Characteristics of multiple sclerosis in aboriginals living in British Columbia, Canada

Objectives: The objectives of this study were to identify and describe the demographic and clinical characteristics of multiple sclerosis (MS) in aboriginals in British Columbia (BC), Canada and compare these findings with non-aboriginal MS patients. Methods: This retrospective chart and database review accessed patient information from the linked BC-wide MS clinical and genetics databases. Data gathered included: demographics (age, sex and ethnicity); clinical characteristics (MS onset date, disease course and disability scores (Expanded Disability Status Scale [EDSS]). Aboriginals were identified via the database linkage augmented by physician and nurse recall. Two non-aboriginal comparator groups with definite MS were selected. Group one included all definite MS patients in the BC MS database, and group two comprised MS patients matched by sex, age at onset and initial disease course. Patient characteristics were compared using the Student’s t-test, chi-squared test, and Kaplan–Meier survival analysis was used to examine disease progression (time to sustained and confirmed EDSS 6) Results: We identified 26 aboriginals with MS, of which 19/26 (73%) were female, 23/26 (89%) had relapsing-onset MS and a mean onset age of 31.1 years. There were no significant differences between the MS aboriginals and the non-matched ( n = 5708) comparator group with respect to age, sex or disease course ( p > 0.1), However, aboriginals progressed more rapidly to EDSS 6 from disease onset ( p < 0.001) when compared with the matched and unmatched comparator groups. Conclusion: We identified a small, but important cohort of aboriginals with MS; being the largest identified to date. There was evidence of more rapid MS progression in aboriginals compared with non-aboriginals.

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Age at onset as a determinant of presenting phenotype and initial relapse recovery in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458511417479 ◽

2011 ◽

Vol 18 (1) ◽

pp. 45-54 ◽

Cited By ~ 52

Author(s):

M Cossburn ◽

G Ingram ◽

C Hirst ◽

Y Ben-Shlomo ◽

TP Pickersgill ◽

...

Keyword(s):

Multiple Sclerosis ◽

Late Onset ◽

Age At Onset ◽

Disease Onset ◽

Complete Recovery ◽

Population Based ◽

Disease Course ◽

Index Event ◽

Relapsing Remitting ◽

Age Dependent

Background: Age at onset modifies prognosis in multiple sclerosis (MS) and may also exert an effect on the characteristics of disease ignition. Understanding how age influences presentation informs disease management and may allow differentiation of distinct clinical sub-groups. Objectives: To determine the nature of age-specific presentations of relapsing–remitting MS (RRMS) with respect to onset symptoms, gender ratios and index event outcomes. Methods: In a prospective, population-based sample of 1424 patients in South-East Wales we examined associations between age at onset, clinical features and outcome of the onset event, making specific comparisons between paediatric, adolescent and late-onset MS. Results: Age at onset varied significantly between sexes (Male 31.2, Female 29.3, p = 0.002), 0.7% had paediatric onset, 2.7% adolescent onset and 2.8% late-onset MS (>50 years). Optic neuritis was common in younger patients and declined after age 30. Lower limb motor, facial sensory, sexual and sphincteric symptoms rose with age independent of sex and disease course. F:M ratios were highest <16 years of age and declined with increasing age, with a male excess in those over 50. Probability of complete recovery from index event declined with age from 87.4% in the youngest group to 68% in the eldest ( p = 0.009). Conclusions: Age at disease onset in RRMS exerts a significant effect on gender ratios and presenting phenotype, and allows identification of specific clinical sub-groups. In addition, ability to recover from initial relapse declines with age, suggesting accumulation of disability in MS is an age-dependent response to relapse.

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Late onset multiple sclerosis: concerns in aging patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170070 ◽

2017 ◽

Vol 75 (7) ◽

pp. 451-456 ◽

Cited By ~ 6

Author(s):

Claudia Beatriz de Campos Lotti ◽

Acary Souza Bulle Oliveira ◽

Denis Bernardi Bichuetti ◽

Isac de Castro ◽

Enedina Maria Lobato Oliveira

Keyword(s):

Multiple Sclerosis ◽

Medical Records ◽

Clinical Characteristics ◽

Matched Control ◽

Late Onset ◽

Age At Onset ◽

Control Group ◽

Disease Course ◽

Matched Control Group ◽

Progressive Course

ABSTRACT Late onset multiple sclerosis (LOMS) is when the first symptom starts after 50 years of age, representing 4.5% of multiple sclerosis (MS) patients. This study describes the clinical characteristics of patients with LOMS followed at a specialized MS center in São Paulo. Data was obtained from medical records of 742 patients with MS. The LOMS frequency was 4.18%, median age at onset was 54 years and the predominant disease course was primary progressive (64.3%). The patients reached the disability landmarks of EDSS grades 3.0, 6.0 and 7.0 in the following proportion and time: EDSS 3.0: 77.42% of patients in 3.7 years; EDSS 6.0: 58.06% in 5.1 years and EDSS 7.0: 32.26% in 5.7 years. The comparative analysis with a matched control group of patients with early onset MS showed that late onset, associated with a progressive course, were predictors of reaching EDSS 3.0 and 6.0 in a shorter time.

