenon typically spreads to two or three affected areas of the body in 33.3% and 48.2% of cases, respectively. The most commonly used descriptors for the Lhermitte phenomenon are "shooting" (72.7%), "tingling" (18.2%), and "crawling ants" (9.1%).
 No significant differences in social, demographic, neuropsychological, and neurocognitive characteristics were observed between patients with and without Lhermitte phenomenon. According to the results of univariate Cox regression analysis, we has found that during the 2-year period, an increase in the duration of the disease for each subsequent year is associated with a decrease in the relative risk of Lhermitte phenomenon by 1.15 times (1.02-1.29, p=0.02). In patients with multiple sclerosis, the average risk of experiencing the Lhermitte phenomenon remains consistent at approximately 2.3-2.5% per year throughout the course of the disease.
 Patients who have a short history of multiple sclerosis are a risk group for the occurrence of the Lhermitte phenomenon. It is quite difficult to explain the regularity we have identified, for its clarification a detailed study of a special additional study is necessary. But, in any case, from a practical point of view, patients in the early stages of multiple sclerosis can be considered as a group of increased risk for the occurrence of the Lhermitte phenomenon.

Treatment of Multiple Sclerosis.

Given the expansion of options for the treatment of relapsing multiple sclerosis, this review outlines the framework for developing a treatment strategy, with consideration of when to switch or discontinue therapies, and a comprehensive elaboration of the mechanisms of action, efficacy, and safety considerations for each of the therapeutic classes. The armamentarium of immunotherapies has grown rapidly, to encompass 19 US Food and Drug Administration (FDA)-approved immunotherapies available in 2021, which are addressed in the review. The coronavirus pandemic that began in 2020 underscored existing concerns regarding vaccine efficacy in those treated with immune-suppressing immunotherapies, which are also addressed here. By choosing a treatment strategy before exploring the individual medications, patients and providers can focus their efforts on a subset of the therapeutic options. Although the mechanisms of action, routes of administration, efficacy, safety, and tolerability of the described agents and classes differ, all are effective in reducing relapse frequency in multiple sclerosis (MS), with most also showing a reduction in the accumulation of neurologic disability. These powerful effects are improving the lives of people with MS. Pharmacovigilance is critical for the safe use of these immune-modulating and -suppressing agents, and vaccine efficacy may be reduced by those with immune-suppressing effects.

Temporal trends in the incidence and prevalence of Multiple Sclerosis in the Northwest of Spain

BackgroundDuring the last decades, the frequency of multiple sclerosis (MS) is increasing worldwide. Nevertheless, the higher sensibility of the new diagnostic criteria obscures the comparison between studies performed in different decades. MethodsThe evolution of the frequency of MS in Santiago de Compostela (North-West of Spain) between 2003 and 2015 was analyzed using Poisson regression. The diagnosis was confirmed according to Poser criteria. Several sources were consulted for case ascertainment: databases from the MS Unit, the Infusion Center, and the Departments of Neurology, Pharmacy, Pediatric Neurology and Codification of the public Hospital of Santiago, private hospitals, neurologists with private activity, general practitioners, and associations of patients. ResultsIn 12 years, the prevalence increased from 68 to 143 cases/100,000 inhabitants, from 83 to 176 in females; and from 49 to 106 in males (p <0.0001, 0.0001, and 0.0002 respectively). The incidence rise was not significant (from 5 to 8 cases/ 100,000 inhabitants/ year (p=0.4243). The mean age of the population growth 5.7 years (p=0.008). The changes in female: male ratio (12.9%), in the age at the first symptom (2.2 years), and the diagnosis delay (0.12 years) did not achieve significance (p=0.7750, 0.1606, 0.8581). ConclusionThe prevalence of MS doubled in 12 years whilst the difference in incidence was lower and not significant. The disproportion in the growth of both parameters, as well as the higher mean age in the last study, suggest a longer survival of patients with MS.

Author response: Neonatal vitamin D status and risk of multiple sclerosis: A population-based case-control study.

In response to our article,1 Dr. Zarghami suggests that clinical trials are necessary to compare the efficacy and cost–benefit of vitamin D supplementation vs sun exposure in pregnancy. Such trials are not feasible because of the relatively low frequency of multiple sclerosis (MS) and the long interval between any intervention in pregnancy and the observation of its potential effect on MS risk in offspring. We agree, nevertheless, that judicious sun exposure provides an alternative approach for the correction of vitamin D deficiency in regions with levels of ultraviolet B radiation high enough to support year-round vitamin D production. This is not the case in countries like Denmark, where winter sunlight cannot produce sufficient vitamin D levels.2

Seeing is believing: a demonstration of critical fusion frequency and its multidimensional nature.

critical fusion frequency (CFF), or the flicker fusion threshold, is defined as the critical frequency above which a flickering light source appears steady to the observer (see [Fig. 1][1]). It is known to depend on a number of parameters, namely, intensity of the light source ([5][2], [15][3]),

Author response: The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study.

