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1.
Epidemiol Psychiatr Sci ; 29: e84, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915099

RESUMO

AIMS: Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD. METHODS: We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts. RESULTS: We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47-2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69-2.84), MS (IRR 1.79; 95%CI: 1.29-2.50) and RA (IRR 1.61; 95%CI: 1.29-1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45-64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls. CONCLUSIONS: IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.


Assuntos
Artrite Reumatoide/epidemiologia , Doenças do Sistema Imunitário/complicações , Inflamação/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Esclerose Múltipla/epidemiologia , Transtornos da Personalidade/epidemiologia , Adolescente , Adulto , Canadá/epidemiologia , Estudos de Coortes , Comorbidade/tendências , Feminino , Humanos , Doenças do Sistema Imunitário/epidemiologia , Incidência , Inflamação/epidemiologia , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
2.
BMC Neurol ; 19(1): 286, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727014

RESUMO

BACKGROUND: Some studies have looked at the age at menarche and risk of Multiple Sclerosis (MS).We aimed to conduct a systematic review and meta-analysis to estimate a pooled odds ratio of developing MS by increasing age at menarche. METHODS: We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, google scholar and gray literature (references of references, congress abstracts) up to 10th April 2019. RESULTS: The literature search found 312 articles. After eliminating duplicates, reviews, case reports and trials, 18 articles remained. Three articles were ultimately included in the final analysis. Two studies were from Iran, and one from Canada. The pooled odds ratio (OR) for increasing 1 year of age at menarche was 0.88 (95% CI:0.82-0.94), with no significant heterogeneity (I2 = 49%, p = 0.1). Mean age at menarche was significantly different between case and control groups (mean difference = - 0.22, 95% CI = -0.42,-0.02). CONCLUSION: The result of this systematic review showed that the risk of MS decreases by increasing age at menarche.


Assuntos
Menarca , Esclerose Múltipla/epidemiologia , Feminino , Humanos , Razão de Chances
3.
Neurology ; 93(14): e1348-e1359, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31484713

RESUMO

OBJECTIVE: To determine which pathologic process could be responsible for the acceleration of cognitive decline during the course of multiple sclerosis (MS), using longitudinal structural MRI, which was related to cognitive decline in relapsing-remitting MS (RRMS) and progressive MS (PMS). METHODS: A prospective cohort of 230 patients with MS (179 RRMS and 51 PMS) and 59 healthy controls was evaluated twice with 5-year (mean 4.9, SD 0.94) interval during which 22 patients with RRMS converted to PMS. Annual rates of cortical and deep gray matter atrophy as well as lesion volume increase were computed on longitudinal (3T) MRI data and correlated to the annual rate of cognitive decline as measured using an extensive cognitive evaluation at both time points. RESULTS: The deep gray matter atrophy rate did not differ between PMS and RRMS (-0.82%/year vs -0.71%/year, p = 0.11), while faster cortical atrophy was observed in PMS (-0.87%/year vs -0.48%/year, p < 0.01). Similarly, faster cognitive decline was observed in PMS compared to RRMS (p < 0.01). Annual cognitive decline was related to the rate of annual lesion volume increase in stable RRMS (r = -0.17, p = 0.03) to the rate of annual deep gray matter atrophy in converting RRMS (r = 0.50, p = 0.02) and annual cortical atrophy in PMS (r = 0.35, p = 0.01). CONCLUSIONS: These results indicate that cortical atrophy and cognitive decline accelerate together during the course of MS. Substrates of cognitive decline shifted from worsening lesional pathology in stable RRMS to deep gray matter atrophy in converting RRMS and to accelerated cortical atrophy in PMS only.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/psicologia , Adulto , Idoso , Atrofia/diagnóstico por imagem , Atrofia/epidemiologia , Atrofia/psicologia , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Estudos Prospectivos
4.
Public Health ; 175: 138-144, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31476710