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Multiple Sclerosis in Malaysia: Demographics, Clinical Features, and Neuroimaging Characteristics

Multiple Sclerosis International ◽

10.1155/2013/614716 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

S. Viswanathan ◽

N. Rose ◽

A. Masita ◽

J. S. Dhaliwal ◽

S. D. Puvanarajah ◽

...

Keyword(s):

Multiple Sclerosis ◽

Neuromyelitis Optica ◽

Demyelinating Disease ◽

Age At Onset ◽

Positive Family History ◽

Disease Onset ◽

Demyelinating Diseases ◽

Lesion Length ◽

Relapsing Remitting ◽

Spectrum Disorders

Background. Multiple sclerosis (MS) is an uncommon disease in multiracial Malaysia. Diagnosing patients with idiopathic inflammatory demyelinating diseases has been greatly aided by the evolution in diagnostic criterion, the identification of new biomarkers, and improved accessibility to neuroimaging in the country.Objectives. To investigate the spectrum of multiple sclerosis in Malaysia.Methods. Retrospective analysis with longitudinal follow-up of patients referred to a single tertiary medical center with neurology services in Malaysia.Results. Out of 245 patients with idiopathic inflammatory demyelinating disease, 104 patients had multiple sclerosis. Female to male ratio was 5 : 1. Mean age at onset was 28.6 ± 9.9 years. The Malays were the predominant racial group affected followed by the Chinese, Indians, and other indigenous groups. Subgroup analysis revealed more Chinese having neuromyelitis optica and its spectrum disorders rather than multiple sclerosis. Positive family history was reported in 5%. Optic neuritis and myelitis were the commonest presentations at onset of disease, and relapsing remitting course was the commonest disease pattern observed. Oligoclonal band positivity was 57.6%. At disease onset, 61.5% and 66.4% fulfilled the 2005 and 2010 McDonald’s criteria for dissemination in space. Mean cord lesion length was 1.86 ± 1.65 vertebral segments in the relapsing remitting group as opposed to 6.25 ± 5.18 vertebral segments in patients with neuromyelitis optica and its spectrum disorders.Conclusion. The spectrum of multiple sclerosis in Malaysia has changed over the years. Further advancement in diagnostic criteria will no doubt continue to contribute to the evolution of this disease here.

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Clinical characteristics and genetic analyses of 187 patients with undefined autoinflammatory diseases

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-214472 ◽

2019 ◽

Vol 78 (10) ◽

pp. 1405-1411 ◽

Cited By ~ 12

Author(s):

Nienke M Ter Haar ◽

Charlotte Eijkelboom ◽

Luca Cantarini ◽

Riccardo Papa ◽

Paul A Brogan ◽

...

Keyword(s):

Genetic Variants ◽

Clinical Characteristics ◽

Disease Onset ◽

Clinical Information ◽

Large Cohort ◽

Autoinflammatory Diseases ◽

Disease Course ◽

Intellectual Impairment ◽

Web Based ◽

Inflammatory Drugs

ObjectivesTo describe the clinical characteristics, treatment response and genetic findings in a large cohort of patients with undefined systemic autoinflammatory diseases (SAIDs).MethodsClinical and genetic data from patients with undefined SAIDs were extracted from the Eurofever registry, an international web-based registry that retrospectively collects clinical information on patients with autoinflammatory diseases.ResultsThis study included 187 patients. Seven patients had a chronic disease course, 180 patients had a recurrent disease course. The median age at disease onset was 4.3 years. Patients had a median of 12 episodes per year, with a median duration of 4 days. Most commonly reported symptoms were arthralgia (n=113), myalgia (n=86), abdominal pain (n=89), fatigue (n=111), malaise (n=104) and mucocutaneous manifestations (n=128). In 24 patients, relatives were affected as well. In 15 patients, genetic variants were found in autoinflammatory genes. Patients with genetic variants more often had affected relatives compared with patients without genetic variants (p=0.005). Most patients responded well to non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, colchicine and anakinra. Complete remission was rarely achieved with NSAIDs alone. Notable patterns were found in patients with distinctive symptoms. Patients with pericarditis (n=11) were older at disease onset (33.8 years) and had fewer episodes per year (3.0/year) compared with other patients. Patients with an intellectual impairment (n=8) were younger at disease onset (2.2 years) and often had relatives affected (28.6%).ConclusionThis study describes the clinical characteristics of a large cohort of patients with undefined SAIDs. Among these, patients with pericarditis and intellectual impairment appear to comprise distinct subsets.

