Incidence Of Multiple Sclerosis Research Articles

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.

Epidemiology of multiple sclerosis in Lebanon: A rising prevalence in the middle east

BackgroundThe epidemiology of multiple sclerosis (MS) has been studied in many countries of the Middle East but the prevalence and incidence of MS in Lebanon is still unknown. ObjectivesTo determine the incidence and prevalence of MS in Lebanon. MethodsLebanese patients diagnosed with MS between January 2018 and December 2018 were identified using the database of governmental third-party payers. The crude, age- and sex-specific 2018 prevalence and incidence among Lebanese patients were calculated. Results2248 MS patients were identified of whom 67.1% were women (female: male ratio 2:1) with a mean age of 41.8 ± 12.96 years. The 2018 prevalence of MS was 62.91 cases per 100,000 persons (95% CI: 60.41 - 65.41). The overall incidence of MS in Lebanon was 8.36 cases per 100,000 (95% CI: 7.45 – 9.27) with a mean age at onset of 34.5 ± 12.5 years. ConclusionThis is the first study to assess prevalence and incidence of MS in Lebanon, confirming that Lebanon is a moderate to high-risk area for MS. Those high rates are commensurate with recently published studies from the Middle East, pointing to a significant rise in incidence and prevalence of this disease in our region.

The trend of incidence, prevalence, and DALY of multiple sclerosis in the Middle East and Northern Africa region compared to global, West Europe and, Iran's corresponding values during 1990–2017: Retrieved from global burden of diseases data

BackgroundMultiple sclerosis (MS) is the most common immune mediated disorder of the central nervous system (CNS). This study compares the worldwide occurrence and epidemiologic burden of MS in the Middle East and Northern Africa (MENA) region and Western Europe from 1990 to 2017. MethodsThis study used data from the global burden of disease (GBD) studies. Initially, all age and age-specific values were estimated and then, these values were compared among the mentioned areas. In addition, the changes of sex distribution of MS according to incidence, prevalence, and disability-adjusted life years (DALYs) were calculated. The trend of MS incidence was also compared among the MENA region countries. ResultsAccording to MS incidence per 100,000 populations during 1990 to 2017, the occurrence of new cases has decreased slightly in the world (from 0.7 to 0.65) and Western Europe (from 2.55 to 2.50). Except Iran with a sharp rise of 2 to 2.8, there was a slow increase in the MENA region (from 0.9 to 1). The MS prevalence, between 1990 and 2017, in all ages was stable in the world and the MENA region except a steady increase in Iran and highest value in Western Europe. In this study, we determined the age-specific incidence of MS in all regions from 1990 to 2017. Although data showed a different trend of changes between age groups and regions, the group age 25–29 years had the highest risk of MS incidence. Based on gender, the incidence, prevalence, and DALY of MS in all regions were higher in female. ConclusionFrom 1990 to 2017, Western Europe had the highest MS prevalence and the MENA region had a relatively stable trend for MS incidence. In particular, in Iran, the MS incidence has been constantly increasing and has surpassed Western Europe since 2013.

Gender differences in geriatric syndromes as mental illness and nervous system diseases in hospitalized Thai older patients.