We appreciate the comments of Dalla Costa et al. on our Contemporary Issues article.1 As discussed, this study was not designed to assess the frequency of multiple sclerosis (MS) misdiagnosis or its specific causes.1 We catalogued the diagnoses ultimately assigned to patients mistaken as having MS and reported the evaluation of the MS specialists who determined that a misdiagnosis had occurred according to their analysis of what led to misdiagnosis. Accepting this limitation, application of MS diagnostic criteria to a neurologic syndrome not typical for MS contributed to misdiagnosis in 65% of cases.1 MS diagnostic criteria fail in this situation, but are often applied in clinical practice. In 60% of cases, declaring MRI criteria for dissemination in space satisfied in a patient with nonspecific symptoms contributed to misdiagnosis.1 Ultimately, these 2 errors perpetuate one another. Nonspecific symptoms acquire additional and unwarranted attention when nonspecific MRI lesions are present, and nonspecific MRI lesions are accorded undue attention in the presence of symptoms of common conditions such as migraine. Further studies should establish the frequency of misdiagnosis, but the combination of nonspecific symptoms and nonspecific MRI abnormalities is likely a common contemporary source of MS misdiagnosis.

Affective disorders in multiple sclerosis

BackgroundPsychiatric disorders have a remarquable frequency in multiple sclerosis. The leading group of these disorders consists of affective disorders. These psychiatric conditions can worsen the outcome of multiple sclerosis, thus contributing to increase the burden of the disease to both patients and relatives. Managing such a complicated situation needs a focus on the underlying links between affective disorders and multiple sclerosis.ObjectiveTo examine the hypotheses proposed to explain the high prevalence of affective disorders in patients with multiple sclerosis.MethodsLiterature was reviewed using the Medline database and the following keywords “bipolar disorder” “affective disorder”, “mania” and “multiple sclerosis”.ResultsPubMed research returned 13 results. After manual inspection, 10 articles were retained and examined. The cause of the high comorbidity between multiple sclerosis and mood disorders is regarded as being multifactorial: the medication used in multiple sclerosis possibly inducing/exacerbating mood disturbances, the demyelinazing brain lesions which could bring about depression or mania, genetic overlapping with affective disorders and last the psychological reactions and adjustment difficulties to the neurological handicap.ConclusionDespite the fact that the higher prevalence of affective disorders in multiple sclerosis is well established, these disorders still remain underdiagnosed and undertreated. A shift towards a better assessment of the psychiatric comorbidity in multiple sclerosis patients and the optimal treatment of those disorders is fundamental.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Frequency of Multiple Sclerosis (MS) Among Relatives of MS Patients in Hamadan Society, Iran

Frequency of Multiple Sclerosis (MS) Among Relatives of MS Patients in Hamadan Society, Iran

Качество жизни у больных рассеянным склерозом проживающих в северном регионе в зависимости от когнитивного статуса

Multiple sclerosis is the most frequent disease of the central nervous system. An increase in multiple sclerosis frequency was registered in several countries including Russia. This may be associated with better multiple sclerosis diagnosis and treatment, better data collection and real increase in multiple sclerosis incidence. Early disability and its rapid progression emphasize the medico-social importance of multiple sclerosis. Neuropsychological disturbances are often observed in multiple sclerosis, being one of the important components in the formation of clinical disease. 43 patients living in the North region with definite multiple sclerosis and mild or moderate disability were tested with expended neuropsychological, neurological and study of quality of life. The purpose of the study was to analyze the role of cognitive, emotional and personal peculiarities at multiple sclerosis on quality of life. To assess quality of life the authors used SF-36. The results of this study of quality of life revealed significant differences in the physical, role and social components depending on the cognitive peculiarities.