RESUMO

OBJECTIVES: The incidence of multiple sclerosis (MS) is not well known in Iran. This study was conducted to estimate the trends in annual MS incidence in Iran from March 21, 2010, to March 20, 2016. STUDY DESIGN: Longitudinal study. METHODS: In this longitudinal study, data for all MS patients fulfilling McDonald criteria were obtained from a national registry, coordinated by the Ministry of Health (MOH). In Iran, all MS patients are eligible to receive public care and treatment services based on their records in this registry, and thus nearly all MS patients are registered in this database. The annual incidence rates were calculated based on year of diagnosis and were standardized using the World Health Organization (2000-2025) population as a standard. RESULTS: In this registry, 36,287 (8202 [22.6%] males and 28,085 [77.4%] females) confirmed MS cases were registered by the MOH between 2010 and 2016. The female-to-male ratio was 3.11. The mean age of patients was 31.6 ± 0.9 years at the time of diagnosis. It was 31.3 ± 0.8 and 32.3 ± 0.9 for females and males, respectively. Overall incidence rate was 6.7/100,000 population (95% confidence interval [CI]: 6.2-7.2); 10.5 and 3.0 in females and males, respectively. The age-adjusted incidence rates increased significantly from 4.4 (95% CI: 4.3-4.6) in 2010 to 5.8 (95% CI: 5.7-6.0) in 2016, with its peak at 6.5 (95% CI: 6.3-6.6) in 2014. CONCLUSIONS: This study revealed that Iran is a high-risk area for MS disease and that MS incidence and female-to-male ratio are more or less comparable with the dominant patterns in developed countries. Also, this study showed that the incidence trend of MS in Iran is similar to regional and global observed patterns.


Assuntos
Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
5.
Neurosciences (Riyadh) ; 24(3): 168-175, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31380815

RESUMO

OBJECTIVE: To assess the outcome and impact of multiple sclerosis (MS) using validated Arabic versions of the Barthel index (BI) multiple sclerosis impact scale (MSIS-29), the modified Rankin scale (mRS), and the expanded disability status scale (EDSS). METHODS: A cross-sectional study conducted at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia, during July-November 2017. All Saudi adult patients diagnosed with MS between 2000-2016 (269 patients) were included. Patients were contacted via phone calls and were assessed using a newly developed and validated multi-component questionnaire that included demographic data, disease course, and Arabic versions of the scales RESULTS: Out of 269 patients, 210 (78.2%) responded. The average patient age was 37.44+/-10.3 years. The majority were females (69.5%). Only, 51 (24.3%) patients reported worsening conditions. Annually, the average relapse rate was 2.28+/-1.91. In regard to patient outcomes, 120 (57.1%) showed no significant disability in mRS, 146 (69.5%) were ambulatory without aid in EDSS, and 185 (89.4%) were independent in BI scores. The average MSIS-29-PHYS score was 33.6+/-27.6 and MSIS-29-PSYCH score was 38.2+/-25.8. Modified Rankin scale and EDSS were significantly associated with the current use of disease-modifying therapy (DMT). Modified Rankin scale was negatively associated with delayed diagnosis. Barthel index showed significant association with medication compliance and the absence of attacks. CONCLUSION: Majority of patients had a favorable outcome that was linked with the use of DMT, compliance, early diagnosis, and absence of attacks.


Assuntos
Esclerose Múltipla/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/epidemiologia , Arábia Saudita , Resultado do Tratamento
6.
Acta Neurol Scand ; 140(5): 328-335, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31291697

RESUMO

BACKGROUND: A rising trend for incidence of multiple sclerosis (MS) has been observed during the recent years in Iran. Several factors have been investigated as the reason, but socioeconomic determinants have been neglected. The present study aimed to investigate the relationship between Human Development Index (HDI), income and education and MS prevalence in the provinces of Iran. METHODS: The data used in this study were obtained from three sources: (a) National Registry of MS for MS prevalence data from 2006 to 2013, (b) Statistical Centre of Iran for demographic, income, and percentage of educated people data, and (c) some previous studies for HDI data. RESULTS: The findings showed high prevalence of MS in the provinces of Iran. Most patients were residents of provinces with a higher socioeconomic level. Significant relationships were found between the prevalence of MS and HDI, income and educational level (P = .002, P = .006, and P = .001, respectively). CONCLUSION: Socioeconomic determinants in Iran are different from those in many other countries. It seems that Iranian provinces with a higher socioeconomic level have higher prevalence of MS. Further studies in smaller scale are needed to better understand the relationship between socioeconomic determinants and MS prevalence in the provinces of Iran.


