Month-of-birth-effect in multiple sclerosis in Austria.

BACKGROUND: The month-of-birth-effect (MoBE) describes the finding that multiple sclerosis (MS) patients seem to have been born significantly more frequently in spring, with a rise in May, and significantly less often in autumn and winter with the fewest births in November. OBJECTIVES: To analyse if the MoBE can also be found in the Austrian MS population, and if so, whether the pattern is similar to the reported pattern in Canada, United Kingdom, and some Scandinavian countries. METHODS: The data of 7886 MS patients in Austria were compared to all live births in Austria from 1940 to 2010, that is, 7.256545 data entries of the Austrian birth registry and analysed in detail. RESULTS: Patterns observed in our MS cohort were not different from patterns in the general population, even when stratifying for gender. However, the noticeable and partly significant ups and downs over the examined years did not follow the distinct specific pattern with highest birth rates in spring and lowest birth rates in autumn that has been described previously for countries above the 49th latitude. CONCLUSION: After correcting for month-of-birth patterns in the general Austrian population, there is no evidence for the previously described MoBE in Austrian MS patients.

Kappa free light chains: diagnostic and prognostic relevance in MS and CIS.

BACKGROUND: Quantification of kappa free light chains (KFLC) in cerebrospinal fluid shows high diagnostic sensitivity in multiple sclerosis and clinically isolated syndrome patients. However, a clearly defined threshold value is still missing and a possible prognostic value of the KFLC levels in these patients remains undefined. METHODS: Results of KFLC quantification in 420 controls were used to set an upper limit of normal KFLC concentration in CSF under different blood-CSF-barrier conditions. Additionally, KFLC values of MS and CIS patients were assessed and results were evaluated with reference to the patients corresponding disease courses. RESULTS: The calculated upper limit of normal KFLC-concentration covers 98% of these control patients. Using this cut-off, plasma cell activity in CSF can be detected in 97% of MS patients and in 97% of CIS patients. However, there is no evidence that the extent of KFLC elevation provides prognostic value in MS and CIS patients in this study. CONCLUSION: KFLC determination should become a first line screen in the diagnostic algorithms of MS and CIS. The extent of elevation of intrathecal KFLC has no prognostic value on the disease course in MS and CIS patients.

Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge.

BACKGROUND: Oral anticoagulation is indicated in secondary prevention of stroke or transient ischemic attack (TIA) in patients with atrial fibrillation, but it is often withheld because of contraindications and/or fear of bleeding complications. METHODS: We analysed recurrent cerebral and non-cerebral ischemic vascular events, major intracerebral and extracerebral bleeding and vascular death in 401 consecutive patients with ischemic stroke or TIA and atrial fibrillation who were discharged with oral anticoagulation (OAC), antiplatelet agents (AA), or heparin only in a clinical routine setting. The median follow-up time was 25 (interquartile range (IQR): 15-38) months. RESULTS: Patients on OAC at time of discharge were significantly younger and had suffered a major stroke less often than patients who received AA or heparin at discharge. One year after discharge, adherence to therapy was higher in patients discharged on OAC (72%) than in those on AA (46%; p<0.001). The majority of patients discharged on heparin were subsequently treated with OAC. Patients on AA at discharge suffered from ischemic complications significantly more often during the follow-up period than patients on OAC or heparin at discharge (30% vs. 16% vs. 23%, p=0.031). 3% of the patients on AA and 4% of those on OAC suffered from major bleeding complications during follow-up (p=0.028). CONCLUSION: Our results document the high risk of ischemic vascular complications in patients with ischemic stroke/TIA and atrial fibrillation in a clinical routine setting. The risk was particularly high in patients treated with AA. The risk of major bleeding complications in our population was comparably low.