164-P: HLA DQB1 06:09 SIGNIFICANTLY INCREASES THE RISK OF MULTIPLE SCLEROSIS AMONGST PARSIS (ZOROASTRIANS) OF INDIA

The frequency of Multiple Sclerosis (MS) varies worldwide. Zoroastrians (Parsis) of Mumbai, India comprise a tiny inbred group who have shown a significantly higher prevalence of MS. DNA typing of HLA Class II DRB1 and DQB1 alleles was performed on 13 Parsi patients. DNA was extracted from blood samples of 13 MS Parsi patients (remitting relapsing) and 50 healthy Parsi controls. Low and high resolution HLA-DRB1 and DQB1 molecular typing was performed by polymerase chain reaction using sequence specific primers (PCR-SSP) (Olerup SSP, Qiagen). A statistically significant increase in HLA-DRB1∗15 xx (23% vs. 8%) and HLA-DQB1∗06 xx (26.9% vs 8%,) was detected in Parsi patients as compared to controls. High resolution typing of HLA-DQB1∗06 xx amongst them showed a significant increase in DQB1∗06:09 (11.53% vs. 2%) OR = 7.2; Chi square = 2.86; p value 0.05, CI (0.82-73.29).[ Table 1 ] Dean and Wadia studied MS patients amongst Asian immigrants in England. Five Parsis were found with definite MS in a community of 5000, as compared to 23 amongst 383,000 ethnic Indian immigrants. It has been of some concern that our genetic analysis is in a small number of patients, but such is the cohort available from this tiny community, which is now spread worldwide. Earlier clinical data has shown small affected populations can yield valuable information that may reflect on broader issues of genetic susceptibility. So a higher frequency of DRB1∗15 and DQB1∗06 in MS patients with a statistically significant increase in the DQB1∗06:09 allele is detected.

Increased frequency of multiple sclerosis, the influence of environmental and immunological factors

Increased frequency of multiple sclerosis, the influence of environmental and immunological factors

Antiparasitic antibodies occur with similar frequency in patients with clinically established multiple sclerosis with or without oligoclonal bands in the cerebrospinal fluid

The "hygiene hypothesis" postulates an inverse relationship between the prevalence of parasitic infections and the frequency of multiple sclerosis (MS). It was to study whether antibodies against parasites could be demonstrated more frequently in blood serum from MS patients with oligoclonal bands (OCB) than from MS patients without OCB. We studied serum samples from 164 patients who had previously been analyzed to investigate OCB. Parasitic antibodies were studied through unidimensional electrophoresis of proteins on polyacrylamide gel against Taenia antigens, searching for antiparasitic specific low molecular weight antibodies and also for antiparasitic nonspecific high molecular weight antibodies. Two of the 103 patients with no evidence of OCB had antibodies of low molecular weight and 59 of them had antibodies of high molecular weight. Of the 61 patients with evidence of OCB, one showed antibodies of low molecular weight and 16 showed antibodies of high molecular weight. Antiparasitic antibodies are detected with similar frequency in MS patients with OCB and in MS patients without OCB.

Clinical Utility of Glatiramer Acetate in the Management of Relapse Frequency in Multiple Sclerosis

Glatiramer acetate (GA) represents one of the most common disease-modifying therapies for multiple sclerosis. GA is currently approved for patients at high risk of developing clinically definite multiple sclerosis (CDMS) after having experienced a well-defined first clinical episode (clinically isolated syndrome or CIS) and for patients with relapsing-remitting multiple sclerosis (RRMS). GA’s efficacy and effectiveness to reduce relapse frequency have been proved in placebo-controlled and observational studies. Comparative trials have also confirmed the lack of significant differences over other choices of treatment in the management of relapse frequency, and long-term studies have supported its effect at extended periods of time. Additionally, RRMS patients with suboptimal response to interferon β may benefit from reduced relapse rate after switching to GA, and those with clinically isolated syndrome may benefit from delayed conversion to CDMS. All these results, together with its proven long-term safety and positive effect on patients’ daily living, support the favorable risk-benefit of GA for multiple sclerosis treatment.

A 20-Year Incidence Trend (1989–2008) and Point Prevalence (March 20, 2009) of Multiple Sclerosis in Tehran, Iran: A Population-Based Study

Background: The frequency of multiple sclerosis (MS) is still undetermined in Tehran. We conducted this survey to assess the incidence trend and point prevalence of MS on March 20, 2009, in Tehran province, Iran. Methods: Data for patients with a definite diagnosis of MS were obtained from the Iranian MS Society (IMSS). The annual incidence rates were calculated based on year of diagnosis. The prevalence and annual incidence rates were standardized using the WHO (2000–2025) population as a standard. Results: We detected 8,026 definite MS cases that had been registered by the IMSS till the prevalence day. The age- and sex-adjusted incidence rates increased significantly from 0.68/100,000 in 1989 to 2.93/100,000 in 2008 with its peak (4.58) in 2005. On March 20, 2009, we identified 7,896 prevalent cases (5,888 females and 2,008 males) yielding an age-adjusted prevalence rate of 50.57/100,000 (females: 77.24 and males: 25.54). The female-to-male ratio was 3.11 (95% confidence interval: 2.95–3.27). The age-specific prevalence showed a peak in the group aged 35–39 years in females and in that of 40–44 years in males with a mean (±SD) age of 35.48 (±9.9) years for females and 36.98 (±10.5) years for males. Conclusion: Tehran is a high-risk area for MS disease, and the incidence has dramatically increased over the last 20 years.

