Increased incidence of multiple sclerosis in the Veneto region, Italy

Background: To what extent the progressive increase in the incidence of multiple sclerosis (MS) observed in the province of Padova over the period 1970–1999 was an expression of a real increased risk of developing MS remained unclear. Objective: The objective of this paper is to update the epidemiological figures of MS and probe whether the risk of having MS has increased in the province of Padova during the decade 2000–2009. Methods: All patients born in Italy and having a diagnosis of MS or possible MS identified through analysis of all available sources of information were included in the study. The incidence and prevalence rates between 2000 and 2009 were obtained and compared with our previously published data. Results: On 31 December 2009, the overall prevalence was 139.5/100,000, 192.0±9.5 for females and 83.9±6.3 for males. During the decade 2000–2009, the overall incidence rate of MS was 5.5±0.5, 7.4±0.8 for females and 3.5±0.6 for males. The onset-diagnosis delay, the female/male ratio and the mean age at onset did not significantly change compared to the prior period of observation. Conclusion: Our findings support the hypothesis of a real increased risk of developing MS in the province of Padova. Moreover, the actual prevalence of 1.4/1000 makes our region a high-risk geographical area for MS. The role played by exogenous factors in determining susceptibility to MS needs to be thoroughly investigated.

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Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era

Neurology ◽

10.1212/wnl.0000000000005065 ◽

2018 ◽

Vol 90 (10) ◽

pp. e840-e846 ◽

Cited By ~ 41

Author(s):

Raed Alroughani ◽

Maryam S. Alowayesh ◽

Samar F. Ahmed ◽

Raed Behbehani ◽

Jasem Al-Hashel

Keyword(s):

Multiple Sclerosis ◽

Age At Onset ◽

Cross Sectional Study ◽

Cross Sectional ◽

Increased Risk ◽

Pregnancy And Postpartum ◽

Prior Use ◽

The Mean ◽

New Treatment ◽

The Relationship

ObjectiveTo determine the rate of relapse occurrence during pregnancy and postpartum.MethodsIn a cross-sectional study using the national multiple sclerosis (MS) registry, pregnant women with relapsing MS were identified. Data on demographics, clinical characteristics, and disease-modifying therapies (DMTs), including washout periods, were collected. Timings and durations of relapses were extracted. A multivariate logistic regression was used to assess the relationship between relapses and prior use of different DMTs.ResultsCompleted data were available for 99 pregnancies (87 patients). Mean age and mean age at onset were 31.8 ± 5 and 24.4 ± 5.6 years, respectively, while the mean disease duration was 7.4 ± 4.6 years. Most pregnancies (89.9%) occurred in patients who were on DMTs in the year preceding pregnancy with a mean treatment duration of 63.4 ± 29 months. The rates of occurrence of relapses during pregnancy and postpartum were 17.2% and 13.7%, respectively. Most of the relapses occurred during the first (n = 6) and third (n = 7) trimesters. Rate of relapse was highest among patients receiving natalizumab and fingolimod before pregnancy. A longer washout period was significantly associated with relapse occurrence.ConclusionThe relapse occurrence during pregnancy is higher than the previously published rates. The use of high-efficacy therapies with long washout periods before conception was associated with an increased risk of relapses during pregnancy. Postpartum relapse occurrence was similar to that in previous reports.

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Higher weight in adolescence and young adulthood is associated with an earlier age at multiple sclerosis onset

Multiple Sclerosis Journal ◽

10.1177/1352458514555787 ◽

2014 ◽

Vol 21 (7) ◽

pp. 858-865 ◽

Cited By ~ 38

Author(s):

Katelyn S Kavak ◽

Barbara E Teter ◽

Jesper Hagemeier ◽

Karen Zakalik ◽

Bianca Weinstock-Guttman ◽

...

