Ten-year prognosis in multiple sclerosis: a better outcome in relapsing-remitting patients but not in primary progressive patients.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) prognosis remains a challenge for both patients and physicians. Complementary to natural history studies, updated population-based data from the first event suggestive of MS, at the time of the first approved disease modifying drug (DMD), are needed. Our objective was to provide a 10-year history of MS from clinical onset at time of first approved DMDs in a population-based cohort. METHODS: A population-based cohort of patients whose first clinical event suggestive of MS had occurred in Brittany between 2000 and 2001 was prospectively selected. History of relapses, treatments and disability up to 10 years after onset were collected. RESULTS: In all, 278 patients with either attack-onset (n = 244) or progressive-onset (n = 34) were recruited. Amongst attack-onset patients, 30% remained as clinically isolated syndrome and 70% had a second relapse after a median time of 1.7 years (95% confidence interval 1.2-2.4). 80% of relapsing-remitting MS patients received DMDs for at least 6 months. 29% reached disability status scale (DSS) 3 and 8% DSS 6. Amongst progressive-onset patients, 100% reached DSS 3 and 59% DSS 6. CONCLUSION(S): Our population-based study reports a lower risk of disability progression at 10-year follow-up in the relapsing-remitting MS group than previously reported. This better prognosis was not observed in the progressive-onset MS group. This finding impacts the prognosis given to patients in clinical practice.

Register-based incidence of multiple sclerosis in Brittany (north-western France), 2000-2001.

OBJECTIVES: To report on multiple sclerosis (MS) incidence in Brittany, north-western France. MATERIALS & METHODS: From 2000, we set up a population-based register for patients presenting a putative incident MS (PIMS), that is first symptoms compatible with MS onset. We used 3 medical sources of case ascertainment (neurologists, CSF, regional MS-Clinic). Eligibility criteria required both clinical onset and being permanent resident of Brittany in 2000 or 2001. From 2010, all medical records were tracked, the 10-year follow-up allowing previously reported data to be updated. RESULTS: Of 313 eligible PIMS, there were 208 definite MS (both McDonald and Poser criteria), 41 CIS-probable MS (Poser criteria), 32 CIS-possible MS and 32 non-MS. Our incident cohort of 249 MS cases with definite/probable MS (sex ratio 2.95) gave a crude annual incidence of 4.28 per 100,000 inhabitants (6.22 for women, 2.23 for men), and age-standardized rates (adjustment to the European population) of 4.41 [3.32-5.51], 6.68 [4.75-8.60], and 2.21 [1.12-3.31], respectively. Age-specific rates by gender and initial course showed that attack onset MS peaked at 25-29 years and progressive onset MS at 40-44 years in women (20-24 years and 45-49 years in men, respectively). CONCLUSIONS: Brittany is confirmed a high-risk region for MS. Our data show marked differences in sex-specific pattern of MS incidence by clinical course and point out 25- to 29-year-old women as having the highest MS risk. While temporal variations cannot be excluded, comparison with overall French data suggests that other factors rather than latitude may influence the MS risk in France.

[Childhood cancer incidence in French Brittany, 1991-2005]. / Incidence des cancers de l'enfant en Bretagne entre 1991 et 2005.

BACKGROUND: The aim of this study was to describe childhood cancer incidence in French Brittany from 1991 to 2005, as well as its temporal and geographical variations. METHODS: Childhood cancer incidence was analyzed from the data from the Brittany child tumor registry. Crude rates, world age standardized rates and cumulative rates were estimated for all cancers and for each diagnosis group. Standardized rates were also estimated for each of the four Brittany districts. Poisson regressions were performed to estimate trends in annual rates and to compare incidence rates between 2000-2005 and 1991-1999 periods, and between districts. RESULTS: Between 1991 and 2005, 1176 incident cancer cases were recorded in children younger than 15. Age standardized incidence was 169.5 cases per million of children per year. The most frequent cancers were leukemia (30%), central nervous system tumors (24%), lymphomas (12%) and neuroblastomas (8%). For the period 1991-2005 in Brittany, the risk of cancer diagnosis among children aged less than 15 years was 1/459. No significant increase trend was observed over the 1991-2005 period. There was however a significant or close to significant increase in incidence for lymphomas (RR: 1.38 [95%CI: 1.00-1.93]) and central nervous system tumors (RR: 1.24 [95%CI: 0.99-1.56]) between the 1991-1999 and 2000-2005 periods. A significant decrease trend was observed for renal tumors over the 1991-2005 period (Estimated Annual Percent Change=-7.6%, P=0.02). There was no significant difference of incidence between the four districts of the region. CONCLUSION: For the period studied, childhood cancer incidence in French Brittany was lightly higher than for the whole country. Although increases in lymphomas and central nervous system tumors coincided with increasing use of a standardised data collection system for medical information, the data collected provided no evidence in favor of more complete data collection following implementation of the system.

