Prevalence Of Multiple Sclerosis Research Articles

Use of telemedicine to assist in the diagnosis of multiple sclerosis from a clinically isolated syndrome

Multiple sclerosis (MS) is a neurological autoimmune disease that affects nearly 100,000 Canadians between the ages of 20 and 49 [1]. The disease damages myelin, a protective layer surrounding nerves, which causes irreversible damage to the central nervous system (CNS) [1]. Common symptoms for patients with MS include vision impairment, loss of coordination, and cognitive impairment. As of 2015, the life expectancy of MS patients is approximately 7 years shorter than the general population, with a cause of death due to the disease itself or related conditions such as infections [1, 2]. Despite the significant global prevalence of MS and its severity, no cure has been discovered, and instead all approved treatments merely aim to slow down disease progression [1]. As such, timely diagnosis of MS is critical to minimize the more severe symptoms early in life [3].

Estado actual de la esclerosis múltiple en Colombia

Introducción: Dos estudios epidemiológicos de esclerosis múltiple (EM) la describen como de bajo riesgo en Colombia. Hay, sin embargo, nuevos sistemas de información que permiten una aproximación más precisa.
 Objetivo:Estimar la prevalencia nacional de EM, así como por regiones del país, y analizar los costos de los fármacos usados en Colombia.
 Materiales y métodos: Se obtuvieron datos del Registro Individual de Prestación de Servicios de Salud (RIPS), con el código diagnóstico G35X para esclerosis múltiple, tomando los diagnósticos confirmados nuevos y repetidos entre 2009 y 2013, por sexo, grupo etario y departamento. Para el análisis de medicamentos se usó la base de datos Sismed del 2014, incluyendo los fármacos disponibles en Colombia: interferón beta-1A, interferón beta-1B, acetato de glatiramer, natalizumab, fingolimod y mitoxantrona.
 Resultados:Según los RIPS, en Colombia se atendieron, en el período 2009-2013, un total de 3.462 personas con diagnóstico de esclerosis múltiple. La prevalencia nacional para el período fue de 7,52/100.000, con las cifras más altas en Bogotá (16,25), donde se atendieron 1.213 pacientes, seguido de los departamentos del Quindío (13,03) y Risaralda (11,18). La mayor proporción de pacientes se encuentra entre los 50 y 54 años de edad, y las mujeres representan más del 70%. Adicionalmente, en 2014 se invirtieron 86.000 millones de pesos (43 millones de dólares) en medicamentos para esclerosis múltiple, lo que equivale a cerca de 25 millones por paciente.

Population-Based Estimates for the Prevalence of Multiple Sclerosis in the United States by Race, Ethnicity, Age, Sex, and Geographic Region