Older persons are affected by mental and neurological disorders differently, and gender plays a significant role influencing geriatric disorder differentiation. Accordingly this study characterized gender differences in geriatric syndromes among hospitalized elderly Thai patients. Probabilities of disease occurrence reflecting gender differences were calculated using historical data obtained from the Ministry of Public Health website, Thailand. We selected older patients aged 60 years and above admitted to inpatient departments in public hospitals with mental disorders and nervous system diseases from 2014 to 2018, counting over 160 000 cases each year. Descriptive statistics and odds ratios (ORs) were used to analyse and demonstrate gender differences. Compared to older females, older males had higher occurrences of four mental disorders revealed by OR and 95% confidence interval (CI) values: substance abuse (5.74, 5.08-6.49), alcohol use (5.66, 5.44-5.89), behavioural problems (1.34, 1.31-1.37), and schizophrenia (1.10, 1.06-1.14). Lower incidences for older males were seen in the same values for three mental disorders: neurotic issues (0.46, 0.44-0.49), mood disorders (0.58, 0.56-0.60), and dementia (0.91, 0.88-0.94). For neurological disorders, men had similar higher incidences for epilepsy (1.67, 1.63-1.72), cerebral palsy (1.61, 1.57-1.65), nervous system inflammatory diseases (1.53, 1.46-1.60), ischaemic attacks (1.42, 1.36-1.48), miscellaneous other nervous disorders (1.20; 1.18-1.22), and Parkinson's disease (1.15, 1.12-1.19). By contrast, older men had lower incidences of multiple sclerosis (0.55, 0.35-0.86), migraines (0.66, 0.62-0.70), and Alzheimer's disease (0.75, 0.71-0.78). Accurate characterization of gender differences in geriatric syndromes can better inform policies for appropriate early detection and prevention, and contribute to the development of treatment and intervention for various issues affecting elderly men and women's health.

Use of anti-TNF-α therapy in Crohn's disease is associated with increased incidence of multiple sclerosis

ObjectiveWe investigated if anti-tumor necrosis factor-α (anti-TNF-α) drugs used in the treatment of inflammatory bowel disease (IBD) alter the incidence of MS and if so, to understand the magnitude of such an effect. MethodsThis is a retrospective cohort study of data from Truven Health Market Scan administrative claims database. The patients included in the study had to be ≥ 18 years of age. The presence of IBD was based on at least 2 claims of International Classification of Diseases (ICD-9 or 10) diagnosis codes. The IBD diagnosis index date had to precede the MS diagnosis index date for inclusion in the study. The diagnosis of multiple sclerosis (MS) was defined as having at least 2 claims for the disease (ICD 9, 340 and ICD 10 codes, G35) and at least one prescription claim for any of the drugs that were defined as MS therapy. ResultsPatients with IBD had 1.32 times the risk of MS incidence compared to healthy controls (adjusted incidence rate ratio (IRR): 1.32; 95% CI: 1.03 – 1.71; p = .0312). Patients with IBD exposed to anti-TNF-α therapies had a 43% increase in the incidence of MS compared to those with IBD without exposure (adjusted incidence rate: 1.43; 95% CI: .062 – 3.32; p = .3989). Among CD patients treated anti-TNF-α medications an increase in the incidence of MS, compared to CD patients not exposed to such medications was observed (IRR = 2.62; 95% CI: 1.00 to 6.83; p = 0.049), statistically significant. After adjusting for age/gender, patients with CD using anti-TNF-α agents had an increase of incidence in MS (adjusted IRR: 2.24; 95% CI: 0.85 – 5.94; p = .1035) but it was not statistically significant. ConclusionsUse of anti-TNF-α drugs in CD was associated with a statistically significant increase in the incidence of MS but this effect was lost when controlled for age/gender.

Epidemiology, treatment patterns and healthcare utilizations in multiple sclerosis in Taiwan

“Real-world” data on the nationwide epidemiology and treatment patterns of multiple sclerosis (MS) is very scarce in Asia. This study is aim to evaluate the 10-years trends in epidemiology and treatment patterns of MS with Taiwan’s National Health Insurance Database (NHIRD). Patients aged 20 years or older and were newly diagnosed with MS between 2007 and 2016 were identified. The crude incidences of MS were presented annually and stratified by sex and age. Baseline characteristics and treatment patterns, particularly disease-modifying drugs (DMDs), were also analyzed. This study included 555 MS patients (mean age was 36.9 and 74.4% were female). The crude incidence rate of MS decreased slightly from 0.43 per 100,000 persons in 2007 to 0.24 per 100,000 persons in 2015. The female to male ratios remained mainly between 2 to 3. Approximately 80% of MS patients received initial DMDs, with interferon β-1a as the dominant one. Furthermore, 37.5% of MS patients received subsequent DMDs, with fingolimod being the most frequently used. The median times from diagnosis to initial and to subsequent DMDs were 77 and 1239 days, respectively. This nationwide study provides up-to-date and sophisticated estimates of MS epidemiology and treatment pattern in “real-world” setting in Taiwan.

