Epidemiology Of MS Research Articles

Longitudinal epidemiology of multiple sclerosis over 60 years in Newcastle, Australia: 1961 to 2021

IntroductionNewcastle, Australia, has been serially studied for MS epidemiology since 1961, showing consistently increasing prevalence estimates and incidence rates, including to our 2011 study. ObjectivesTo assess the 2011–2021 epidemiology of MS in Newcastle and to compare with previous measures. MethodsDemographic and clinical data were extracted from medical records of MS cases residing in Newcastle, as identified by public and private clinicians. Prevalence (2011 and 2021) and incidence rates (2011-2021, from onset and from diagnosis) and mortality rate (2011–2021) were estimated and age-standardised to the 2021 Australian population. ResultsThe 2021 prevalence was 173.1/100,000 (age-standardised = 178.7/100,000, F/M-sex-ratio = 3.3), a 42.2 % increase from 2011 (F/M-sex-ratio = 3.1), 175.0 % from 1996 (F/M-sex-ratio = 2.6), and 831.0 % from 1961 (F/M-sex-ratio = 1.2). The 2011–21 age-standardised onset incidence rate was 3.5/100,000 person-years (F/M-sex-ratio = 2.8), a 68.7 % increase from 1971 to 81 (F/M-sex-ratio = 1.1) and 44.5 % from 1986 to 96 (F/M-sex-ratio = 2.3). The age-standardised diagnosis incidence rate was 6.1/100,000 (F/M-sex-ratio = 2.2), statistically unchanged from that in 2001–2011 (6.8/100,000, F/M-sex-ratio = 3.2). The 2011–21 mortality rate was 2.1/100,000 person-years (2.2 age-standardised, F/M-sex-ratio = 1.4), with a standardised mortality ratio of 1.6. ConclusionThe Newcastle region continues to be a high frequency zone for MS. The incidence rate from onset is significantly increased from previous estimates, but incidence rate from diagnosis is stable. Prevalence and incidence sex ratios have stabilised at roughly 3.0, similar to other Australian sites.

The initial symptoms in multiple sclerosis: clinical and demographic data of Çorum province

Aims: Multiple sclerosis, which has individual and societal effects such as being observed in young and middle-aged people and its long and expensive treatment process, has become an important public health issue.
 Methods: Between January 2022 and January 2023, 103 patients with MS were evaluated using anamnesis, neurological examinations, and neuroimaging results. The patients’ initial findings upon their MS diagnosis, the duration of diagnosis, their neurological observations in the past month, and their clinical categorization were examined.
 Results: Out of the 103 patients, 70 (67.96%) were female, and 33 (32.04%) were male, which was detected as a female-to-male ratio of 2.12/1. The average age of the patients was 34.41±8.4 years, and the average disease duration was 8±5.8 years. The initial findings in females were as follows; 25 patients (35.7%) had sensory, 13 patients (18.6%) had motor (pyramidal), 17 patients (24.3%) had brain stem-cerebellar, 10 patients (14.3%) had a visual impairment, and 5 patients (7.1%) had other findings. The distributions of the initial symptoms in males were as follows; 12 patients (36.4%) were motor (pyramidal), 10 patients (30.3%) were sensory, 5 patients (15.1%) were brain stem-cerebellar, 5 patients (15.1%) had visual impairment, and 1 patient (.3.1%) had other findings. The mean Expanded Disability Status Scale (EDSS) at the time of initial diagnosis was 2.5± 1.5. Among the 60 patients with RRMS who were first diagnosed, the duration elapsed between initial symptom onset and diagnosis was 12.8± 5.7 months.
 Conclusion: Demographic information of the MS patients followed up in our clinic, their initial complaints, frequency of clinical subtypes, differences between clinical subtypes, their clinical status in the last month, and their EDDS at their initial diagnosis and last follow-up are presented. As this represents the first data on the epidemiology of MS in our city, we believe it will contribute to the national data of Turkey and help raise MS awareness among clinicians.