[Incidence of inflammatory bowel diseases in Bretagne (1994-1995). ABERMAD. Association Bertonne d'Etude et de Recherche des Maladies de l'Appareil Digesif]. / Incidence des maladies inflammatoires du tube digestif en Bretagne (1994-1995). ABERMAD. Association Bertonne d'Etude et de Recherche des Maladies de l'Appareil Digesif.

OBJECTIVES: The aim of the study was to determine the incidence and the main clinical data of inflammatory bowel disease in Brittany. METHODS: According to EPIMAD registry's methodology, private and public gastroenterologists (n = 139) of Brittany (2836418 inhabitants) referred all patients consulting for the first time, in 1994 and 1995 with clinical symptoms compatible with inflammatory bowel disease. An interviewer practitioner completed at the gastroenterologist's consulting room a standard questionnaire for each patient. Each case was reviewed separately by four experts to assign a diagnosis of definite, probable, possible Crohn's disease, ulcerative colitis, unclassifiable chronic colitis, or acute colitis (onset of symptoms < 6 weeks). RESULTS: 657 cases were recorded: 205 Crohn's disease (31%), 165 ulcerative colitis (25%) including 75 ulcerative proctitis (46%), 42 unclassifiable chronic colitis (7%), 245 acute colitis (37%). The crude mean annual incidence (per 10(5) inhabitants) based on definite and probable cases only was 2.8 for Crohn's disease and 2.9 for ulcerative colitis. The female/male ratio was 0.9 for Crohn's disease and 0.5 for ulcerative colitis. The median age at time of diagnosis was 27 for Crohn's disease and 36 for ulcerative colitis. The median time between onset of symptoms and diagnosis was equal to 3 months for Crohn's disease and ulcerative colitis. CONCLUSION: In Brittany the observed incidence of ulcerative colitis is similar to that of Crohn's disease and close to that observed in northern France. The incidence of Crohn's disease is lower. However, the real incidence of inflammatory bowel disease is currently underestimated due to the large number of acute colitis requiring a follow up and the cases of Crohn's disease classified as possible not taken into account.

[Suicide attempts in Brittany (France). Distribution at the regional level]. / Les gestes suicidaires en Bretagne. Distribution au niveau d'un département.