Prevalence and Incidence of Multiple Sclerosis (MS) in Guilan Province

Introduction: The aim of this study was to investigate the prevalence and incidence of multiple sclerosis (MS) in Guilan Province) and to compare the standardized prevalence by the factor of age in this province. Methods: The study was a cross-sectional design that was conducted in 2018 at the Guilan MS Society (GMSS) on people with multiple sclerosis and examined the 654 people with multiple sclerosis case. In this study, the trend of MS disease was examined from 2009 to 2019 and in order to investigate the rate of cumulative incidence of the disease, new cases were defined based on the date of diagnosis of the disease from the beginning of 2018. Data collection was performed using a checklist that was collected during the GMSS registration by a registrar in the form of a structured interview. Prevalence rate was compared between different subgroups using Chi-Square and Fisher's exact tests. Field characteristics were described by using absolute and relative frequency indices or mean and standard deviation using Stata 13 and SPSS 19 statistical software. Results: The results showed that 71.4% of all patients were female. The mean age of the patients was 36.5 years and the highest frequency of MS was observed in the age group of 30-40. The MS patients lived in the urban were 81%. The highest initial manifestations of people with multiple sclerosis were reported in numbness or tingling, vision problems, weakness, other symptoms, and walking (Gait) difficulties, respectively. The highest prevalence of MS was in Lahijan and then Rasht and Astaneh-ye Ashrafiyeh citie.. Conclusion: From the results of this study, it is concluded that there is no significant difference between the prevalence rate in Guilan Province and the standardized rate with the age adjustment based on the WHO standard population, although no analytical comparison has been performed in this study.

Male sex chromosomal complement exacerbates the pathogenicity of Th17 cells in a chronic model of central nervous system autoimmunity

Sex differences in multiple sclerosis (MS) incidence and severity have long been recognized. However, the underlying cellular and molecular mechanisms for why male sex is associated with more aggressive disease remain poorly defined. Using a Tcell adoptive transfer model of chronic experimental autoimmune encephalomyelitis (EAE), we find that male Th17 cells induce disease of increased severity relative to female Th17 cells, irrespective of whether transferred to male or female recipients. Throughout the disease course, a greater frequency of male Th17 cells produce IFNγ, a hallmark of pathogenic Th17 responses. Intriguingly, XY chromosomal complement increases the pathogenicity of male Th17 cells. An X-linked immune regulator, Jarid1c, is downregulated in pathogenic male murine Th17 cells, and functional experiments reveal that it represses the severity of Th17-mediated EAE. Furthermore, Jarid1c expression is downregulated in CD4+ Tcells from MS-affected individuals. Our data indicate that male sex chromosomal complement critically regulates Th17 cell pathogenicity.

Age and sex adjusted prevalence and annual incidence of multiple sclerosis in East-Azerbaijan, Iran

BackgroundIncidence and prevalence of multiple sclerosis (MS) is postulated to be rising in recent decades. Therefore, updating and completing the information of patients is essential, especially in high population areas. East-Azerbaijan is the largest and most populous province in the northwest of Iran. This study aimed to determine the prevalence and annual incidence of MS from 2008 to 2017 in East-Azerbaijan. MethodsWe evaluated the data of all patients who had registered at the MS center in the university hospital. The data include nearly all MS patients in the East-Azerbaijan region, because it is the only referral site in the area. All of the reported rates were calculated in 100,000 of the total population. ResultsBy the end of 2017, the number of MS patients was 2995 (residing in the, with 769 (25.67%) men and 2226 (74.32%) women. The prevalence rate was 75.72/100,000 (95 % CI: 73.06-78.48), 38.2 in men (95% CI: 35.5-41.0), and 114.61 for women (95% CI: 109.9-119.4), with a female to male (F/M) ratio of 3:1. The mean annual incidence rate was 7.63/100,000 (95% CI: 5.6-9.3), and this rate was higher in women than men. During the nine years, the incidence rate increased. The patients' mean age was 32.33 ± 8.92, with a peak prevalence in 25-29 years for both genders. In this study, 13.9% of patients had a positive MS family history. ConclusionsThis study showed a high prevalence of MS in the region. There is a significant increase in the incidence of MS during the nine years in East-Azerbaijan. The increment of incidence was more prominent in women. Also, considering the increasing incidence rate, it is concluded that the risk of MS is increasing in this region.