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Demographic Factors Associated with Insertional and Noninsertional Achilles Tendinopathy

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00275 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Matt Levitsky ◽

Justin Greisberg ◽

J Turner Vosseller ◽

Shirin Dey ◽

Briana Hickey

Keyword(s):

Physical Examination ◽

Medical Center ◽

Academic Medical Center ◽

Patient Characteristics ◽

Antibiotic Use ◽

Achilles Tendinopathy ◽

Insertional Tendinopathy ◽

Chi Squared ◽

The Mean ◽

Student’S T

Category: Sports Introduction/Purpose: Achilles tendinopathy is a common clinical entity encountered by orthopaedic surgeons, although the demographics of patients that suffer from this pathology are incompletely understood. It has been suggested that there may be differences in patients that get insertional (IAT) and noninsertional Achilles tendinopathy (NIAT), and our clinical experience has been that older, less active patients tend to get insertional tendinopathy. The goal of this study is to further investigate the features of patients in a single institution who presented with Achilles tendinopathy. Methods: We used ICD-9 and ICD-10 codes to find patients who presented with Achilles tendinopathy to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, medical comorbidities, and level of activity. Physical examination, including the presence of a gastrocnemius equinus, was noted as well. Characteristics of insertional and non-insertional tendinopathy subgroups were compared using Student’s T-tests and chi- squared tests. Results: The characteristics of 948 consecutive patients were analyzed. The mean age was 55 years and 50.5% of the patients were male. Patients with IAT had significantly higher BMIs than did those with NIAT (30.5 compared to 28.0, p < .05). The mean age was 54.5 years in the IAT group compared to 55.8 years in the NIAT group (p>.05). Patients with NIAT self-identified as active a greater percentage of the time (63% vs 45%, p<0.5). 76% of the IAT group had a gastrocnemius equinus on physical examination, compared to 67% of the non-insertional group. Antecedent fluoroquinolone antibiotic use was only reported in 10% of patients, and all of these patients presented with NIAT. Conclusion: The age at which patients present with insertional and noninsertional Achilles tendinopathy is not significantly different, although patients with NIAT had a lower BMI and self-identified as active a greater percentage of the time. A gastrocnemius equinus was present in a high percentage of patients with both IAT and NIAT. Fluoroquinolone use was not involved in most cases, although, when it was, patients presented with NIAT.

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MANAGEMENT AND OUTCOME OF STAGE I SEMINOMA IN ONTARIO.

Clinical & Investigative Medicine ◽

10.25011/cim.v31i4.4786 ◽

2008 ◽

Vol 31 (4) ◽

pp. 2

Author(s):

Howard H An ◽

Paul Y Peng ◽

William J Mackillop

Keyword(s):

Testicular Cancer ◽

Patient Outcomes ◽

Management Strategies ◽

Patient Characteristics ◽

Population Based ◽

Stage I ◽

Adjuvant Radiation ◽

Chi Squared ◽

Stage I Seminoma ◽

Student’S T

Purpose: To describe the uptake and use of surveillance andirradiation in stage I seminoma post-orchiectomy in Ontario and to evaluate theimpact of these management strategies on patient outcomes. Background: Testicular cancer is the most common cancer in menbetween the ages of 20 and 44 (1). About half of testicular cancers areseminomas (2). Overall 85% of seminoma patients present with stage I disease with10-year survival over 99%. Adjuvant radiation therapy once constituted thestandard of care but surveillance as a post-orchiectomy management strategy isnow preferred in Ontario (3). Treatment with radiation results in importantlong-term toxicities (2). The actual management patterns and the effect ofthese patterns on seminoma patient outcomes is unknown. This will be the firstphase IV study to describe the management of stage I seminoma and to evaluateit’s effect on patient outcomes. Methods: This is a retrospective, population based cohort studyof seminoma patients in Ontario. Cases of seminoma are identified through theOntario Cancer Registry and linked with patient data from the CanadianInstitute of Health Information and Ontario radiotherapy data. An instrumentalvariable approach will be taken with time and location of treatment as theinstruments. Mantel-Haensel Chi-Squared tests, Student’s T-test, and Log ranktests will be used to find differences in patient characteristics, morbidity andsurvival. The Kaplan-Meier method will be used to model overall survival. Results and Conclusions:Pending data analysis. References: 1. Warde P, Srugeon J,Gospodarowicz M. Testicular Cancer. In: Gunderson L, Tepper J, eds. Clinicalradiation oncology. Philadelphia: Chruchill Livingstone; 2000: 844-862. 2. Nichols CR, Hung A, Corless CL, Foster RS, Roth BJ, Einhorn LH.Testis cancer. In: Kufe DW, Frei III E, Holland JF, Weichselbaum RR, PollockRE, Bast Jr RC, Hong WK, Hait WN, eds. Holland-Frei cancer medicine – 7^thEd.[e-book], Columbia: BC Decker; 2006 [cited 2008 Mar 17]: ch. 99. Availablefrom: Stat!Ref. 3. Chung P, Mayhew LA, Warde P, Winquist E, Lukka H et al. Management of stage I seminoma: Guidelinerecommendations. Cancer Care Ontario, Evidence-Based Series #3-18: Section1; Report date: 30 Jan 2008.