Racial, ethnic, and geographic differences in multiple sclerosis (MS) are important factors to assess when determining the disease burden and allocating health care resources. To calculate the US prevalence of MS in Hispanic, non-Hispanic Black (hereafter referred to as Black), and non-Hispanic White individuals (hereafter referred to as White) stratified by age, sex, and region. A validated algorithm was applied to private, military, and public (Medicaid and Medicare) administrative health claims data sets to identify adult cases of MS between 2008 and 2010. Data analysis took place between 2019 and 2022. The 3-year cumulative prevalence overall was determined in each data set and stratified by age, sex, race, ethnicity, and geography. The insurance pools included 96 million persons from 2008 to 2010. Insurance and stratum-specific estimates were applied to the 2010 US Census data and the findings combined to calculate the 2010 prevalence of MS cumulated over 10 years. No exclusions were made if a person met the algorithm criteria. Prevalence of MS per 100 000 US adults stratified by demographic group and geography. The 95% CIs were approximated using a binomial distribution. A total of 744 781 persons 18 years and older were identified with MS with 564 426 cases (76%) in females and 180 355 (24%) in males. The median age group was 45 to 54 years, which included 229 216 individuals (31%), with 101 271 aged 18 to 24 years (14%), 158 997 aged 35 to 44 years (21%), 186 758 aged 55 to 64 years (25%), and 68 539 individuals (9%) who were 65 years or older. White individuals were the largest group, comprising 577 725 cases (77%), with 80 276 Black individuals (10%), 53 456 Hispanic individuals (7%), and 33 324 individuals (4%) in the non-Hispanic other category. The estimated 2010 prevalence of MS per 100 000 US adults cumulated over 10 years was 161.2 (95% CI, 159.8-162.5) for Hispanic individuals (regardless of race), 298.4 (95% CI, 296.4-300.5) for Black individuals, 374.8 (95% CI, 373.8-375.8) for White individuals, and 197.7 (95% CI, 195.6-199.9) for individuals from non-Hispanic other racial and ethnic groups. During the same time period, the female to male ratio was 2.9 overall. Age stratification in each of the racial and ethnic groups revealed the highest prevalence of MS in the 45- to 64-year-old age group, regardless of racial and ethnic classification. With each degree of latitude, MS prevalence increased by 16.3 cases per 100 000 (95% CI, 12.7-19.8; P < .001) in the unadjusted prevalence estimates, and 11.7 cases per 100 000 (95% CI, 7.4-16.1; P < .001) in the direct adjusted estimates. The association of latitude with prevalence was strongest in women, Black individuals, and older individuals. This study found that White individuals had the highest MS prevalence followed by Black individuals, individuals from other non-Hispanic racial and ethnic groups, and Hispanic individuals. Inconsistent racial and ethnic classifications created heterogeneity within groups. In the United States, MS affects diverse racial and ethnic groups. Prevalence of MS increases significantly and nonuniformly with latitude in the United States, even when adjusted for race, ethnicity, age, and sex. These findings are important for clinicians, researchers, and policy makers.

Making Sure Multiple Sclerosis Counts and Is Counted for All—An Update on Multiple Sclerosis Prevalence by Race and Ethnicity in the United States

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Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study

Background and aimsMetabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up. MethodsLongitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years. ResultsWe included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18–34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003–0.118]), body weight (aOR 1.05 [95% CI, 1.007–1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01–1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02–1.16]). On follow-up (n = 100), 13 (13%) had MS. ConclusionsOne in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.

The prevalence of multiple sclerosis in Tehran, Iran, in 2020.

The Article Abstract is not available.

The prevalence and incidence of multiple sclerosis over the past 20 years in northern Japan

The prevalence of multiple sclerosis (MS) in East Asia is thought to be lower than in Western countries. Globally, there is a trend of increasing MS prevalence. We investigated the changes in the prevalence and clinical phenotype of MS in the Tokachi province of Hokkaido in northern Japan, from 2001 to 2021. Data processing sheets were sent to all related institutions inside and outside the Tokachi area of Hokkaido island in Japan and were collected from April to May 2021. The prevalence according to the Poser's diagnostic criteria for MS was determined on March 31, 2021. In 2021, the crude MS prevalence in northern Japan was 22.4/100,000 (95% confidence interval, 17.6-28.0). The prevalences of MS standardized by the Japanese national population in 2001, 2006, 2011, 2016, and 2021 were 6.9, 11.5, 15.3, 18.5, and 23.3, respectively. The female/male ratio was 4.0 in 2021, increased from 2.6 in 2001. We checked the prevalence using the 2017 revised McDonald criteria, and found only additional male patient who had not fulfilled Poser's criteria. The age- and sex-adjusted incidence of MS per 100,000 individuals increased from 0.09 in 1980-1984 to 0.99 in 2005-2009; since then, it has remained stable. The proportions of primary-progressive, relapsing-remitting, and secondary-progressive MS types in 2021 were 3%, 82%, and 15%, respectively. Our results demonstrated a consistent increase in the prevalence of MS among the northern Japanese over 20 years, particularly in females, and consistently lower rates of progressive MS in northern Japan than elsewhere in the world.