The Core of Gut Life: Firmicutes Profile in Patients with Relapsing-Remitting Multiple Sclerosis.

The multiple sclerosis (MS) incidence rate has been increasing in Russia, but the information about the gut bacteriobiome in the MS-afflicted patients is scarce. Using the Illumina MiSeq sequencing of 16S rRNA gene amplicons, we aimed to analyze the Firmicutes phylum and its taxa in a cohort of Moscow patients with relapsing-remitting MS, assessing the effects of age, BMI, disease modifying therapy (DMT), disability (EDSS), and gender. Among 1252 identified bacterial OTUs, 857 represented Firmicutes. The phylum was the most abundant also in sequence reads, overall averaging 74 ± 13%. The general linear model (GLM) analysis implicated Firmicutes/Clostridia/Clostridiales/Lachospiraceae/Blautia/Blautia wexlerae as increasing with BMI, and only Lachospiraceae/Blautia/Blautia wexlerae as increasing with age. A marked DMT-related decrease in Firmicutes was observed in females at the phylum, class (Clostridia), and order (Clostridiales) levels. The results of our study implicate DMT and gender as factors shaping the fecal Firmicutes assemblages. Together with the gender-dependent differential MS incidence growth rate in the country, the results suggest the likely involvement of gender-specific pathoecological mechanisms underlying the occurrence of the disease, switching between its phenotypes and response to disease-modifying therapies. Overall, the presented profile of Firmicutes can be used as a reference for more detailed research aimed at elucidating the contribution of this core phylum and its lower taxa into the etiology and progression of relapsing-remitting multiple sclerosis.

Is the sharp increasing trend of multiple sclerosis incidence real in Iran?

BackgroundSome epidemiologic studies have reported a sharp increase in multiple sclerosis (MS) incidence in different provinces in Iran. This report aimed to investigate more closely the increasing trend of MS incidence in the past 10 years in Iran.MethodsIn this longitudinal study, the data for all MS patients meeting the McDonald criteria were obtained from a national registry, coordinated by the Ministry of Health (MOH). Joinpoint (JP) regression was used for time trend analysis of MS incidence and determine the optimal number of significant joinpoints. Finally, an annual percentage change (APC) in MS incidence for each segment of the trend line was estimated with 95% confidence interval.ResultsThe mean age of the patients and the mean annual incidence rate of MS were 30.9 ± 1.1 and 5.3 ± 1.9 per 100,000 population, respectively. The overall incidence rate of MS had increased significantly from 2.14 in 2006 to its peak (7.5) in 2014, per 100,000 population (APC = 12%, P < 0.001). The first JP was observed in 2011 in both male and female groups. The overall APC in the first segment was 22.6% (17.2–28.2%, p < 0.01). Besides, the corresponding APC values for males and females were 22.1% (14.7–30%, p < 0.01) and 22.5% (17.5–27.8%, p < 0.01), respectively. After 2011, the MS incidence underwent a more or less decreasing trend in both genders.ConclusionContrary to previous studies, the MS incidence trend in Iran was rising just before 2011, and in the recent decade, Iran has a stable rate of MS cases.

Association of the global distribution of multiple sclerosis with ultraviolet radiation and air pollution: an ecological study based on GBD data.

