Epidemiology of multiple sclerosis in Santiago de Compostela (Spain).

OBJECTIVES: To analyze the frequency and demographic characteristics of multiple sclerosis (MS) in the Council of Santiago de Compostela (SPAIN). MATERIAL AND METHODS: The patients diagnosed with MS according to the McDonald 2010 diagnostic criteria were identified within the population of the District of Santiago de Compostela. Several sources were used (records and databases from Hospital, General Practitioners, Private Clinics, and the MS Patients Association). Demographic and clinical data were obtained from the electronic files. RESULTS: The incidence of MS between 2010 and 2015 was 8/100 000/year (95% CI: 6-10), and the prevalence on December 31, 2015, was 152/100 000 (95% CI: 127-176). The age-standardized prevalence (using the European Standard Population 2013) was 137 (95% CI: 114-159) and the incidence of 7 (95% CI: 2-12). The female:male ratio was 1.84, the mean age at the first symptom was 32.23 years, the diagnosis was delayed 3.12 years, and the mean EDSS was 2.82. 71.17% had relapsing-remitting MS, 16.55% secondary progressive MS, 7.59% primary progressive MS, and 0.69% progressive relapsing MS. A disease-modifying treatment was established in 62.76% of patients in a mean of 1.96 years after the diagnosis. CONCLUSIONS: The northwest of Spain is a high-risk area for MS, with frequencies similar to other Atlantic regions and higher than the rest of the country.

Temporal trends in the incidence and prevalence of Multiple Sclerosis in the Northwest of Spain.

BACKGROUND: During the last decades, the frequency of multiple sclerosis (MS) is increasing worldwide. Nevertheless, the higher sensibility of the new diagnostic criteria obscures the comparison between studies performed in different decades. METHODS: The evolution of the frequency of MS in Santiago de Compostela (North-West of Spain) between 2003 and 2015 was analyzed using Poisson regression. The diagnosis was confirmed according to Poser criteria. Several sources were consulted for case ascertainment: databases from the MS Unit, the Infusion Center, and the Departments of Neurology, Pharmacy, Pediatric Neurology and Codification of the public Hospital of Santiago, private hospitals, neurologists with private activity, general practitioners, and associations of patients. RESULTS: In 12 years, the prevalence increased from 68 to 143 cases/100,000 inhabitants, from 83 to 176 in females; and from 49 to 106 in males (p <0.0001, 0.0001, and 0.0002 respectively). The incidence rise was not significant (from 5 to 8 cases/ 100,000 inhabitants/ year (p=0.4243). The mean age of the population growth 5.7 years (p=0.008). The changes in female: male ratio (12.9%), in the age at the first symptom (2.2 years), and the diagnosis delay (0.12 years) did not achieve significance (p=0.7750, 0.1606, 0.8581). CONCLUSION: The prevalence of MS doubled in 12 years whilst the difference in incidence was lower and not significant. The disproportion in the growth of both parameters, as well as the higher mean age in the last study, suggest a longer survival of patients with MS.

SARS-CoV-2 Infection in Multiple Sclerosis: Results of the Spanish Neurology Society Registry.

OBJECTIVE: To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. METHODS: Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. RESULTS: Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. CONCLUSIONS: This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.

Clinical response and tolerability of fampridine in clinical practice.

BACKGROUND: Gait disorder is very prevalent in multiple sclerosis. After 15 years of disease progression, 50% of patients need assistive devices for walking. MATERIALS & METHODS: We performed a multicenter observational study, including multiple sclerosis patients with an Expanded Disability Status Scale score between 4.0 and 7.0, normal kidney function and no previous history of seizures. RESULTS: The study sample comprised 138 patients with average age of 50.3 years median Expanded Disability Status Scale of 6.0. After treatment, a significant reduction was observed in both the Timed 25-Foot Walk test (baseline, 20.3 s; 14 days, 13.2 s; p < 0.001; 3 months, 12.1 s; p < 0.001) and the 12-Item Multiple Sclerosis Walking Scale score (baseline, 82.3; 14 days, 59.4; p < 0.001; 3 months, 57.2; p < 0.001). Adverse events were recorded in 39.9% of patients.