Discordant Race and Ethnicity Documentation in the Georgetown Multiple Sclerosis and Neuroimmunology Center (P4-9.005)

<h3>Objective:</h3> We aimed to evaluate the reliability of R/E documentation in the EHR of MedStar Georgetown University Hospital. <h3>Background:</h3> The incidence and prevalence of multiple sclerosis (MS) appears to vary by race and ethnicity (R/E), and prognosis has been reported to be worse in Black and Hispanic/Latinx MS patients compared to White MS patients. Frequently, studies rely on electronic health records (EHR), but discrepancies in R/E documentation may be a potential source of errors in health disparities assessment. <h3>Design/Methods:</h3> Self-reported data from the MS-ADVANCE study at Georgetown University was compared to demographics extracted from the MedStar Georgetown University Hospital EHR. Concordance was defined as the percent agreement between self-reported R/E and R/E demographic information found in the EHR. <h3>Results:</h3> R/E data from 197 participants in the MS-ADVANCE study were analyzed. Most participants self-reported as Non-Hispanic White (n=142), which generally matched EHR documentation (concordance 92.6%). Similarly, 86% of Non-Hispanic Black (n=43) and 100% of Asian individuals (n=2) were accurately identified in the EHR. However, only 2 of 8 self-identified Hispanic/Latinx patients were identified as such in the EHR (concordance 25%). <h3>Conclusions:</h3> This is the first study evaluating concordance of self-reported R/E information compared to EHR documentation in patients with MS. While concordance was generally good in most groups, R/E information in the EHR was often incorrect for Hispanic/Latinx patients. Because most epidemiological analyses extract data from electronic records, this considerable observed discrepancy in R/E documentation may impact our understanding of prevalence, incidence, and prognosis in Hispanic/Latinx individuals with MS. Since obtaining reliable demographic information is crucial to determine quality of care and health outcomes, improvement in data collection is necessary when exploring healthcare disparities in Hispanic/Latinx individuals living with MS. <b>Disclosure:</b> Dr. Manrique has nothing to disclose. Miss Peres Da Silva has nothing to disclose. Dr. Osborne has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Osborne has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Osborne has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myer Squibb. Dr. Osborne has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Horizon. Dr. Osborne has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Peter Angelos Law Firm. Dr. Osborne has received publishing royalties from a publication relating to health care. Dr. Tornatore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Serono. Dr. Tornatore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Tornatore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Tornatore has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Shin has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Shin has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Biogen. Dr. Shin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Shin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Celgene. Dr. Shin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Shin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Shin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mallinckrodt. Dr. Shin has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Shin has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Shin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Shin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Celgene. Dr. Shin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. Dr. Shin has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Shin has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Mallinckrodt.

Association Between TBI Exposure and Multiple Sclerosis Among Post-9/11 Era Veterans (P1-5.027)

<h3>Objective:</h3> Identify associations of traumatic brain injury (TBI) history and subsequent diagnosis of multiple sclerosis (MS). <h3>Background:</h3> MS prevalence has increased since 2013 and has been linked to environmental factors (e.g., smoking history, obesity, Epstein-Barr Virus). More limited data suggest a link between MS and multiple concussions and TBI. This study examined the association of TBI and MS in Post-9/11 era veterans. <h3>Design/Methods:</h3> Our retrospective cohort study included Veterans who received Department of Defense (DoD) care in at least three years FY2000–2019. We identified MS using ICD9 (340) or ICD10 codes (G35). We identified TBI exposure using a hierarchical approach prioritizing data from the DoD Trauma Registry, self-reported loss/alteration of consciousness, or post-traumatic amnesia, and then ICD-9/10 diagnosis. TBI was classified as no TBI, mild TBI, moderate/severe TBI, and penetrating TBI. Index dates were the first date of TBI diagnosis or were simulated by drawing from the distribution of true index dates within age brackets for those without TBI. Other covariates included age, sex, race/ethnicity, health behaviors (e.g., smoking, substance use disorders, overdose, obesity) and comorbid health conditions associated with MS (e.g., depression, anxiety, hypertension, hypercholesterolemia, and chronic lung disease). We conducted competing event (Fine-Gray) analyses examining time from TBI/index day to MS diagnosis. <h3>Results:</h3> Of the 2,291,789 Veterans who met inclusion criteria (mean age=33; SD=11) 16.6% had TBI exposure. Time to MS was fastest for women (HR 2.4; 95%CI 2.2–2.6) and veterans with the following clinical characteristics before index date: stroke (HR 2.1; 95%CI 1.8–2.5), other neurological conditions (HR 2.2; 95%CI 1.8–2.6) and TBI severity (penetrating [HR 1.96; 95%CI 1.5–2.6]; moderate/severe [HR 1.5; 95%CI 1.2–1.8]; mild [HR 1.5; 95%CI 1.3–1.6]). <h3>Conclusions:</h3> Our study found that neurological conditions including TBI were the strongest clinical predictors of MS emergence in this younger Veteran cohort, which should be considered in caring for Post-9/11 Veterans with neurological conditions. <b>Disclosure:</b> The institution of Dr. Pugh has received research support from Department of Defense, Epilepsy Research Program. The institution of Dr. Pugh has received research support from VA Health Services Research and Development Service. The institution of Dr. Pugh has received research support from VA Rehabilitation Research and Development Service. The institution of Dr. Pugh has received research support from Congressionally Directed Research Programs. The institution of Dr. Pugh has received research support from Sanofi. Megan Amuan has nothing to disclose. Dr. Ocier has nothing to disclose. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Romaguera Law Group. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Lewis Brisbois. The institution of Dr. Graham has received research support from Department of Veterans Affairs. Dr. Graham has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with MER (non-profit CME provider). Dr. Graham has received personal compensation in the range of $500,000-$999,999 for serving as a Employee with Department of Veterans Affairs. An immediate family member of Dr. Graham has received personal compensation in the range of $100,000-$499,999 for serving as a Exployee with Department of Veterans Affairs. Dr. Adamson has nothing to disclose.