Given the growing global trend of multiple sclerosis (MS), this study was designed to evaluate environmental determinates of the worldwide distribution of MS in the presence of socioeconomic and geographic indices. MS data was obtained from the Institute for Health Metrics and Evaluation website. The air pollution parameters, including particles with aerodynamic diameter less than 2.5μm (PM2.5), tropospheric ozone, and solid fuel use, were acquired from global burden of disease resources and the World Health Organization. Ultraviolet index (UVI) values were obtained from the Tropospheric Emission Monitoring Internet Service website. Correlation and linear regression analyses were used to investigate the relationship between air pollution and environmental parameters with MS variables. The average prevalence and incidence rates in countries with high UVI were 5.17 and 0.25 per 100,000, respectively, and in countries with low UVI were 101.37 and 0.78, respectively. The results showed negative associations between prevalence, incidence and mortality of MS with ozone concentrations (β = - 1.04, - 0.04, and - 0.01 respectively; P < 0.01). Also, the fully adjusted model showed significant negative correlation of UVI with the MS variables in the presence of other variables (P < 0.01). Our findings demonstrated that UVI had the strongest significant inverse association with MS distribution. Consequently, vitamin D intake may be a major contributor to MS development. However, this study showed a slight influence of air pollution on the prevalence of MS in the presence of other parameters. Given the inconsistent results of previous studies, further studies may be required.

Ambient air pollution and multiple sclerosis: a systematic review.

Some studies have shown that environmental risk factors, including air pollution, might be related to the incidence or recurrence of multiple sclerosis (MS). This systematic review was conducted to investigate the relation between air pollution and MS. A systematic search was conducted in PubMed, Scopus, Science Direct, Embase, and Web of Science; until January 2020 with no restrictions. The search strategy wasconducted with air pollution key words such as CO, PM2.5, PM10, SO2, and NO2, for exposure and the key word "Multiple sclerosis" as the outcome. Eventually, after applying the inclusion and exclusion criteria, 17 articles were included. The methodologies and outcomes reported were heterogeneous and different metrics had been used in the results; therefore conducting a meta-analysis was not possible. Eight studies had analyzed the relation between particulate matter (PM) and the prevalence or relapse of MS and had observed a significant relation. NO2 and NOx were associated with recurrence or prevalence of MS in three studies. But, in three cohort studies, no association was observed between air pollution and recurrence or occurrence of MS. The results of this systematic review show that outdoor air pollution, especially PM and nitrogen oxides might be related to the prevalence or relapse ofMS.

Multiple sclerosis risk with air pollution

Multiple sclerosis (MS) is the most common potentially disabling disease affecting people. The incidence of MS is increasing day by day around the world, and it also has many social and economic impacts. The underlying causes of MS and the mechanisms behind the development of the disease are so widespread. genetic and environmental interactions are almost certainly contributing to the formation of this disease. MS epidemiology illustrated that low levels of vitamin D, childhood obesity, smoking and infection with Epstein-Barr virus have a very important role in disease progression. Developments in diagnostic criteria and methods aim to increase the early recognition and diagnosis of MS. Hence, given the increasing advances in the medical field, it is now possible to detect MS before symptoms. As a result, potential preventive strategies can be studied. In this review, the MS epidemiology, potential pathogens, pathophysiology, MS types, symptoms, their diagnosis and treatment, and disease management are discussed.

Environmental factors: Possible reasons for higher incidence and prevalence of multiple sclerosis in high-income countries

Background: Multiple sclerosis (MS) has had a remarkable increase in prevalence during recent years. This study was conducted to evaluate the correlation between prevalence and incidence of MS with the income level and lifestyle condition of countries with considering the effect of latitude. Subjects and Methods: This is an ecological study with secondary data obtained from several sources such as MS International Federation for MS variables data, and World Bank is a reliable source for economic variables. The latitude is also added in all models as an important effective factor. The bivariate correlation and linear regression were used to analyze of data. Results: The prevalence of MS in 2013 (54.06/100,000) increased by 9% in comparison to that in 2008 (49.96/100,000). According to fully adjusted analysis, there were significant positive correlations between income level with the incidence and prevalence of MS in reported 2008 and 2013 (P < 0.05) throughout the world. Our results revealed that the mean MS prevalence estimates in northern hemisphere, especially in North of America and Europe were different with those in the southern hemisphere. Conclusion: MS is more prevalent in high-income countries and the prevalence in developing countries is increasing by economically growth. It seems that environmental factors related to economic determinants are associated with increased incidence and prevalence of MS, further, geographic location continues to influence risk for MS, but these associations require more studies.