1325Longitudinal epidemiology of MS in the Greater Hobart region, 1961 to 2019

Abstract Background The Greater Hobart region (42.3°S) of Tasmania has the highest frequencies of MS in Australia, this consistent across studies conducted over the last half century. However, the degree of excess compared to mainland sites like Newcastle (32.5°S) has declined over time. Methods Cases were recruited from clinic-based samples and other multiple other data sources. Prevalence date was 1 June 2019. 2019 prevalence and 2009-19 incidence and mortality rates were estimated. Prevalence and incidence and mortality rates were age/sex-standardised to the 1961 and 1954 Hobart populations, respectively, to allow longitudinal comparisons. Female:male prevalence and incidence sex-ratios were also assessed. Differences between timepoints were assessed using Poisson regression. Results 472 MS cases (female:71.4%) resident on prevalence day were identified, a crude prevalence=212.3/100,000 (155.8 age/sex-standardised), 57% increase vs 2009 and 388.0% vs 1961. The 2009-19 incidence rate=7.56/100,000 person-years (7.03 age/sex-standardised), 91% increase vs 2001-9 and 218.1% vs 1951-61. The 2009-19 mortality rate was 2.25/100,000 person-years (1.12 age/sex-standardised), comparable to 2001-9 (1.00). The age/sex-standardised prevalence-sex-ratio was 2.61, comparable to 2009 (2.65), but the incidence-sex-ratio was 2.68, 31% increase vs 2001-9 (2.05). Conclusions Prevalence and incidence continue to be high in Hobart, although the differences compared to lower-latitude Newcastle have attenuated significantly. Changes in lifestyle may underlie the deterioration of the latitudinal gradient of MS in Australia. Further investigation is required to define the factors that drive these associations. Key messages MS prevalence and incidence are still highest in Australia in southern Tasmania but the latitudinal variation is declining.

ACTRIMS Forum 2021 – Invited Program

Background: After an historical absence of data, studies on MS epidemiology in Latin America (LATAM) have consistently increased since the foundation of LACTRIMS in 1999. The socioeconomic and political health impact of MS in the region remains to be established. Objectives: To assess the presence of MS frequencies in the different regions of LATAM and its reflection in local health policies and neurological care and education on the disease. Methods: Thematic presentations from 10 biennial LACTRIMS meetings (2000-2019) and recent publications on Latin American epidemiology cited in PubMed (2012-2020) assessing content for societal effects and policy provided the framework for this study. Official statement of principles (SOP) from 16 MS organizations representing 14 different countries from the Latin American MS organizations Network (LATEM) were included. Since 2018, LATEM's positions derive from input led by ASOGEM (Guatemala);APEMED (Paraguay);ALEM (Colombia) and ABEM (Brazil). Other groups explored for SOP) were 'Renacer' (Dominican Republic), ESMUP (Peru), ALCEM and EMA (Argentina), EMUR (Uruguay), FEMMEX (Mexico) and FUCACEM (MS Central American and Caribbean Foundation). Determination of societal impact was assessed by the development of registered local neurological MS study groups, or events of significance including legal accomplishments or governmental determinations improving education and care of MS. Results: The MS International Federation and the WHO place the prevalence of disease for the majority of countries in LATAM from very low (0-5/100,000) to low-to-moderate (5.5-20/100,000). Two areas, a Monterrey's suburb in northeast Mexico (25° N), and Buenos Aires, Argentina (34° S) show moderate frequencies (30/100,000), while the highest prevalence in LATAM is noted in Puerto Rico (77.7/100,000). Countries with a large geographic extensions show zonal differences. Prevalence data from 15 countries is available. Only four national incidence studies: Panama, Uruguay, Chile and Argentina, exist. A study from the six Central American countries and three Spanish-speaking Caribbean country islands (Cuba, Puerto Rico and Dominican Republic) show high index of EDSS disability > 3.5 (37%) among the subjects included in these series, hence potentially reflecting into additional socioeconomic burden to the local communities. Eight CTRIMS national associations have developed in the region, all functioning as LACTRIMS' chapters. Another multinational study group from Central America and the Caribbean emerged recently as a forum (FOCEM). Recent virtual discussions emphasized every effort to avoid the COVID-19 pandemic to disrupt access to MS therapies in the region. The organizations play a determining role in preventing the indiscriminate approval by uninformed local health agencies of medications lacking safety and efficacy evidence, i.e. biosimilar products (ASOGEM). Conclusions: The emergence of MS in the Americas, despite its reportedly low epidemiologic frequencies, has affected importantly the socioeconomic health regional systems. Initiatives to integrate the neurological community with MS organizations and stakeholders to improve MS education, its management, and access to quality therapy in LATAM appear thus far to be a regionwide unifying tendency.