Disparities in Multiple Sclerosis Mimickers in a Diverse Population of Urban Patients (P9-3.005)

<h3>Objective:</h3> To identify disparities in patients with multiple sclerosis (MS) mimics in a diverse urban population. <h3>Background:</h3> Our institution was ranked among the top five most racially inclusive hospitals in the US in 2021 and 2022. This allows us to analyze health disparities among racially and ethnically diverse populations of patients diagnosed with MS and disorders that mimic MS. To our knowledge, health disparities among patients wrongly suspected of having MS have yet to be studied. <h3>Design/Methods:</h3> We conducted a retrospective chart analysis of 129 patients suspected to have MS and referred to our MS center for evaluation. Our analysis included patients’ demographic, clinical and laboratory/imaging data. Graphpad Prism software was used for statistical analysis. <h3>Results:</h3> Out of 129 patients suspected to have MS, most of them identified themselves as Black (44%), White (28%), and Hispanic (17%). Based on 2017 McDonald diagnostic criteria, MS was not confirmed in 56 patients (43%), further referred to as MS mimics. A higher proportion of White patients were diagnosed with MS mimics than Non-white patients (P=0.031, Chi-square test). The most common MS mimics were nonspecific demyelinating disease (NDD, 9 patients), MOG antibody disease (MOGAD, 7 patients), and Tuberculosis (TB, 6 patients). A TB diagnosis was statistically more prevalent among Black than White non-MS patients (P=0.026). 14% of patients whom we diagnosed with MS mimics were treated with disease modifying therapies (DMTs) prior to their visit in our center. Non-English speakers were disproportionately represented in this group (14% of non-English vs 5% of English speakers, not statistically significant). <h3>Conclusions:</h3> The prevalence of MS mimics is very high in a diverse urban population of patients suspected to have MS. NDD, MOGAD, and TB are the most prevalent MS mimics. Many of these patients were treated with DMTs prior to visit in our center. TB was disproportionally diagnosed among Black non-MS patients. <b>Disclosure:</b> Dr. Balashov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Miss Rubenstein has nothing to disclose.

Sexual Behavior and Multiple Sclerosis (P13-3.018)