Multiple sclerosis in the COVID-19 era: Vocational rehabilitation strategies to meet the needs of a growing and immune-vulnerable clientele

BACKGROUND: This article describes people with multiple sclerosis (MS) as an emerging vocational rehabilitation (VR) clientele. OBJECTIVE: Following an overview of the incidence, prevalence, and impact of MS, the authors suggest strategies to meet the employment and career development needs of Americans with MS across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, and interface with medical and mental health professionals is emphasized throughout the article. CONCLUSION: Implications related to the COVID-19 pandemic are discussed.

Vitamin D and Multiple Sclerosis; Is There a Real Association?

Multiple sclerosis is a demyelinating autoimmune disease that commonly affects young people. Several risk factors are associated with multiple sclerosis, including low vitamin D levels. Vitamin D is essential in various regulatory processes, particularly in the immune system. Fifty years ago, vitamin D was suggested to have a role in the risk of multiple sclerosis development and relapses, which was proposed after reporting seasonal and geographic variation of multiple sclerosis incidence around

PND76 Interest: Testing Three Different Definitions of Secondary Progressive Multiple Sclerosis

Assess the prevalence and incidence of secondary progressive multiple sclerosis (SPMS) in Relapsing Remitting Multiple Sclerosis patients in an Italian MS registerr according to three different definitions of SPMS: the data driven definition (based on the Lorscheider algorithm LA),the EXPAND study inclusion criteria definition and neurologist’s definition (gold standard in clinical practice). We extracted data from the registerby applying manually sequential filters to the dataset. First we selected RRMS patients fulfilling the inclusion criteria. Annual incidence of SPMS conversion was reported as number of patients converting to SPMS every 100 patients/year. We tested diagnostic performances of definitions of SPMS (data driven and EXPAND criteria) against neurologist’s definition in terms of calibration, discrimination and goodness of fit (i.e. sensibility, sensitivity, Positive Predictive Value (PPV), Negative Predictive Value (NPV)). 10,240 RRMS patients were analyzed. According to the neurologist definition 880 (8.59%) were SPMS. By applying data-driven definition 1,806 (17.64%) patients were SPMS, whereas, based on the EXPAND study definition 1,134 (11.07%) patients were SPMS. Annual rate of conversion to SPMS was 0.74 every 100 patients/year (neurologist), 1.57 every 100 patients/year (data-driven) and 0.94 every 100 patients/year (EXPAND criteria). Number of patients identified as SPMS by data-driven and neurologist’s definition together was 1,569, while 604 patients were identified as SPMS by EXPAND and neurologist’s definition. Data driven algorithm showed greater discrimination power (AUC: 0.83 vs 0.65) and had higher sensibility (77.1% vs 38.0%) in comparison to EXPAND definition. Both definitions showed similar specificity (88.0% vs 91.5%). An accurate disease course classification is needed for an efficacious understanding and treatment of SPMS. Real-world data from the Italian MS Register suggests that a data-driven definition based on the LA is more accurate in the diagnosis of SPMS. The two authors write on behalf of the Italian MS Register.

The epidemiology of multiple sclerosis in the Scottish Highlands: Prevalence, incidence and time to confirmed diagnosis and treatment initiation