Geography of hospital admissions for multiple sclerosis in Greece

BackgroundMultiple sclerosis (MS) is the 2nd most common, disability causing neurological disorder in young adults, known for its differences in prevalence according to geographical position. Data on MS epidemiology is lacking in Greece. In this study, we aimed to examine the pattern of MS related hospital admissions in Greece and analyze their spatial distribution. Data for hospital admissions due to MS was obtained from the Hellenic Statistical Authority (ELSTAT) database and they were available from 1999 to 2012. MethodsWe used the proportional hospitalization ratio (PHR) which was age and sex adjusted according to hospitalizations of Greek population, in order to calculate the ratio between hospitalizations in each regional unit (RU) and hospitalizations of national population. PHR was calculated for each RU, which is categorized as level 3 based on the Nomenclature of Territorial Units for Statistics (NUTS level 3). The classification of MS was based on International Classification of Diseases, Ninth Revision (ICD-9), code 340. Descriptive analysis was conducted to understand the epidemiological characteristics and time series analysis was used to investigate the trend of annual PHR's values during the study period. Global spatial autocorrelation analysis was conducted to assess spatial homogeneity of MS across the country. Moreover, local spatial autocorrelation analysis was performed using the LISA statistic to detect any potential clusters of similar values. Finally, multiple linear regression was conducted to examine correlations between PHR and latitude. ResultsOver the 14-year period the number of hospitalizations increased while the proportion of hospitalizations remained higher for females compared to males, as well as for the 25-44 year age group. RUs that appeared to be most affected included Evros with a sex- and age- adjusted PHR of 2.00 (95%CI: 1.89-2.10), Larisa with a PHR of 1.74 (95%CI: 1.67-1.81) and Chios with a PHR of 1.77 (95%CI: 1.60-1.95). The least affected RU was Arkadia with a PHR of 0.29 (95%CI: 0.24-0.36). ConclusionIn this study we present a rise in hospital admissions related to MS over a 14-year period, possibly indicating a parallel rise in incidence. A combinational analysis of the number of hospitalizations along with incidence studies could be further performed to be used to design public health interventions

Prevalence and incidence of multiple sclerosis in Ardabil, Northwest of Iran

BackgroundMultiple sclerosis (MS) epidemiology is studies in many populations; however, studying populations with unique characteristics could provide opportunities to deepen the understanding of the underlying reason of the disease. In this regard, we aimed to study the epidemiology of MS in Ardabil, a province in northwest Iran, where the majority are of Iranian Azerbaijanis. MethodA retrospective population-based study was conducted from 2008 to 2018 in Ardabil, based on the data of Iran's Ministry Of Health. Collected information includes sex, age, age at disease onset, education and type of MS. We used t-test to compare means and chi-square test to analyze the association among variables. ResultsThe total number of patients was 760 with 533 (70.13%) females and 227 (29.87%) males. The crude prevalence was 59.37 per 100,000 in 2018 (95% CI: 55.31, 63.73). The crude incidence rate was 7.65 per 100,000 in 2018 (95% CI: 6.28, 9.32). The most frequent educational level was high school diploma (38.36%). The relapsing-remitting (RR) form was the most frequent type of MS (48.16%). The F/M ratio was 2.92:1 and the mean onset age was 33.14 (95% CI: 31.56, 34.72) in 2018, significantly higher in males (P value= 0.01). ConclusionArdabil is a medium risk zone of MS. The different ethnicity of its population, climate and environmental features, may explain the factors modulating the risk of MS in similar areas and present windows of opportunity to understand the causes of MS.

Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis.