<h3>Objective:</h3> We sought to determine if engaging in same-sex high risk sexual behavior correlates with higher likelihood of diagnosis of MS. <h3>Background:</h3> Adolescence is a pivotal time window during which lifestyle and environmental factors impact the lifetime risk of multiple sclerosis (MS). Sexual behavior is one personal factor that is relevant in adolescence and young-adulthood; however, it is unclear the relationship that sexual behavior has to lifetime risk of MS. Early identification and treatment of MS is a crucial factor in predicting health outcomes of patients with MS. <h3>Design/Methods:</h3> This study is a retrospective secondary analysis of cross-sectional data in the TriNetX health database. High risk sexual behavior (HRSB) includes: unprotected intercourse, intercourse under influence of substances, intercourse with persons with intravenous drug use, multiple sexual partners, early age of sexual intercourse, and intercourse with sex workers. ICD-10 separates HRSB into same-sex (Z72.52-53) and opposite-sex (Z72.51) behavior. <h3>Results:</h3> We identified 13,595 males and 9,589 females with same-sex HRSB, and 64,409 males and 137,450 females with opposite-sex HRSB. Cohorts were balanced on age, race, and ethnicity. Males engaging in same-sex behavior had a 2.80-fold higher risk of MS diagnosis (95% CI: 1.66–4.73). Females engaging in same-sex behavior had a 2.30-fold higher risk (95% CI: 1.65–3.20). There was no significant risk difference between adults engaging in any form of high-risk sexual behavior compared to adults not engaging in high-risk sexual behavior (p = 0.41). <h3>Conclusions:</h3> Our findings advance the understanding of MS prevalence in a unique patient population that may be at an increased baseline risk for more negative health outcomes. <b>Disclosure:</b> Mr. Kennis has received personal compensation for serving as an employee of Neurocrine Biosciences. Mr. Hale has nothing to disclose.

Cycling in primary progressive multiple sclerosis (CYPRO): study protocol for a randomized controlled superiority trial evaluating the effects of high-intensity interval training in persons with primary progressive multiple sclerosis

BackgroundPrimary progressive multiple sclerosis (PPMS) is the least prevalent multiple sclerosis (MS) phenotype. For persons with PPMS (pwPPMS), pharmacological treatment options are limited. As a complementary non-pharmacological treatment, endurance training improves the health-related quality of life (HRQoL), numerous MS symptoms, and MS-related performance impediments. High-intensity interval training (HIIT) has been shown to induce superior effects compared to moderate-intensity continuous training (MCT). As current evidence is based on MS samples with mixed phenotypes, generalizability to pwPPMS remains unclear.MethodsCYPRO is a parallel-group, single-center, and single-blind randomized controlled superiority trial evaluating the effects of HIIT compared to MCT in pwPPMS. Sixty-one pwPPMS are randomized (1:1) to perform volume-matched HIIT or MCT sessions on bicycle ergometers two to three times per week in addition to standard rehabilitative care during their three-week inpatient stay at Valens rehabilitation clinic, Switzerland. Standard rehabilitative care comprises endurance and strength training, physiotherapy, and occupational therapy. HIIT sessions include six 90-second intervals at 95% peak heart rate (HRpeak), interspersed by 90-second active breaks with unloaded pedaling, aimed to reach 60%HRpeak. MCT represents the standard treatment at Valens rehabilitation clinic and is performed as continuous cycling at 60%HRpeak for the duration of 26 minutes. The primary outcome is cardiorespiratory fitness, assessed as peak oxygen consumption (V̇O2peak) during cardiopulmonary exercise testing (CPET). Secondary outcomes include peak power output during CPET, walking capacity, cognitive performance, HRQoL, fatigue, anxiety and depressive symptoms, and blood-derived biomarkers (e.g., serum neurofilament light chain, glial fibrillary acidic protein, kynurenine pathway metabolites) related to MS pathophysiology. All outcomes are assessed at baseline and discharge after three weeks. Venous blood sampling is additionally performed immediately and two hours after the first HIIT or MCT session.DiscussionCYPRO will expand current knowledge on symptom management and rehabilitation in MS to the subpopulation of pwPPMS, and will contribute to the exploration of potential disease-modifying effects of endurance training in MS. The superiority design of CYPRO will allow deriving explicit recommendations on endurance training design in pwPPMS that can be readily translated into clinical practice.Trial registrationCYPRO has been prospectively registered at ClinicalTrials.gov on 8 February 2022 (NCT05229861).