IntroductionAlthough multiple sclerosis (MS) is frequent in the northern hemisphere, there have not been recent epidemiological studies in the Scottish Highlands about MS. ObjectivesTo get updated data regarding MS prevalence, incidence and mortality in the Highlands. Time between symptom onset and MS diagnosis was also evaluated in incident MS cases and the pattern of use of disease-modifying therapies (DMTs) was analysed. MethodsStudy population was people with MS under the care of the Highland Health and Social Care Partnership. The catchment area included North area (Wick, Thurso, Brora, Invergordon), Center (Inverness, Aviemore, Nairn, Fort William), and West coast (Ullapool, Skye). Data were obtained from the MS database at Raigmore hospital (prevalence, midyear 2017) and the prospective hospital-register based study (diagnosis) that was carried out over a 12-month period, in 2016. The 2010 McDonald criteria for diagnosis of new MS cases were used. Crude prevalence and incidence and 95% confidence interval (CI) were calculated for the MS adult onset population, and data was standardised to the European standard population 2013; cause-specific mortality rate was analysed. Pattern of use of DMTs during the first year of diagnosis was also registered. Results745 patients were registered in the MS database. 75.4% (562 cases) were females, and female/male ratio was 3:1. Mean age of population was 54.1 ± 14.1 years (range: 15-95 years). Mean number of years since diagnosis was 8.5 ± 4.6 years. Estimated prevalence for the population aged 15 and older was 376 cases per 100,000 inhabitants (95% CI: 354-399). 36 incident MS cases were registered in 2016 (88.8% females; mean age 40.4 ± 12.1 years). Annual incidence in Highlands was 18.2 per 100,000 inhabitants (95% CI: 14-24). The mean period of time from symptom onset to diagnosis was 38.8 ± 43.2 months. 47.2% (17/36) did not take any DMT during the first year after the diagnosis. ConclusionPrevalence and incidence of MS in the Scottish Highlands is high. Although the gap period between symptom onset and diagnosis is moderate, a significant proportion of recently diagnosed MS patients were not keen to start a DMT the first year after the diagnosis.

Joinpoint Regression Analysis of Trends in Multiple Sclerosis Incidence in Kuwait: 1980–2019

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of the central nervous system with unknown precise etiology. Temporally, a tendency for increasing MS incidence has been recorded worldwide. This cross-sectional cohort study sought to quantify trends in the age-standardized incidence rates (ASIRs) (per million person-years) of MS in Kuwait from 1980 to 2019, overall and by subcohorts defined by age at MS onset, sex, and nationality. Methods: MS incidence data from 1980 to 2019 were obtained from the Kuwait National MS Registry (KNMSR). Using midyear relevant Kuwait population as denominator and the World Standard Population as a reference, MS ASIRs overall and by subcohorts defined by age at onset (0–19, 20–39, and 40+ years), sex (male and female), and nationality (Kuwaiti and non-Kuwaiti) were computed. Joinpoint regression analysis was conducted to estimate average annual percent change (AAPC) and its 95% confidence interval (CI) overall and by subcohorts. Results: During 1980–2019, a total of 1,764 MS incident cases of 95.6 million person-years at-risk were diagnosed and registered in KNMSR. The overall MS ASIR (per million person-years) during the study period was 34.1 (95% CI: 16.1, 52.1). Between 1980 and 2010, in the total cohort, ASIRs of MS significantly increased by 13% (AAPC = 13.0; 95% CI: 10.8, 15.3; p < 0.001), followed by statistically nonsignificant declining trend during the ensuing period (AAPC = −3.8; 95% CI: −14.8, 8.8; p = 0.522). Joinpoint regression analysis revealed that 2 subcohorts of Kuwaiti females each with one joinpoint had significant increasing trends in MS ASIRs (0- to 19-year-old Kuwaiti females, AAPC: 1980–2009, 81.0; 95% CI: 58.2, 107.0; p = 0.001; 20- to 39-year-old Kuwaiti females, AAPC: 1980–1999, 131.7; 95% CI: 26.9, 322.8; p = 0.021). Additionally, of remaining 10, 6 subcohorts had significantly (p < 0.05) increasing trends in MS ASIRs from 1980 to 2019. Conclusions: From 1980 to 2010, Kuwait has an overall significantly increasing trend in MS ASIRs followed by a nonsignificant declining drift in the ensuing period. The increasing trend in MS risk appeared to be driven by increased risk among Kuwaiti females younger than 40 years. The underlying factors modulating MS risk in Kuwait need further studies.