Assuntos
Esclerose Múltipla/epidemiologia , Fatores Socioeconômicos , Adulto , Feminino , Humanos , Renda , Irã (Geográfico)/epidemiologia , Masculino , Esclerose Múltipla/etiologia , Prevalência , Sistema de Registros
7.
Acta Neurol Scand ; 140(5): 303-311, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31271648

RESUMO

OBJECTIVES: Finland is a high-risk multiple sclerosis (MS) region, but a national MS register has not existed until 2014. In this paper, we present the Finnish MS register variables and data collected by 31 December 2018. MATERIALS AND METHODS: Numbers and data counts of MS patients in the register (ICD-10 code G35) are presented. The disease types and proportion of patients receiving disease-modifying treatments (DMTs) were analysed in five hospital districts with most complete data sets. MS prevalence in Finland was estimated using administrative hospital discharge data as an additional resource. RESULTS: There were a total of 8722 MS patients in the Finnish MS register by 31 December 2018 (71.5% females). Mean age at MS diagnosis was 38.7 years and peak prevalence was at age 50-54 years. Disease course was relapsing remitting (RRMS) in 66.7%, secondary progressive (SPMS) in 13.5%, and primary progressive (PPMS) in 7.9% of the 5365 MS patients in the selected districts with most complete data. A total of 66.0% of RRMS patients, 19.6% of SPMS patients and 9.9% of PPMS patients were receiving DMTs. By combining MS register data with databases of those hospitals that had not joined the register, the nationwide prevalence estimate was between 10 and 11 thousand patients (corresponding to crude prevalence 180-200/100 000). CONCLUSIONS: The Finnish MS register is currently used in 15/21 Finnish hospital districts. By register integration into the electronic patient files, the coverage of the register has increased to approximately 80% of the estimated Finnish MS population.


Assuntos
Esclerose Múltipla/epidemiologia , Adulto , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros
8.
Rev. neurol. (Ed. impr.) ; 69(1): 32-38, 1 jul., 2019. tab, graf, mapas
Artigo em Espanhol | IBECS | ID: ibc-184009

RESUMO

Introducción. La esclerosis múltiple es una enfermedad crónica autoinmune, inflamatoria y degenerativa del sistema nervioso central, y es el trastorno neurológico discapacitante no traumático más común en adultos jóvenes. Los estudios de prevalencia más recientes indican que la frecuencia de la enfermedad ha aumentado en el mundo en las últimas décadas, que dicho incremento de la prevalencia ocurre fundamentalmente a expensas de un mayor número de casos de mujeres con formas remitentes, y que el gradiente latitudinal de la incidencia de la enfermedad se viene atenuando. Objetivo. Revisar los estudios sobre epidemiología de esclerosis múltiple en España para verificar si las tendencias mundiales se confirman en nuestro país. Desarrollo. Búsqueda bibliográfica en las bases de datos PubMed y Teseo usando como palabras clave "epidemiology", "prevalence" e "incidence", cruzándolas con los términos "multiple sclerosis" y "Spain"; se realiza una selección inicial por título y resumen, en castellano e inglés, entre los años 1968 y 2018. Conclusiones. Un buen número de estudios epidemiológicos recientes en España confirman que es una región de prevalencia media-alta de la enfermedad a lo largo de su geografía. Las cifras de prevalencia aumentan progresivamente a lo largo de las últimas décadas hasta alcanzar en la actualidad 80-180 casos por 100.000 habitantes, y ello ha ocurrido a expensas de una mayor frecuencia de la enfermedad en las mujeres


Introduction. Multiple sclerosis is a chronic autoimmune, inflammatory and neurodegenerative disease of the central nervous system and the most common non-traumatic disabling neurological disease in young adults. In the latest decades, multiple sclerosis is increasing worldwide, especially in women. The latitudinal distribution has been progressively attenuated. Aim. To review the epidemiological studies of multiple sclerosis in Spain to verify if this worldwide trend also occurs in Spain. Development. We searched PubMed and Teseo databases using the search terms 'epidemiology', 'prevalence', 'incidence', 'multiple sclerosis' and 'Spain'. We selected articles published in Spanish and English between 1968 and 2018. Conclusions. Recent epidemiological studies confirm that Spain is a medium-high risk area for MS. The prevalence of MS has increased significantly throughout Spain in the latest years, especially in women, and recent studies show prevalence as high as 80-180 cases per 100,000


Assuntos
Humanos , Esclerose Múltipla/epidemiologia , Espanha/epidemiologia , Prevalência , Incidência
9.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(2. Vyp. 2): 7-11, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31156234