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Effects of Age and Disease Duration on Excess Mortality in Patients With Multiple Sclerosis From a French Nationwide Cohort

Neurology ◽

10.1212/wnl.0000000000012224 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012224

Author(s):

Fabien ROLLOT ◽

Mathieu Fauvernier ◽

Zoe Uhry ◽

Sandra Vukusic ◽

Nadine Bossard ◽

...

Keyword(s):

Multiple Sclerosis ◽

Excess Mortality ◽

Disease Duration ◽

Age At Onset ◽

Disease Onset ◽

Death Rates ◽

Excess Death ◽

Clinical Onset ◽

Lost To Follow Up ◽

The Impact

ObjectiveTo determine the effects of current age and disease duration on excess mortality in multiple sclerosis, we described the dynamics of excess deaths rates over these two time scales and studied the impact of age at multiple sclerosis clinical onset on these dynamics, separately in each initial phenotype.MethodsWe used data from 18 French multiple sclerosis expert centers participating in the Observatoire Français de la Sclérose en Plaques. Patients with multiple sclerosis living in metropolitan France and having a clinical onset between 1960 and 2014 were included. Vital status was updated on January 1st, 2016. For each multiple sclerosis phenotype separately (relapsing onset (R-MS) or primary progressive (PPMS)), we used an innovative statistical method to model the logarithm of excess death rates by a multidimensional penalized spline of age and disease duration.ResultsAmong 37524 patients (71% women, mean age at multiple sclerosis onset ± standard deviation 33.0 ± 10.6 years), 2883 (7.7%) deaths were observed and 7.8% of patients were lost-to-follow-up. For R-MS patients, there was no excess mortality during the first 10 years after disease onset; afterwards, whatever age at onset, excess death rates increased with current age. From current age 70, the excess death rates values converged and became identical whatever the age at disease onset, which means that disease duration had no more impact. Excess death rates were higher in men with an excess hazard ratio of 1.46 (95% confidence interval 1.25-1.70). In contrast, in PPMS patients, excess death rates rapidly increased from disease onset, and were associated with age at onset, but not with sex.ConclusionsIn R-MS, current age has a stronger impact on multiple sclerosis mortality than disease duration while their respective effects are not so clear in PPMS.

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Clinical, Biochemical and Imaging Parameters that may be Predictive of High Disease Activity, Rapid Progression or Increased Disability in Multiple Sclerosis

European Neurological Review ◽

10.17925/enr.2013.08.s1.10 ◽

2013 ◽

Vol 8 ((Suppl.1)) ◽

pp. 10

Author(s):

Anders Svenningsson ◽

Barry A Hendin ◽

◽

Keyword(s):

Multiple Sclerosis ◽

Age At Onset ◽

Scoring Systems ◽

Predictive Biomarker ◽

Individual Characteristics ◽

Response To Treatment ◽

Prognostic Indicators ◽

Rapid Progression ◽

Disease Course ◽

Alternative Means

Increased ability to predict disease course and response to disease-modifying therapies in multiple sclerosis (MS) would optimise treatment outcomes by guiding selection of patients for a particular therapeutic intervention. Several factors affecting disease progression have been identified, including individual characteristics such as age at onset and race onset of symptoms, early disease outcomes and radiological measures. While studies of magnetic resonance imaging (MRI) prognostic indicators have given mixed results, advances in technology are increasing the predictive power of MRI, and new techniques and outcome measures are providing alternative means of predicting disease course and response to treatment. The search for a predictive biomarker is an area of active research but studies remain poorly validated. Potential biomarkers include neurofilament proteins, microRNAs, gene expression and antibodies. Since it is unlikely that a single factor may predict disease course, a number of composite scoring systems have been proposed, but none have yet received widespread acceptance. However, it seems likely that in the future, a combination of MRI and biochemical biomarkers will provide a foundation for therapeutic decision-marking in MS allowing an individualised approach.