Keyword(s):

Multiple Sclerosis ◽

Young Adulthood ◽

Symptom Onset ◽

Age At Onset ◽

Early Adulthood ◽

New York State ◽

Disease Onset ◽

Future Research ◽

Increased Risk ◽

Adolescence And Young Adulthood

Background: Growing evidence suggests an association between adolescent obesity and increased risk of multiple sclerosis (MS). Objective: The objective of this paper is to investigate whether weight or body mass index (BMI) in adolescence and young adulthood was associated with age at MS symptom onset. Methods: Our cohort is comprised of a sub-group of 184 women enrolled in the New York State MS Consortium registry. Individuals were asked to recall their weight at the time of first menstruation and at age 25. BMI was calculated accordingly for age 25. Regression analyses were carried out to investigate the association between weight or BMI and age at onset. Results: Weight at menarche was significantly related to younger age at symptom onset (β = −0.073, p = 0.001). These results were also found at age 25 for weight (β = −0.080, p < 0.001) and BMI (β = −0.448, p = 0.001). Significantly earlier disease onset (26.9 years ±9.9) was observed in individuals who were overweight at 25 compared to those who were not overweight (32.1 years ±9.2, p = 0.006). Conclusions: Women who reported higher weight in adolescence and BMI in early adulthood were younger at MS onset. Future research should investigate whether there is a causal link between body weight and MS, as prevention lifestyle and dietary interventions could be implemented.

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COVID-19 in two patients with multiple sclerosis treated with beta interferons

Pharmacotherapy in Psychiatry and Neurology ◽

10.33450/fpn.2020.12.004 ◽

2021 ◽

Vol 36 (4) ◽

pp. 327-334

Author(s):

Karolina Kania ◽

Elżbieta Tokarz-Kupczyk ◽

Alicja Kalinowska-Łyszczarz

Keyword(s):

Multiple Sclerosis ◽

Interferon Beta ◽

Medical Literature ◽

Case Reports ◽

Published Data ◽

Clinical Experiences ◽

Disease Modifying Therapy ◽

Increased Risk ◽

Disease Modifying ◽

Benign Course

Objectives. Treatment of multiple sclerosis (MS) in the era of the COVID-19 (coronavirus disease 2019) pandemic raises many questions for doctors. Case reports. We are presenting two cases of patients suffering from multiple sclerosis (MS) treated with interferon beta-1b and interferon beta-1a, who suffered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with a benign course in one case and an asymptomatic one in another. None of the patients required hospitalisation. Conclusions. MS treatment during coronavirus disease 2019 (COVID-19) pandemics poses several questions. Considering our own clinical experiences, we present a brief review of medical literature on the safety of MS immunotherapy. So far, the published data on MS and COVID-19 do not show increased risk associated with MS diagnosis or disease modifying therapy, even when associated with immunosuppression.

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

Neuroepidemiology ◽

10.1159/000511205 ◽

2020 ◽

Vol 54 (6) ◽

pp. 472-481

Author(s):

Saeed Akhtar ◽

Jarrah Al-Abkal ◽

Raed Alroughani

Keyword(s):

Multiple Sclerosis ◽

Regression Analysis ◽

Age At Onset ◽

Joinpoint Regression ◽

Annual Percent Change ◽

Joinpoint Regression Analysis ◽

Increased Risk ◽

Increasing Trend ◽

Increasing Trends ◽

Incident Cases

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.

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IgG index and not serum 25-hydroxyvitamin D is associated with age at onset of multiple sclerosis.

10.1101/2021.05.31.21258017 ◽

2021 ◽

Author(s):

Pernilla Stridh ◽

Ingrid Kockum ◽

Jesse Huang

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Random Distribution ◽

Age At Onset ◽

Disease Onset ◽

Hydroxyvitamin D ◽

Increased Risk ◽

Igg Index ◽

25 Hydroxyvitamin D ◽

The Relationship

Background Vitamin D deficiency is associated with an increased risk of multiple sclerosis (MS). However, its effect on the age of disease onset remains unclear. This study examines the relationship between serum 25 hydroxyvitamin D (25(OH)D) levels and age of first symptom onset among recently diagnosed MS patients. Method Serum 25(OH)D was measured from forty MS patients sampled near disease onset. After correcting seasonal variability, a multivariable linear regression was used to examine associations to age at onset. Results Serum 25(OH)D was not correlated with age at onset (P>0.5). However, CSF IgG index was lower among patients with later disease onset (B=-5.35, P=0.028). Furthermore, we observed bias resulting from non-random distribution of sampling by season, which after correcting indicates a higher 25(OH)D level among patients sampled at relapse compared to remission, instead of lower as previously reported. Conclusion In summary, serum 25(OH)D was not associated with the age at onset.

