Gut microbiota composition during a 12-week intervention with delayed-release dimethyl fumarate in multiple sclerosis - a pilot trial.

INTRODUCTION: Patients with multiple sclerosis may have a distinct gut microbiota profile. Delayed-release dimethyl fumarate is an orally administered drug for relapsing-remitting multiple sclerosis, which has been associated with gastrointestinal side-effects in some patients. OBJECTIVES: The purpose of this study was to determine if dimethyl fumarate alters the abundance and diversity of commensal gut bacteria, and if these changes are associated with gastrointestinal side-effects. METHODS: Thirty-six patients with relapsing-remitting multiple sclerosis received either dimethyl fumarate (n = 27) or an injectable multiple sclerosis disease-modifying therapy (glatiramer acetate or interferons, n = 9) for 12 weeks. Stool samples were collected at baseline, two and 12 weeks. We included 165 healthy individuals as controls. RESULTS: At baseline, 16 microbial genera were altered in multiple sclerosis patients compared with healthy controls. In the dimethyl fumarate-treated patients (n = 21) we observed a trend of reduced Actinobacteria (p = 0.03, QFDR = 0.24) at two weeks, mainly driven by Bifidobacterium (p = 0.06, QFDR = 0.69). At 12 weeks, we observed an increased abundance of Firmicutes (p = 0.02, QFDR = 0.09), mostly driven by Faecalibacterium (p = 0.01, QFDR = 0.48). CONCLUSIONS: This pilot study did not detect a major effect of dimethyl fumarate on the gut microbiota composition, but we observed a trend towards normalization of the low abundance of butyrate-producing Faecalibacterium after 12 weeks treatment. The study was underpowered to link microbiota to gastrointestinal symptoms.

High prevalence and increasing incidence of multiple sclerosis in the Norwegian county of Buskerud.

OBJECTIVES: The objective was to investigate the incidence of multiple sclerosis (MS) as well as estimate the prevalence as of 1 January 2014 in the southeastern Norwegian county of Buskerud. MATERIALS AND METHODS: All patients with MS living in Buskerud county in Norway between 01 January 2003 and 01 January 2014 were identified. Point prevalence of MS was identified on 01 January 2014. RESULTS: We found a prevalence of 213.8 (95% CI 196.4-231.1) per 100 000. The sex ratio was 2.2:1 with a female prevalence of 293.4 (95% CI 264.7-322.2) per 100 000 and a male prevalence of 134.7 (95% CI 115.3-154.2) per 100 000. About 82% of our MS population had a confirmed relapsing-remitting MS at disease onset, while 16.8% had primary progressive MS. The mean annual incidence between 2003 and 2013 was 11.8 (95% CI 10.6-13.1) per 100 000. CONCLUSION: This study shows a high incidence of MS in Buskerud county in southeastern Norway, and the incidence may still be on the rise. We found a relatively high prevalence of MS in our population, although this does correspond with the recently published national data. Further studies investigating both changes in incidence and possible factors causing the increasing incidence are warranted.

Migraine and frequent tension-type headache are not associated with multiple sclerosis in a Norwegian case-control study.

BACKGROUND: Inconsistent results have been obtained with regard to headache comorbidity in multiple sclerosis (MS). OBJECTIVE: Investigate the one-year prevalence of migraine and tension-type headache (TTH) in Norwegian MS patients and relate this to clinical parameters. METHODS: A questionnaire concerning headache was administered to 756 MS patients and 1090 controls and used to determine the one-year prevalence of migraine and frequent TTH. RESULTS: No significant differences were seen between patients and controls or between patients with different disease course. Less migraine was observed in patients with Expanded Disability Status Scale score (EDSS) ≥4.0. CONCLUSIONS: This case-control study does not support an association between migraine or TTH and MS.

Socio-economic factors and immigrant population studies of multiple sclerosis.

The uneven geographical distribution of multiple sclerosis (MS) and the differences in disease severity observed between different ethnic groups indicate a complex interplay between genetic and environmental risk factors involved in the disease pathogenesis. Changes in MS risk after migration suggest influence of environmental factors on disease susceptibility. Whether the risk of MS is affected by socio-economic status (SES) is still controversial. In the present review, the combined knowledge from studies of migration and SES in MS is discussed.

No association between multiple sclerosis and periodontitis after adjusting for smoking habits.

BACKGROUND AND PURPOSE: Periodontitis has been reported to be associated with several systemic disorders, and recently a possible relationship with multiple sclerosis (MS) was suggested. The aim of the present study was to investigate the association between periodontitis and MS in a Norwegian cohort. METHODS: A case-control study in 756 MS patients and 1090 controls was conducted, and logistic regression analysis, adjusting for age, gender, place of residence, mononucleosis and smoking, was performed to investigate the association between MS and periodontitis. RESULTS: In the unadjusted analysis a higher prevalence of periodontitis was seen in MS patients, but this difference was not statistically significant after adjusting for the covariates. CONCLUSIONS: The previously suggested association between MS and periodontitis is not supported in this study. Our results underline the importance of adjusting for relevant covariates in epidemiological research.

High prevalence and no latitude gradient of multiple sclerosis in Norway.

The prevalence of multiple sclerosis (MS) is increasing, and the presence of a latitude gradient for MS risk is still discussed. We present the first nationwide prevalence estimates for Norway, spanning the latitudes from 58-71 degrees North, in order to identify a possible latitude gradient. Information from the Oslo MS Registry and the Norwegian MS Registry and Biobank was combined with data from the Norwegian Patient Registry, the Norwegian Prescription Database and Statistics Norway. We estimated a crude prevalence of 203/100,000 on 1 January 2012. The prevalence in the Northern and Southern regions were not significantly different. MS prevalence in Norway is among the highest reported worldwide. We found no evidence of a latitude gradient.

Increased disease severity in non-Western immigrants with multiple sclerosis in Oslo, Norway.

BACKGROUND AND PURPOSE: Non-Western immigrants to Norway acquire an increased risk of multiple sclerosis (MS) after migration. Ethnicity and the presence of oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) might influence the disease course. The aim of this study was to investigate differences in disease severity and in the presence of OCBs in ethnic Norwegian and immigrant MS patients. METHODS: Clinical data and CSF findings from 47 non-Western immigrants with MS were compared with those from 447 Norwegian and 48 immigrant patients from Western countries. RESULTS: The non-Western immigrants had a higher mean Multiple Sclerosis Severity Score (MSSS) than the Norwegian patients (5.68 vs. 4.13, P = 0.001). Age at onset was 4 years lower amongst the non-Western immigrants (P = 0.001). After adjusting for year of birth, age at onset, gender and disease course, the mean difference in MSSS between the groups was 2.17 (P < 0.001). Amongst the non-Western immigrants, 70% received disease-modifying drugs, compared with 48% of the Norwegian patients (P = 0.005). In both groups, 88% were OCB-positive. CONCLUSIONS: Non-Western immigrants with MS had an increased disease severity compared with native Norwegians and immigrants from Western countries. The presence of OCBs in the CSF was not different between the groups.