BackgroundMultiple sclerosis (MS) is one of the most common neurological disorders and is one of the main causes of disability. The prevalence and incidence of MS in Iran is reported to range from 5.3 to 89/ 100,000and 7 to 148.1/ 100,000, respectively. There are no systematic and meta-analysis studies on MS in Iran. Therefore, this study was conducted to investigate the prevalence and incidence of MS in Iran using meta-analysis.MethodA systematic review of the present study focused on MS epidemiology in Iran based on PRISMA guidelines for systematic review and meta-analysis. We searched eight international databases including Scopus, PubMed, Science Direct, Cochrane Library, Web of Science, EMBASE, PsycINFO, Google Scholar search engine and six Persian databases for peer-reviewed studies published without time limit until May 2018. Data were analyzed using Comprehensive meta-analysis ver. 2 software. The review protocol has been registered in PROSPERO with ID: CRD42018114491.ResultsAccording to searching on different databases, 39 (15%) articles finalized. The prevalence of MS in Iran was estimated 29.3/ 100,000 (95%CI: 25.6–33.5) based on random effects model. The prevalence of MS in men and women was estimated to be 16.5/ 100,000 (95%CI: 13.7–23.4) and 44.8/ 100,000 (95%CI: 36.3–61.6), respectively. The incidence of MS in Iran was estimated to be 3.4/ 100,000 (95%CI: 1.8–6.2) based on random effects model. The incidence of MS in men was estimated to be 16.5/ 100,000 (95%CI: 13.7–23.4) and the incidence of MS in women was 44.8/ 100,000 (95%CI: 36.3–61.6). The meta-regression model for prevalence and incidence of MS was significantly higher in terms of year of study (p<0.001).ConclusionsThe results of this study can provide a general picture of MS epidemiology in Iran. The current meta-analysis showed that the prevalence and incidence of MS in Iran is high and is rising over time.

Epidemiological study of metabolic syndrome in Brazilian soldiers.

The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.

The Swiss Multiple Sclerosis Registry (SMSR): study protocol of a participatory, nationwide registry to promote epidemiological and patient-centered MS research

BackgroundMultiple sclerosis (MS) is one of the most frequently observed neurological conditions in Switzerland, but data sources for country-wide epidemiological trend monitoring are lacking. Moreover, while clinical and laboratory MS research are generally well established, there is a gap in patient-centered MS research to inform care management, or treatment decisions and policy making not only in Switzerland but worldwide.MethodsIn light of these research gaps, the Swiss Multiple Sclerosis Society initiated and funded the Swiss Multiple Sclerosis Registry (SMSR) an open-ended, longitudinal and prospective, nationwide, patient-centered study.The SMSR recruits adult persons with a suspected or confirmed MS diagnosis who reside or receive care in Switzerland. The SMSR has established a governance structure with clear rules and guidelines. It follows a citizen-science approach with direct involvement of persons with MS (PwMS), who contribute actively to registry development, operations, and research. Main scientific goals entail the study of MS epidemiology in Switzerland, health care access and provision, as well as life circumstances and wellbeing of persons with MS.The innovative study design (“layer model”) offers several participation options with different time commitments. Data collection is by means of regular surveys and medical record abstraction. Survey participation is offered in different modes (web, paper & pencil) and in the three main national languages (German, French, Italian). Participants also receive regular data feedbacks for personal use and self-monitoring, contextualized in the whole population of study participants. Data feedbacks are also used to solicit data corrections of key variables from participants.DiscussionThe SMSR combines the advantages of traditional and novel research methods in medical research and has recruited over 1600 PwMS in its first year. The future-oriented design and technology will enable a response not only to future technological innovations and research trends, but also to challenges in health care provision for MS.Trial registrationClinicalTrials.gov NCT02980640; December 6, 2016; retrospectively registered.

Multiple sclerosis prevalence in Salta City, Argentina

IntroductionMultiple Sclerosis (MS) is one of the leading causes of disability in young adults. Its prevalence varies according to different countries. In Argentina there is a wide heterogeneity regarding data published in different areas of the country. Prevalence established in most studies is 17 cases per 100,000 inhabitants; however, most of the available data comes from studies that took place in Buenos Aires. There is little or no information from other provinces, especially from Northwest of Argentina (NOA), where there are no studies of the disease prevalence. The aim of this study is to investigate MS prevalence, phenotypes and epidemiological characteristics in Salta, Argentina, in order to contribute to the current knowledge of MS epidemiology and distribution in our country. MethodsA descriptive, observational, transversal study was carried out in the capital city of Salta. Researchers from all public and private hospitals with a Neurology Department have participated. Private researchers who are well known leaders in demyelinating diseases in the city provided valuable information. Patients who did not have medical control for the past two years as well as patients whose last address was not registered in Salta were excluded. Results120 registries were obtained from the four hospitals that participated and from the 12 private researchers. Ten patients were excluded due to overlapping data. The population of the area based on 2010 census was 535,310, so we estimated an MS prevalence 23.8 cases per 100,000 inhabitants (95% CI 20.1–27.4), 24.1 cases per 100,000 inhabitants in female population (95% CI 21.2–28.6) and 18.2 cases per 100,000 inhabitants (95% CI 15.2–21.1) in male population. In our analysis, 64 (58.2%) were female and the average age was 42.1 years. 81.8% are recurrent remitting forms, 16.4% secondary progressive and 1.8% primary progressive. ConclusionThis is the first study that provides epidemiological data on the prevalence and clinical forms of MS in Salta City as well as in the entire Northwest Region of Argentina(NOA). We estimate a prevalence of 23.8 cases per 100,000 inhabitants, which establishes a moderate risk area for MS.