RESUMO

AIM: Analysis of the dynamics of epidemiological indicators of multiple sclerosis (MS) in the Altai region of the Russian Federation for the period from 2009 to 2017. MATERIAL AND METHODS: A comparative analysis of the prevalence, incidence and main clinical characteristics of MS in the Altai region was carried out based on the data of patients with MS from 2009 (1001 patients) to 2017 (1322 patients). RESULTS AND CONCLUSION: The prevalence of MS increased from 41.2 to 56.3 per 100 000. The higher prevalence of the disease in cities compared to villages (by 1.8 times) and the ratio of women and men about 2 0 have not changed. About 2% of patients have a family history of MS. The average age of MS onset did not change significantly during the period analyzed (28.5±9.9 years in 2017). The remitting type of the disease is the most common (73%). The incidence of MS was 1.1±0.3 and 2.6±0.5 cases per 100 000 in 1998-2009 and 2010-2017, respectively. Patients with pediatric MS make up 6.5% of all patients with MS. The clinical features of MS onset before the age of 18 compared to the onset at a later age are the lower frequency of motor disorders, pelvic organ dysfunction (no cases were detected), general brain symptoms detectability (10.5%). CONCLUSION: The population of the Altai region is at high risk of MS. Monitoring and analysis of the dynamics of clinical and epidemiological characteristics of MS are rational for the planning of medical care for patients with MS.


Assuntos
Esclerose Múltipla , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Masculino , Esclerose Múltipla/epidemiologia , Prevalência , Estudos Prospectivos , Federação Russa/epidemiologia , Adulto Jovem
10.
Continuum (Minneap Minn) ; 25(3): 753-772, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31162315

RESUMO

PURPOSE OF REVIEW: This article discusses the prevalence, identification, and management of multiple sclerosis (MS)-related symptoms and associated comorbidities, including complications that can present at all stages of the disease course. RECENT FINDINGS: The impact of comorbidities on the outcome of MS is increasingly recognized. This presents an opportunity to impact the course and outcome of MS by identifying and treating associated comorbidities that may be more amenable to treatment than the underlying inflammatory and neurodegenerative disease. The identification of MS-related symptoms and comorbidities is facilitated by brief screening tools, ideally completed by the patient and automatically entered into the patient record, with therapeutic suggestions for the provider. The development of free, open-source screening tools that can be integrated with electronic health records provides opportunities to identify and treat MS-related symptoms and comorbidities at an early stage. SUMMARY: Identification and management of MS-related symptoms and comorbidities can lead to improved outcomes, improved quality of life, and reduced disease activity. The use of brief patient-reported screening tools at or before the point of care can facilitate identification of symptoms and comorbidities that may be amenable to intervention.


Assuntos
Gerenciamento Clínico , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/tratamento farmacológico , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/tratamento farmacológico , Anticonvulsivantes/administração & dosagem , Carbamazepina/administração & dosagem , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/epidemiologia , Comorbidade , Depressão/diagnóstico por imagem , Depressão/tratamento farmacológico , Depressão/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Doenças Neurodegenerativas/diagnóstico por imagem , Doenças Neurodegenerativas/tratamento farmacológico , Doenças Neurodegenerativas/epidemiologia , Neuromielite Óptica/epidemiologia
11.
J Clin Neurosci ; 66: 51-55, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155343

RESUMO

The data for oligoclonal IgG bands (OCB) in cerebrospinal fluid and the association with clinical profiles of Chinese patients with multiple sclerosis (MS) is lacking. We aimed to investigate the positive OCB incidence, as well as the clinical and magnetic resonance imaging (MRI) features associated with positive OCB in MS patients in South China. Consecutive MS patients were recruited from two centers, located in Guangzhou city and Hong Kong in South China. MS was re-diagnosed by McDonald criteria 2017. OCB was tested using isoelectric focusing method. The difference in the clinical and MRI features between OCB-positive and OCB-negative MS patients was evaluated. Among 184 MS patients analyzed (102 from Guangzhou and 82 from Hong Kong), 110 (59.8%) patients were OCB-positive. Except for onset age (P = 0.019), there was no significant difference between MS patients with or without OCB in relation to the course of disease, symptoms of first attack, lesion distribution on MRI, relapse rates, or disability progression. Our results demonstrate no significant clinical differences between the OCB positive and negative MS patients in this MS cohort. Larger cohort in Chinese patients with MS is warranted.