UNLABELLED: A prospective study on para-suicide has been conducted in all 4 "départements" of a french region, Brittany. This paper analyses the distribution of the sociodemographic data collected in one of the "département" of the region, Ille-et-Vilaine. The comparison between urban and rural areas is presented. INCLUSION CRITERIA: Parasuicide was defined as any autoaggressive act which required to be taken in charge either medically or surgically, independently of the nature and seriousness of the somatic consequences. Patients included in the study were over ten years of age. ANALYSIS: Three types of ratios have been calculated: the crude incidence ratios obtained by dividing the total number of events of parasuicide (including repeated admissions for the same individual) by the number of individuals in the catchment area; the age-specific ratios, for which the denominator consists of all the persons of particular age-group in the area and the standardized ratios, for which the total number of parasuicide events in each "département" has been reported to the french population (general population census 1990) taken as a reference, in order to eliminate the influence of the age structure. Comparisons between the general population and the one of parasuicidal patients in the area, were done using a chi-square test. GEOGRAPHICAL COMPARISON: Crude incidence rates of parasuicides calculated for each "département" in Brittany are compared with recent figures published for other parts of France. RESULTS: 2,040 persons domiciled in the "département" were admitted in one of the emergency wards of Ille-et-Vilaine during the year 1990. The crude incidence rates of parasuicides in Ille-et-Villaine was of 2.4/1,000 for men and 3.8/1,000 for women, 3.7/1,000 for men and 5.4/1,000 for women residing in the town of Rennes. The sex ratio is 1.8 female/male in the "département" and 1.7 in town. DEMOGRAPHIC DATA: In the male group, the incidence ratio was maximum for the 25-34 years old (4.2/1,000). In the female group, there was no significant difference between the ratio for the 15-24 and the 25-34 years old (5.9/1,000). For each age group, the ratios are higher for the women. The specific rates of parasuicide calculated in the breton towns of more than 50,000 inhabitants are twice as high as those calculated for the whole region. MARITAL STATUS: The marital status is correlated to the incidence rates of parasuicide events for both sexes (p < 0.001). The incidence of parasuicide is higher for married, single and/or divorced women than for men. One notes the high impact of divorce on parasuicide events for men (10.1/1/1,000) and women (11.8/1,000). The correlation is significative (p < 0.001). In contrast, rates of parasuicides are higher for widows than for widowers. OCCUPATION: The incidence rate of parasuicide is 8 times higher for unemployed men and twice as high for unemployed women than for those having an occupation (regular or temporary). Unemployment is significatively linked with the occurrence of parasuicides (p < 0.001). PLACE OF ABODE: Comparative rates in towns (calculated for both sexes together) and twice as high as those observed in rural districts. GEOGRAPHICAL COMPARISON: The crude incidence rates in various french "département" vary from 0.8 to 2.4/1,000 for men and from 1.7 to 3.8/1,000 for women. The highest rates are observed for both sexes in Ille-et-Vilaine. In Rennes, the standardized ratios of parasuicide among men are maximum for the 35-44 years old (7.68/1,000) and decrease drastically after the age of 45. Among the women, the ratios are nearly identical for the 25-34 and the 35-44 years old (9.90 and 9.87/1,000). CONCLUSION: The survey conducted in 1990 confirms the overall conclusions drawn in previous surveys on parasuicide in France or in other countries. The distribution of the incidence rates of parasuicide among single and unemployed and the percentages of single or unemployed persons is weak but not at random. An increase of the incidence rates among single women and unemployed men is concomitant with higher percentages of single women and unemployed men in the general population. One cannot infer the existence of a cause effect relationship, and these indicators may only be confounding factors.

[Incidence of inflammatory bowel disease in children in Brittany (1994-1997). Breton association of study and research on digestive system diseases (Abermad)]. / Incidence des maladies inflammatoires du tube digestif chez l'enfant en Bretagne (1994-1997). Association bretonne d'étude et de recherche sur les maladies de l'appareil digestif (Abermad).

BACKGROUND: The aim of this work was to determine in Brittany the incidence and main clinical pattern of inflammatory bowel disease (IBD) occurring during childhood. These data are compared to the previous epidemiologic data available from the Northern France registry or around the world. METHODS: Private and public Brittany gastroenterologists (2,836,418 inhabitants including 618,049 children under 17 years of age) referred all patients consulting for inflammatory bowel disease from January 1994 to December 1997. An interviewer-practitioner completed at the gastroenterologist's office a standard questionnaire for each patient. Each case was independently reviewed by four experts in a blind manner and made a final diagnosis of Crohn's disease (CD), ulcerative colitis (UC), or ulcerative proctitis and acute colitis (onset of symptoms < 6 weeks) or unclassified chronic colitis. RESULTS: Among 1,309 cases recorded, 88 were under 17 years of age (6.7%): 43 (49%) had CD (including three possible cases), 14 (16%) had UC (including three proctitis), 24 (27%) acute colitis and 7 (8%) unclassified chronic colitis. The crude mean annual incidence (per 100,000 children) based on definite and probable cases only was 2.5 for IBD, 1.6 for CD and 0.57 for UC, without variation between 1994 and 1997. The male/female ratio was 2.3 for CD and 1.3 for UC. The mean time between onset of disease and diagnosis was equal to 7.2 and 8.6 months for CD and UC respectively (median: 3 and 5 months). A familial history of IBD was present in 5 cases (8%). In CD, the small and large bowel were involved in 58% of patients, whereas an isolated involvement of small or large bowel occurred in 15% and 23% of cases. Among the 14 UC, there were three proctitis and four pancolitis. Among 43 CD, a granuloma was present in 48% of cases. CONCLUSIONS: In Brittany the incidence of CD and UC in childhood was similar to the published data from Northern France. Clinical presentation and symptoms were not different. However, the rate of acute colitis was higher and the accurate incidence of IBD could be underestimated, requiring a follow-up to classify these cases.