MS and infections-Abandoned and surviving hypotheses.

In this introduction, we follow the ups and downs of infections in MS pathogenesis. Our arguments focus on specific agents and events, not referring to general MS epidemiology. The historical approach continues on to contemporary data and a critical analysis.

Nordic MS Epidemiology. Introduction.

Nordic MS Epidemiology. Introduction.

The epidemiology of multiple sclerosis in the Isle of Man: 2006-2011.

We sought to determine the prevalence of MS on the Isle of Man in 2006 and 2011, and the incidence and mortality rates over this interval. Cases were identified by hospital medical record review, General Practitioners and the local MS Society. The significance of the change in prevalence over time and the significance of differences in frequencies by sex and place of birth were assessed by Poisson regression. The 2006 prevalence was 153.64 per 100,000 persons and the 2011 prevalence was 179.89. The prevalence was higher among females and persons born in the Isle of Man at both time points. The 2006-2011 incidence rate was 6.86 per 100,000 person-years, much higher among females and persons born in the Isle of Man. The prevalence sex ratios in 2006 and 2011, 2.77 and 2.59, respectively, and the incidence sex ratio, 2.19, are similar to others found in the region. The mortality rate over the study period was 2.84 per 100,000 person-years, this solely among persons born overseas. This is the first study of MS epidemiology in the Isle of Man, finding this area to be of high prevalence and to have one of the highest incidence rates in the UK region.

A History of Multiple Sclerosis Investigations in Canada Between 1850 and 1950

The medical profession's modern quandaries with Multiple Sclerosis (MS) largely began in 1849, with Friedrich von Frerichs' (1819-1885) early description of the clinical and pathological features of what he termed Hirnsklerose ("brain sclerosis"). This manuscript is an overview of the century of research (1850-1950) that followed the emergence of this clinical entity, with a focus on the hitherto under-explored English Canadian perspective. Using journal articles, reviews, and case studies, this historiographical paper reviews what may be some of the earliest recorded cases of MS in Canada, and outlines the diagnostic challenges that confronted early Canadian physicians in their encounters with MS. Early Canadian attempts to characterize the aetiology and epidemiology of MS and treat it are also discussed. These activities were influenced by developments in the field in Europe and the United States, and helped set the stage for the modern era of immunologic and therapeutic research on MS.

Management of relapsing–remitting multiple sclerosis in Latin America: Practical recommendations for treatment optimization

The Latin American MS Experts' Forum has developed practical recommendations on the initiation and optimization of disease-modifying therapies in patients with relapsing–remitting multiple sclerosis (RRMS). The recommendations reflect the unique epidemiology of MS and the clinical practice environment in Latin American countries. Treatment response may be evaluated according to changes in relapses; progression, as assessed by the Expanded Disability Status Scale and the Timed 25-foot Walk; and lesion number on magnetic resonance imaging. Follow-up assessments are recommended every six months, or annually for stable patients. Cognitive function should be evaluated in all RRMS patients at baseline and annually thereafter. These recommendations are intended to assist clinicians in Latin America in developing a rational approach to treatment selection and sequencing for their RRMS patients.

Russell W Brain and the aetiology of multiple sclerosis--a historical perspective

The contribution of British neurologist Russell Walter Brain (1895-1966) to the field of neurology is difficult to overestimate and his seminal work continues to influence modern neurological education and practice. In a landmark review published in the Quarterly Review of Medicine in 1930, he gives a critically important account summarising ideas of the time thought to underlie the then called 'disseminated sclerosis', a disease he notes to be, 'after syphilis, the most frequent disease of the nervous system' in the UK. Across a century and a half, vast progress has been made in attempting to elucidate the as yet unknown cause of MS, which is unravelling to be multifactorial, highly complex and likely dependent on both genetic and environmental risk factors. Brain's observations highlight the changing epidemiology of MS over the last century which are likely to provide the platform in striving towards elucidating MS causation, notably a seemingly reduced latitudinal gradient of MS incidence, an increasing female-to-male sex ratio and an increasing disease rate in dark-skinned compared to light-skinned individuals. In this report we aim to evaluate the relevance today of what we believe to have been an important review demonstrating a perspective on MS far ahead that of its time, with a focus on Brain's ideas on the aetiology of MS; many of which have stood the test of time.