Depression status of elderly patients with metabolic syndrome in three provinces of China

Objective: To understand the depression status and its influencing factors in elderly patients with MS in China and to explore the correlation between various components of elderly MS and depression. Methods: This study is based on the "Prevention and Intervention of Key Diseases in Elderly" project. We used a multi-stage stratified cluster random sampling method to complete 16 199 elderly aged 60 years and above in 16 counties (districts) in Liaoning, Henan, and Guangdong Provinces in 2019, excluding 1 001 missing variables. Finally, 15 198 valid samples were included for analysis. The respondents' MS disease was obtained through questionnaires and physical examinations, and the respondents' depression status within the past half month was assessed using the PHQ-9 Depression Screening Scale. The correlation between elderly MS and its components and depression and its influencing factors were analyzed by logistic regression. Results: A total of 15 198 elderly aged 60 years and above were included in this study, with the prevalence of MS at 10.84% and the detection rate of depressive symptoms in MS patients at 25.49%. The detection rates of depressive symptoms in patients with 0, 1, 2, 3, and 4 MS abnormal group scores were 14.56%, 15.17%, 18.01%, 25.21%, and 26.65%, respectively. The number of abnormal components of MS was positively correlated with the detection rate of depressive symptoms, and the difference between groups was statistically significant (P<0.05). The risk of depression symptoms in patients with MS, overweight/obesity, hypertension, diabetes, and dyslipidemia was 1.73 times (OR=1.73, 95%CI:1.51-1.97), 1.13 times (OR=1.13, 95%CI:1.03-1.24), 1.25 times (OR=1.25, 95%CI:1.14-1.38), 1.41 times (OR=1.41, 95%CI:1.24-1.60), 1.81 times (OR=1.81,95%CI:1.61-2.04), respectively, more than those without the disease. Multivariate logistic regression analysis showed that the detection rate of depressive symptoms in patients with sleep disorders was higher than that with normal sleep (OR=4.89, 95%CI: 3.79-6.32). The detection rate of depressive symptoms in patients with cognitive dysfunction was 2.12 times higher than that in the average population (OR=2.12, 95%CI: 1.56-2.89). The detection rate of depressive symptoms in patients with impaired instrumental activities of daily living (IADL) was 2.31 times (OR=2.31, 95%CI: 1.64-3.26) higher than that in the average population. Tea drinking (OR=0.73, 95%CI: 0.54-0.98) and physical exercise (OR=0.67, 95%CI: 0.49-0.90) seemed to be protective factors for depression in elderly MS patients (P<0.05). Conclusions: Older patients with MS and its component abnormalities have a higher risk of depression than the average population. Sleep disorders, cognitive impairment, and IADL impairment are important influencing factors for depression in elderly MS patients, while tea drinking and physical exercise may help to reduce the risk of the disease.

Multiple sclerosis in Indigenous Peoples of the Americas: A systematic review of incidence, prevalence, and outcomes.

The incidence, prevalence and outcomes of multiple sclerosis (MS) are unclear in Indigenous Peoples (IP) who are more likely to be underrepresented in research. We completed a systematic review of MS in IP of the Americas. A systematic review was conducted using PubMed, Web of Science, and Cochrane databases as well as references of retrieved papers. Inclusion criteria were: peer-reviewed publications (January 1990- December 2021), incidence, prevalence, or clinical outcome measures of MS in self-identified IP in the Americas. Incidence, prevalence, morbidity and mortality data were summarized and stratified by location and year of publication. Study quality was evaluated by risk of bias or confounding. Out of 416 titles, thirteen studies met inclusion criteria. Four studies evaluated incidence, seven prevalence, three clinical outcomes and one mortality. Most studies were completed in Canada or the United States (US). Incidence rates per 100,000 ranged from 0.48 (in US Indian Health Service records) to 8.15 (First Nations Manitoban Canadians). Prevalence ranged from 0 (Lacandonian Mexicans and Panamanians) to 188.5 (First Nations Manitoban Canadians). Incidence and prevalence are consistently lower in IP than comparator White populations. IP with MS were reported to have higher disability and faster disability progression than non-Indigenous comparators. MS-related mortality is low compared to White people. There is an absence of high-quality studies evaluating MS in IP. Available evidence indicates low, but increasing incidence and prevalence of MS in IP of the Americas. IP with MS may have worse disability than non-Indigenous comparators. Future studies should evaluate the factors influencing the increases in incidence and prevalence as well as better characterize possible disparities in MS care among IP.

