Multiple sclerosis in diverse populations: characteristics in distinct Arab ethnicities in Israel.

BACKGROUND: Multiple sclerosis (MS) prevalence and genetic susceptibility varies among the different ethnic groups of Jews and Arabs in Israel. OBJECTIVE: Characterization of MS disease course in Christian, Muslim and Druze Arabs in Israel. METHODS: Historical cohort and three-year follow-up cohort analyses based on interviews and clinical charts of 149 Arab MS patients (78 Muslims, 49 Christians and 22 Druze) from three MS centers in Israel. Significant findings were adjusted for use of disease modifying therapy. RESULTS: Age of onset (means between 30 and 31 years) and incomplete recovery rates after the first relapse (~50%) were similar for Christian, Muslim and Druze patients. Low rates of primary progressive MS (≤1%) were observed. Differences between the ethnicities in the time from onset to the second neurological episode were observed among females, but not males. Druze and Muslim women were more likely to have a second event within two years from the first event compared with Christians (odds ratios =8.8, p= 0.02; odds ratio=6.6, p=0.007 respectively). Trends for higher annual relapse rates, annual disability progression rates and MS Severity Scores were observed among the Druze. CONCLUSIONS: Among the Israeli Arab female MS patients, Druze and Muslims exhibit a more rapid disease course in comparison with Christians. Further elucidation of population-specific MS phenotypes may contribute to improved disease management.

Repeated electrophysiologic studies in patients with carpal tunnel syndrome following local corticosteroid injection using a novel approach.

BACKGROUND: Local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), using the classic method, is usually associated with improvement in different electrophysiologic parameters of the median nerve. However, there is no correlation between the clinical response and these electrophysiologic parameters. OBJECTIVES: To evaluate the effect of our novel approach of LCI for the treatment of CTS on repeated electrophysiologic studies of the median nerve. METHODS: Patients with symptomatic CTS with duration of symptoms of less than 1 year were offered an LCI of 12 mg methylprednisolone acetate using a novel approach and asked to repeat the electrophysiologic study one month later. Pearson correlation test was used to correlate between the difference of similar electrophysiologic parameters and duration of favorable clinical response and also between the differences among themselves. RESULTS: Thirteen patients completed the study and 25 hands were injected. Improvement in median distal sensory and motor latency was noted in 61% and 75% of the hands respectively. There was no correlation between duration of clinical response and the differences of either the distal latency (sensory or motor) or the amplitude. There was also no correlation between the differences of motor median distal latency and sensory median distal latency. CONCLUSIONS: LCI at the carpal tunnel using our approach is also associated with favorable electrophysiologic results similar to what has been reported using the classic approach.

A novel approach of local corticosteroid injection for the treatment of carpal tunnel syndrome.

The objective of the study was to compare the favorable response rate, time duration, and pain level of local corticosteroid injection using a novel approach for the treatment of carpal tunnel syndrome vs a classic approach. Patients with symptomatic carpal tunnel syndrome of less than 1-year duration were randomized for local corticosteroid injection using either the classic approach or a novel approach. In our approach (novel), we used a 29 gauge x 1/2-in. needle and a 1-ml insulin syringe containing 12 mg of methylprednisolone mixed with 0.15 ml of lidocaine 2%, and the site of the injection was 2-3 cm distal to the middle of wrist crease. In the classic approach, we used a 25 gauge x 3-cm needle and a 2-ml syringe injecting 35 mg of methylprednisolone mixed with 0.5 ml of lidocaine 2%, 3-4 cm proximal to the wrist crease and just ulnar to the tendon of the flexor carpi radialis muscle. Response rate was evaluated 1, 3, 6, and 12 weeks after the injection, and also the duration of time of the procedure and the level of pain using the visual analogue scale were compared between the two groups. Forty-two patients signed the consent form, and all of them completed the study [21 patients in the classic approach group (group 1) and 21 patients in the novel approach group (group 2)]. The favorable response rates were 100, 81, 71, and 57% in group 1 and 100, 71, 67, and 57% in group 2 after 1, 3, 6, and 12 weeks, respectively. There was no significant difference in the favorable response rate between the two groups (p=0.468, 95% CI=-12-31%, after 3 weeks). The average duration of time of the procedure in group 1 was 26.71+/-32.83 s compared to 8.48+/-1.123 s (p=0.021) in group 2. The average grade of pain expressed by the patients in group 1 was 4.38+/-1.523 compared to 3.62+/-1.071 in group 2 (p=0.065). In conclusion, local corticosteroid injection using the novel approach for the treatment of carpal tunnel syndrome is helpful, and the favorable response rates are comparable to those using the classic approach after 1, 3, 6, and 12 weeks. The novel approach is much less time consuming and is not more painful.