Helminth Therapy for MS.

In the last 50 years, environmental factors such as helminth infections have been proposed to explain why autoimmunity is less prevalent in the developing world; this proposal has been termed the hygiene or old friends hypothesis. The epidemiology of MS shows an inverse correlation with helminth infections. Positive effects of helminths in animal models of MS and observational studies in people with MS naturally infected with helminths suggest that those organisms can act as immune regulators and led to clinical trials of helminth therapy. The goal of helminth therapy is to introduce parasitic organisms into people with MS in a controlled and predictable fashion, and to prevent immune-mediated disease without increasing the risk of pathology with high parasite load. This chapter focuses on intestinal worms as they are the current choice as a therapeutic strategy in a number of autoimmune diseases, including MS. Here we review current data regarding the rationale and the current state of research in the field of helminth therapies in MS.

Incidence and prevalence of multiple sclerosis in Europe: a systematic review

BackgroundMultiple sclerosis (MS) is the most common cause of neurological disability in young adults worldwide and approximately half of those affected are in Europe. The assessment of differential incidence and prevalence across populations can reveal spatial, temporal and demographic patterns which are important for identifying genetic and environmental factors contributing to MS. However, study methodologies vary and the quality of the methods can influence the estimates. This study aimed to systematically review European studies of incidence and prevalence of MS and to provide a quantitative assessment of their methodological quality.MethodsA comprehensive literature search was performed to obtain all original population-based studies of MS incidence and prevalence in European populations conducted and published between January 1985 and January 2011. Only peer-reviewed full-text articles published in English or French were included. All abstracts were screened for eligibility and two trained reviewers abstracted the data and graded the quality of each study using a tool specifically designed for this study.ResultsThere were 123 studies that met the inclusion criteria. The study estimates were highly heterogeneous, even within regions or countries. Quality was generally higher in the more recent studies, which also tended to use current diagnostic criteria. Prevalence and incidence estimates tended to be higher in the more recent studies and were higher in the Nordic countries and in northern regions of the British Isles. With rare exceptions, prevalence and incidence estimates were higher in women with ratios as high as 3:1. Few studies examined ethnicity. Epidemiological data at the national level was uncommon and there were marked geographical disparities in available data, with large areas of Europe unrepresented and other regions well-represented in the literature. Only 37% of the studies provided standardized estimates.ConclusionsDespite the breadth of the literature on the epidemiology of MS in Europe, inter-study comparisons are hampered by the lack of standardization. Further research should focus on regions not yet studied and the evaluation of ethnic differences in MS prevalence and incidence. National-level studies using current diagnostic criteria, validated case definitions and similar age- and sex-standardization would allow better geographical comparisons.

Epidemiology and mortality of MS: A nationwide population study in Taiwan

Epidemiology and mortality of MS: A nationwide population study in Taiwan

Is a hypothetical melanoma-like neuromelanin the underlying factor essential for the aetiopathogenesis and clinical manifestations of multiple sclerosis?

BackgroundMultiple sclerosis (MS) has undergone a significant increase in incidence in the industrialised nations over the last 130 years. Changing environmental factors, possibly infections or a lack of or altered timing of them, determine the prevalence of the disease. Although a plethora of aetiological factors, clearly evident in a group of children with MS, appear relevant, there may nevertheless be a single factor essential for the aetiopathogenesis and clinical manifestation of MS.Description and discussionThis hitherto unknown factor is postulated to be a ‘melanoma-like neuromelanin’ (MLN) dependent on the activation of a gene for syncytin-1. An involvement of MLN could explain the diverse findings in the epidemiology, immunology and pathology of MS, requiring a consideration of a complex infectious background, the human leucocyte antigens, as well as cosmic radiation causing geomagnetic disturbances, vitamin D deficiency, smoking, and lower levels of uric acid.SummaryIn principle, the MLN-based concept is a unifying one, capable of explaining a number of characteristics of the disease. To date, MLN has not been addressed in studies on MS and future work will need to be done on human patients, as there is little or no neuromelanin (the precursor of MLN) in the animals used as experimental models in the study of MS.