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Functional electrical stimulation for foot drop in people with multiple sclerosis: The relevance and importance of addressing quality of movement

Multiple Sclerosis Journal ◽

10.1177/1352458520923958 ◽

2020 ◽

pp. 135245852092395

Author(s):

Angela Davies Smith ◽

Terezie Prokopiusova ◽

Rosemary Jones ◽

Tania Burge ◽

Kamila Rasova

Keyword(s):

Multiple Sclerosis ◽

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Foot Drop ◽

Published Data ◽

Activity Levels ◽

Mobility Impairment ◽

Increased Risk ◽

Risk Of Falls ◽

Quality Of Movement

Impaired mobility is common in people with multiple sclerosis (MS). Changes in gait have different causes and require individualised gait rehabilitation. A common and often early cause of mobility impairment is footdrop, inability to lift the foot during the swing phase of gait, with increased risk of falls, effortful walking and fatigue. Using literature review, we have characterised published data on footdrop treatment in MS, specifically functional electrical stimulation (FES) to better understand the reported outcomes relevant to the user. We discuss the strengths and weaknesses of FES and how far it meets the needs of people with footdrop. Physiotherapy combined with FES may further enhance the benefits of FES. MS studies emphasise the value of maintaining activity levels in early MS but discussion on how to achieve this is lacking. We emphasise the value of qualitative measures to broaden our understanding and improve treatment and adherence and identify areas for further research. Supplementary video material illustrates key features of MS gait and its correction using FES and physiotherapy.

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No major association of A poE genotype with disease characteristics and MRI findings in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458504ms1010oa ◽

2004 ◽

Vol 10 (3) ◽

pp. 272-277 ◽

Cited By ~ 24

Author(s):

J NP Zwemmer ◽

T van Veen ◽

L van Winsen ◽

G J van Kamp ◽

F Barkhof ◽

...

Keyword(s):

Multiple Sclerosis ◽

Disease Severity ◽

Disease Susceptibility ◽

Age At Onset ◽

Clinical Findings ◽

Minor Role ◽

Published Data ◽

Genotype Distribution ◽

Mri Findings ◽

A Minor

Background: Whereas a number of studies suggest that the A poE polymorphism is not associated with disease susceptibility in multiple sclerosis (MS), results with regard to disease severity, however, are conflicting. Some studies suggest an unfavourable role of the 4 allele. This study was performed to assess the association of the A poE polymorphism with both disease susceptibility and disease course in a large group of MS patients using clinical and MRI measures. In addition the data were combined with available data from the literature. Methods: In a group of 408 patients with clinically definite MS, genotype distribution was compared with that of 144 healthy controls. C ombined analysis of published data on the association of A poE polymorphism with MS was performed. Demographic and clinical findings were recorded and related to the A poE genotype. In a subgroup, longitudinal MRI findings were available and related to the A poE genotype. Results: No significant differences were found in the distribution of genotypes between MS patients and controls. C ombined analysis of published data showed a slightly increased susceptibility for MS in 2-carriers. Disease character istics (including age at onset and onset type), disease severity (progression index, time to reach EDSS 6) and MRI findings (lesion volumes and atrophy measures) were not associated with carriership o 2 or 4. Conclusions: In this cohort no association of the A poE genotype with disease susceptibility nor clinical and MRI measures could be identified. However, combined analysis of published data could not definitely exclude the possibility of a minor role for 2-carriership in MS.

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