The impact of insulin resistance on the association between metabolic syndrome and lung function: the Kangbuk Samsung Health Study

Background/ObjectiveMetabolic syndrome (MS) is related to lung dysfunction. However, its impact according to insulin resistance (IR) remains unknown. Therefore, we evaluated whether the relation of MS with lung dysfunction differs by IR.Subject/MethodsThis cross-sectional study included 114,143 Korean adults (mean age, 39.6 years) with health examinations who were divided into three groups: metabolically healthy (MH), MS without IR, and MS with IR. MS was defined as presence of any MS component, including IR estimated by HOMA-IR ≥ 2.5. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for lung dysfunction were obtained in MS, MS without IR, and MS with IR groups compared with the MH (reference) group.ResultsThe prevalence of MS was 50.7%. The percent predicted forced expiratory volume in 1 s (FEV1%) and forced vital capacity (FVC%) showed statistically significant differences between MS with IR and MH and between MS with IR and MS without IR (all P < 0.001). However, those measures did not vary between MH and MS without IR (P = 1.000 and P = 0.711, respectively). Compared to MH, MS was not at risk for FEV1% < 80% (1.103 (0.993–1.224), P = 0.067) or FVC% < 80% (1.011 (0.901–1.136), P = 0.849). However, MS with IR was clearly associated with FEV1% < 80% (1.374 (1.205–1.566) and FVC% < 80% (1.428 (1.237–1.647) (all p < 0.001), though there was no evident association for MS without IR (FEV1%: 1.078 (0.975–1.192, P = 0.142) and FVC%: 1.000 (0.896–1.116, p = 0.998)).ConclusionThe association of MS with lung function can be affected by IR. However, longitudinal follow-up studies are required to validate our findings.

Exploring physicians’ prescribing behavior in patients with multiple sclerosis in Saudi Arabia: a sequential explanatory mixed-methods

BackgroundMultiple sclerosis (MS) is the most common disabling neurological disease in young adults worldwide with majority of patients manifest symptoms between 20 and 40 years of age. The aims of this study are to explore physicians’ perspectives, views, and behaviors in diagnosing and treating patients with MS in Saudi Arabia and investigate the prescribing pattern of disease-modifying therapies (DMTs).MethodsA sequential explanatory mixed-method approach was used to achieve the study objectives. The quantitative arm of the study consisted of patient data extracted from the Saudi MS registry from 2015 to 2018. The qualitative study consisted of in-depth semi-structured interviews with physicians using a validated interview topic guide comprising 28 open-ended questions.ResultsWe extracted data of 2,507 patients from 20 different hospitals across Saudi Arabia. Patients’ mean age was 34 ± 10 years; two-thirds (n = 1,668) were female. 92% (n = 2,292) had relapsing-remitting multiple sclerosis, and 5% (n = 126) had secondary-progressive multiple sclerosis. In general, patients with MS received at least one drug as the DMT or DMTs and corticosteroids for those with relapse. Qualitatively, nine physicians agreed to participate in the interviews. Of them, five (55%) were male and four were female from different regions. Thematic analysis yielded three main themes: practice, views, and challenges.ConclusionsThe prevalence of MS in Saudi Arabia is raising but is still much lower than that reported in the Gulf region. A national MS guideline is needed to streamline diagnosis and treatment criteria, avoid any delay in treatment, and guide physicians who provide care for patients with MS.

Melatonin and vitamin D, two sides of the same coin, better to land on its edge to improve multiple sclerosis