Glatiramer Acetate in the Reduction of Relapse Frequency in Multiple Sclerosis

Glatiramer acetate (GA; Copaxone®) is a heterogeneous polymer of four amino acids. It is one of the therapies approved by the Food and Drug Administration in 1996 for treatment of relapsing remitting multiple sclerosis (RRMS). GA reduces the relapse rate for RRMS, and has a good safety profile and moderate efficacy. Preclinical and clinical studies reveal that GA plays a role in modulating the cells of the immune system as well as in neuroprotection. In this article, we review the role of GA in reducing the frequency of relapses in MS, as well as its efficacy, safety, and current place in therapy.

Multiple sclerosis and lung cancer: an unexpected inverse association

Multiple sclerosis is associated with a decreased risk of cancer. Smoking is a risk factor both for multiple sclerosis and lung cancer. We performed a meta-analysis on studies of cancer frequency in multiple sclerosis. Surprisingly, we found that the risk of lung cancer is reduced in multiple sclerosis [odds ratio 0.67 (95% confidence interval 0.59-0.76) P < 0.00001]. Since this does not appear to be secondary to altered smoking behaviour, we hypothesise that this may be secondary to altered immune surveillance.

Restless legs syndrome in multiple sclerosis: A case‐control study

The aim of our study was to explore restless legs syndrome (RLS) frequency in multiple sclerosis (MS)-patients and establish whether RLS could be a symptom of MS. Over a period of 1 year, we consecutively enrolled 202 MS-patients and 212 healthy controls, matched for sex and age, in a case-control study. All of them filled in a structured questionnaire according to IRLSSG criteria. Those patients who fit the diagnostic criteria were subsequently examined by a neurologist to verify the effective presence of RLS. A total of 91 MS-patients (45%) responded positively to the questionnaires. The diagnosis of RLS was carried out in 29 subjects (14.4%). Among the healthy controls, a definite diagnosis of RLS was achieved only in 6 subjects (2.8%). The risk of MS patients to present RLS was significantly higher (OR.5.76 P:0.00002) than the general population. None of them was affected by other medical conditions related to RLS developing. The 62 remaining patients presented numbness and weakness of the legs not suggestive of RLS. Our findings confirm a significant correlation between MS and RLS. In our opinion, MS must be definitively included among RLS causes.

Changes in MS Incidence During a Half-Century

That the frequency of multiple sclerosis (MS) declines with geographic latitude has long been appreciated. To examine temporal trends in incidence,

Prevalence and Incidence of Multiple Sclerosis in Western Greece: A 23-Year Survey

Background: The frequency of multiple sclerosis (MS) in Greece remains speculative, as data from many parts are still lacking. Objective: To estimate trends in MS prevalence and annual incidence in western Greece from January 1, 1984 to December 31, 2006. Methods: Patients were identified from the patient records of the Department of Neurology at Patras University Hospital in Rion-Patras. Only patients with a definite MS diagnosis according to Poser’s criteria and retrospective application of the McDonald’s criteria were included. We calculated age- and sex-specific prevalence rates for patients living in the study area on December 31, 2006. Annual incidence rates were calculated for the period 1984–2006. Results: The crude prevalence rate of definite MS cases increased significantly in 23 years from 10.1/100,000 recorded in northeastern Greece in 1984 to 119.61/100,000 on December 31, 2006 in western Greece for the 780 cases still alive. The mean annual incidence rate increased from 2.71/100,000 recorded during the period 1984–1989 to 10.73/100,000 in the 5-year period of 2002–2006. Conclusion: The prevalence rates were higher than expected, but closer than in previous surveys conducted in Greece to those reported recently in Sicily and Istanbul. These findings place the area in the high-risk zone.

HLA-DRB1 and multiple sclerosis in Malta

By comparison with the neighboring island of Sicily, the frequency of multiple sclerosis (MS) in Malta is remarkably low. To explore whether the relative rarity of MS in Malta might be the result of lower population frequencies of major histocompatibility complex susceptibility alleles, we genotyped the HLA-DRB1 locus in 77 Maltese-born patients (97% of the prevalent unrelated native cases) and 206 Maltese controls. We made comparisons with previously published data for Sicily and other European countries. The anticipated association with HLA-DRB1*15, the main susceptibility allele in most other populations, was confirmed (p(c) = 0.009) but, in addition, we also observed an equally strong, and apparently protective, effect of the HLA-DRB1*11 allele (p(c) = 0.016). In comparison with previously published data from Sicily, we found that all HLA-DRB1 risk alleles were more common in Malta, whereas HLA-DRB1*11 was slightly less common. The difference in prevalence seen between the neighboring islands of Malta and Sicily cannot be explained by differences in background HLA-DRB1 population allele frequencies, which if anything would predict a higher rate of disease in Malta than in Sicily.