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Causes of delayed diagnosis of multiple sclerosis in egypt

QJM ◽

10.1093/qjmed/hcaa054.011 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A A Tohamy ◽

M S Swelam ◽

D M Abdelgawad ◽

H A Aref

Keyword(s):

Multiple Sclerosis ◽

Age At Onset ◽

Disease Onset ◽

Diagnostic Delay ◽

Delayed Diagnosis ◽

P Value ◽

Common Source ◽

University Hospitals ◽

Phone Calls ◽

Diagnostic Delays

Abstract © 2018 Institute of Psychiatry, Ain Shams University Copyright r 2018 Institute of Psychiatry, Ain Shams University. Unauthorized reproduction of this article is prohibited. Background MS is an inflammatory and neurodegenerative disease. Early inflammatory activity might have a profound impact on the risk of developing early disability, and might be a risk factor for early transition into the progressive phase of the illness. However, there are a number of barriers implementing early MS diagnosis and treatment as the patients may delay consulting a physician about their neurological symptoms or may be reluctant to start DMT. Objective The aim of this study is to highlight the causes of delayed diagnosis of multiple sclerosis in Egypt to shorten the time of diagnosis and improve the prognosis for patients with MS. Patients and Methods Retrospective descriptive study .500 Patients coming to multiple sclerosis unit at Ain Shams University hospitals with delayed diagnosis of MS for more than 2 years had been screened. A questionnaire could be applied on 320 patients out of 500. Contacting (direct and via phone calls) the patients for evaluating the causes of delayed diagnosis of MS was done. Results In this study we found number of significant factors adversely affected a timely diagnosis including the age at onset finding that those younger at onset of MS (vs. older) experienced diagnostic delays (P-value = 0.005) and denial of symptoms which was a leading cause for delayed time to first doctor consultation and delayed diagnosis of MS (P-value =0.009). Also there was a correlation between types of MS and delayed diagnosis as we found that PPMS versus RRMS had delayed diagnosis for more than 2 years. Meanwhile, sensory symptoms at onset of the disease were associated with longer diagnostic delay. Although the first specialties the patients visit were ophthalmology and orthopedic services, that the most common Source of referral to a neurologist was suggestion by family and media. Conclusion multiple causes significantly affect time to diagnosis of MS including age at onset of the disease, denial of symptoms sensorial symptoms at the disease onset and referral delay from other specialties.

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Menarche increases relapse risk in pediatric multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458515581873 ◽

2015 ◽

Vol 22 (2) ◽

pp. 193-200 ◽

Cited By ~ 26

Author(s):

Sabeen Lulu ◽

Jennifer Graves ◽

Emmanuelle Waubant

Keyword(s):

Multiple Sclerosis ◽

Sex Ratio ◽

Clinical Features ◽

Regression Models ◽

Disease Onset ◽

Disease Course ◽

Pediatric Multiple Sclerosis ◽

Males And Females ◽

Age Of Menarche

Background: Multiple sclerosis (MS) predominantly affects women with a sex ratio of 3:1 in contrast with a 1:1 sex ratio seen in pre-pubertal onset. Thus, puberty may influence MS risk differentially in males and females. How puberty may be associated with MS clinical features and disease course remains unknown. Objective: The objective of this paper is to determine the association of menarche with disease course in girls with MS. Methods: This is a longitudinal retrospective study from the UCSF Regional Pediatric MS Center database. We categorized patients by time of disease onset: pre-menarche, peri-menarche and post-menarche. Poisson regression models were used for within-subject relapse analyses offset by follow-up time. Results: Seventy-six girls were included (pre-menarche onset = 17; peri-menarche onset = 9; post-menarche onset = 50). Age of menarche was similar in all groups (Kruskal-Wallis p = 0.19). Relapse rate was the same in all three groups during the first two years of follow-up. In girls with follow-up overlapping at least two time periods, within-subject analyses showed increased relapses during the peri-menarche compared to post-menarche period (adjusted IRR = 8.5, 95% CI 2.5–28.7, p = 0.001). Conclusion: Pubertal status may influence MS course at least in female patients. Understanding how puberty influences MS clinical features may offer new insights into important factors regulating disease processes.

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