Previous studies revealed a latitudinal gradient of multiple sclerosis (MS) prevalence, increasing by moving from the equator to the poles. The duration and quality of an individual’s exposure to sunlight vary with latitude. Skin exposure to sunlight activates vitamin D synthesis, while light absence, as perceived by the eyes, activates melatonin synthesis in the pineal gland. Vitamin D or melatonin deficiency/insufficiency or overdose can occur at any latitude due to specific lifestyles and diets. Moving away from the equator, especially beyond 37°, decreases vitamin D while raising melatonin. Furthermore, melatonin synthesis increases in cold habitats like northern countries. Since melatonin's beneficial role was shown in MS, it is expected that northern countries whose individuals have higher endogenous melatonin should show a lower MS prevalence; however, these are ranked with the highest scores. In addition, countries like the United States and Canada have uncontrolled over-the-counter usage. In high latitudes, vitamin D deficiency and a higher MS prevalence persist even though vitamin D is typically compensated for by supplementation and not sunlight. Recently, we found that prolonged darkness increased MS melatonin levels, mimicking the long-term increase in northern countries. This caused a reduction in cortisol and increased infiltration, inflammation, and demyelination, which were all rescued by constant light therapy. In this review, we explain melatonin and vitamin D's possible roles in MS prevalence. The possible causes in northern countries are then discussed. Finally, we suggest strategies to treat MS by manipulating vitamin D and melatonin, preferably with sunlight or darkness, not supplements.

Common pathogenetic mechanisms in affective disorders and multiple sclerosis: role of interleukin imbalance in the progression of comorbid pathology

Relevance. Among many comorbid pathologies, it is of considerable interest to study and compare the pathogenetic mechanisms of neurological and mental disorders that combine the clinical manifestations of multiple sclerosis (MS) and affective disorders. The high MS prevalence, economic and social significance of the disease, heterogeneity of clinical symptoms, an unfavorable progressive course, as well as the frequent combination of this pathology with various forms of hypothymic disorders determine the relevance of studying the common pathogenetic mechanisms for the development of this comorbid pathology, which is necessary for the development of effective and safe preventive medical activities. The purpose of the review is to determine the common immunopathological mechanisms of affective disorders and multiple sclerosis, to analyze the role of cytokine status imbalance in the mutual increase in the severity of clinical symptoms in comorbid pathology, and to identify prognostic markers of disease progression. Materials and methods. On the basis of electronic Russian and foreign databases for the period 2017–2022, a theoretical analysis of the pathophysiological mechanisms of autoimmune CNS damage in MS and affective disorders was carried out. In order to search for literary sources, the following resources were used: https://elibrary.ru/, https://www.ncbi.nlm.nih.gov/pubmed/, https://cyberleninka.ru/. 10 Russian and 25 foreign sources were cited. Results. The mechanisms of development of mental affective disorders and multiple sclerosis have common pathogenetic features and are characterized by a violation of pro-inflammatory cytokine reactions and autoimmune nature of changes in the structures of the central nervous system (CNS). The similarity of immunological disorders underlying the pathogenesis of various forms of multiple sclerosis and affective disorders is of undoubted interest in terms of developing common approaches to the prevention and treatment of detectable interleukin status imbalance in neurological and mental diseases. Conclusion. Identification of mutually reinforcing changes in interleukin status and determination of the features of the course of immune imbalance in multiple sclerosis and hypothymic disorders in various pathologies of the mental sphere are necessary for a deeper understanding of neuroimmune interactions.

Multiple sclerosis mortality in New Zealand: a nationwide prospective study

BackgroundMortality data from Europe and North America show a shorter life expectancy for people with multiple sclerosis (MS). It is not known if a similar mortality risk exists in the...

Epidemiological and Immune Profile Analysis of Italian Subjects with Endometriosis and Multiple Sclerosis

To report for the first time an Italian epidemiological analysis of the prevalence of multiple sclerosis (MS) in patients with endometriosis (EMS), through the study of the endometriosis population of our referral center; to analyze the clinical profile and perform a laboratory analysis to examine the immune profile and the possible correlation to other autoimmune diseases of the enrolled patients. We evaluated 1652 women registered with EMS in the University of Naples Federico II and retrospectively searched patients with a co-diagnosis of MS. Clinical features of both conditions were recorded. Serum autoantibody and immune profiles were analyzed. 9 out of 1652 patients presented a co-diagnosis of EMS and MS (9/1652 = 0.005%). Clinically, EMS and MS presented in mild forms. Hashimoto's thyroiditis was found in two patients (2/9). Even if not statistically significant, a trend of variation in CD4- CD8 T lymphocytes and of B cells were found. Our findings suggest an increased risk of MS in women with EMS. However, large-scale prospective studies are needed.