Multiple sclerosis with a progressive course from onset in Lorraine-Eastern France.

To investigate the patient characteristics, disease progression, and associated risk factors in patients with multiple sclerosis (MS) with a progressive onset, we conducted a longitudinal population-based study of 359 patients (252 with primary progressive MS (PPMS) and 107 with progressive relapsing MS (PRMS)) in Lorraine, France. As outcome measures, we assessed the time from MS onset to reaching disability status scale (DSS) scores of 4, 6 and 7 and the time from assignment of DSS score of 6 to assignment of DSS score of 7. We studied the influence on these outcomes of sex, age of onset and symptoms of onset. We also studied the influence of the time from MS onset to assignment of DSS 6 on the time from MS onset to assignment of DSS 7. There were no significant differences in the demographic data (gender and age at onset of MS) and clinical data (median time to DSS scores of 4, 6 and 7) between the patients with PPMS and PRMS suggesting such a distinction may be unnecessary. The male/female ratio in all 359 patients with MS with a progressive onset was 1/1.36. The median age at onset was 42.7 years (25% Q1 = 34.7; 75% Q3 = 50.0), was lower for male (40.5 years) than for female patients (44.2 years; p = 0.002). The median time to DSS scores of 4, 6 and 7 were (in years) 3.0 (95% CI = 2.8 to 3.7), 9.9 (95% CI = 9.0 to 10.6), and 17.0 (95% CI = 14.9 to 19.0). A cane was required in 25% of patients 5 years after onset and in 75% 15 years after onset. We did not find any significant unfluence of sex, age at onset, or symptoms at onset on the time from MS onset to assignment of scores 6 or 7 or on the time from the assignment of a score of 6 to the assignment of a score of 7.

Voiding ultrasonography: evaluation of the detection of vesicoureteral reflux based on the review of digital ultrasound clips.

PURPOSE: To evaluate the accuracy of voiding urosonography (VUS) compared to X-ray voiding cystoureterography (VCUG) for the detection and grading of vesicoureteral reflux (VUR) by standardised reading of digital clips obtained from VUS and digital images from VCUG. MATERIALS AND METHODS: Approval by the ethics committee was obtained, and written, informed consent was given. 130 children (94 girls and 36 boys, mean age of 4.4 years) underwent VUS using Levovist (Schering, Germany) prior to VCUG. Digital VUS clips and digital VCUG images were reviewed by two groups of two radiologists. Results were mainly analysed in terms of reno-ureteral units (RUUs). Intra and interobserver reproducibility was estimated by calculation of kappa coefficient. Calculation of sensitivity and specificity of VUS was made in comparison with VCUG. RESULTS: Intraobserver reproducibility was good to moderate for the detection of VUR using VUS (kappa = 0.67 and 0.53 for each reviewer respectively) and good for the grading of reflux (kappa = 0.64 and 0.70). Interobserver reproducibility was excellent for the detection and grading of VUR using VCUG (kappa = 0.89 and 0.91) but good to moderate for VUS (kappa = 0.73 and 0.51). Compared to VCUG, sensitivity and specificity of VUS for the detection of VUR were 62.7 % and 83.4 %. Concordance for grading was moderate, with a higher grading using VUS. CONCLUSION: Real-time evaluation and diagnosis based on the review of VUS digital clips is achievable. However, there is a need for standardisation of digital records if a second reading by another radiologist or consideration by urologists is needed. Recent advances in US technology and the use of second-generation contrast agents would be promising to improve the feasibility, reproducibility and accuracy of the method.

Increasing incidence of multiple sclerosis among women in Lorraine, Eastern France.

This study aims to describe the prevalence and incidence rates of multiple sclerosis (MS) in Lorraine, France, and its secular trend from 1990 to 2002. Cases were sourced from the regional network of MS healthcare workers in the Lorraine region and include all cases with definite or probable MS according to Poser's criteria. We identified 2718 patients with MS on 31 December 2004. The prevalence rate was 120/100,000 (95% confidence interval [CI]: 119-121). Between 1990 and 2002, the average age- and sex-adjusted annual incidence rate was 5.5/100,000 (95% CI: 4.4-6.6). During this same period, there was a significant increase in overall incidence in women but not in men. The mean age at MS onset, disability score five years after onset, number of relapses during the first five years, and proportion of first attack with sequelae or polysymptomatic symptoms were not significantly different between each annual cohort during the study period. The prevalence and incidence rates of MS we found in our study were higher than in previous studies in France. The increase in incidence of MS between 1990 and 2002, mostly in women, was not related to better ascertainment of patients with mild disability.

More severe disability of North Africans vs Europeans with multiple sclerosis in France.

OBJECTIVE: To compare the clinical disease progression in European (E) and North African (NA) patients with multiple sclerosis (MS) patients in France. METHODS: We compared the clinical features of MS in 211 NA patients and 2,945 E patients in a French population-based cohort with definite MS according to McDonald's criteria. RESULTS: Among the NA patients with MS, 66.4% were women vs 72.9% of the E patients (p = 0.04), 15.6% had a primary progressive form of MS vs 11.7% of the E patients (p = 0.08), and the mean age at onset was 29.9 +/- 9.8 years in the NA patients vs 32.9 +/- 10.6 years in the E patients (p < 0.0001). In the NA patients, there was a higher proportion of patients with incomplete recovery from the first relapse (p < 0.0001), a shorter time between the first two relapses (p = 0.02), a higher number of relapses in the first 5 years (p = 0.03), and a shorter time to reach an Expanded Disability Status Scale score of 4.0 (p = 0.001) or 6.0 (p < 0.0001). The only statistical difference in these factors between NA patients born in France and those born in North Africa was the mean age at onset of symptoms: it was earlier in NA patients born in France (p < 0.0001). CONCLUSIONS: The course of multiple sclerosis is more aggressive in North African than in European patients.