Assuntos
Esclerose Múltipla/epidemiologia , Esclerose Múltipla/metabolismo , Bandas Oligoclonais/metabolismo , Adulto , Idade de Início , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , China/epidemiologia , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Esclerose Múltipla/diagnóstico por imagem , Recidiva , Adulto Jovem
12.
J Neurol ; 266(9): 2208-2215, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31152298

RESUMO

BACKGROUND: Multiple sclerosis (MS) is an immune-mediated neurological disease that causes demyelination. The etiology is unknown, but patients with a previous viral infection, such as Epstein-Barr virus, have been shown to be at a higher risk of developing MS. In contrast, people living with HIV have a lower risk of developing MS. Hepatitis C virus (HCV) mainly infects the liver, but patients with HCV can experience several extrahepatic manifestations and studies have shown an association with several autoimmune conditions such as neuropathy and myelitis. The present study aimed to investigate the risk of MS in patients with chronic HCV infection compared with matched comparators. METHODS: Patients were identified using the nationwide Swedish inpatient (2001-2013) and outpatient care registers (2001-2013) for HCV (B18.2) and MS (G35) according to the International Classification of Diseases-10. Up to five comparators (matched on age/sex/place of residency) were drawn from the general population for each HCV patient. Follow-up started at the first HCV visit from 2001 and the patients' accrued person-time until death, emigration or 31 December 2013. Risk of MS diagnosis was calculated as standardized incidence ratio (SIR) with 95% confidence intervals (CIs). RESULTS: HCV patients were at lower risk of MS diagnosis (SIR 0.37; 95% CI 0.26-0.50). The incidence of MS during the study in the HCV cohort was 0.087% compared with 0.27% in the matched comparator cohort. CONCLUSION: Surprisingly, these data suggest HCV patients to have a lower risk of MS diagnosis.


Assuntos
Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Vigilância da População , Sistema de Registros , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Fatores de Risco , Suécia/epidemiologia
13.
Mult Scler Relat Disord ; 33: 78-81, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31170564

RESUMO

BACKGROUND: Changes in the demographic epidemiology of multiple sclerosis (MS) may challenge the view of a latitudinal gradient in the distribution of MS. The objective of this study was to assess the incidence and prevalence of MS in addition to information on MS phenotypes and the use of disease modifying therapies (DMTs) in San Vicente del Raspeig in south eastern Spain. METHODS: This was a prospective epidemiological study of MS in San Vicente del Raspeig (population of 57,175 inhabitants based on the 2017 census) from 2005 to 2018. Multiple sources were used to identify MS cases. We considered as prevalent and incident cases all patients who satisfied either the criteria of Poser for clinically or laboratory-supported definite MS, or McDonald criteria. MS phenotypes were defined according to the 2013 revisions. RESULTS: For the prevalence data, 64 patients were identified. The non-adjusted prevalence was 111.9 (95% CI: 87.7-142.9) cases per 100,000 inhabitants; the prevalence was 159.3 cases per 100,000 inhabitants for women and 63.6 cases per 100,000 inhabitants for men. The female-to-male ratio was 2.6:1. The age-adjusted prevalence for the European standard population was 107 cases per 100,000 inhabitants. During the study period, the incidence was 5 cases per 100,000 inhabitants per year. Most patients were being treated with DMTs (81.3%). MS was active in at least 12.5% of patients. CONCLUSIONS: The results are consistent with the increased risk of MS in Spain observed over the last three decades, with growing prevalence rates that place the country in the high-risk prevalence zone.


Assuntos
Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Imunossupressores/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/tratamento farmacológico , Prevalência , Espanha/epidemiologia , Adulto Jovem
15.
BMC Neurol ; 19(1): 139, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234793

RESUMO

BACKGROUND: Multiple sclerosis (MS) and stroke are two common causes of death and disability worldwide. The relationship between these two diseases remains unclear. Effective early preventative measures and treatments are available to reduce the morbidity and mortality of acute stroke. The objectives of our systematic review are to estimate the risk of stroke in patients with MS and to collate related studies to draw preliminary conclusions that may improve clinical practice. METHOD: Relevant studies were systematically searched in MEDLINE, Embase, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure and the VIP database of Chinese periodicals from January 1983 to May 2017, with no restrictions on language. Patients included in this review were adults who suffered from MS. Review Manager 5.3 software program was used to pool data and calculate the risk ratio (RR) and its 95% confidence interval (CI). We also performed heterogeneity and sensitivity analyses and evaluated bias in the meta-analysis. RESULTS: Nine studies including more than 380,000 participants that met our inclusion criteria were incorporated into the meta-analysis. During different follow-up periods, patients with MS had an increased risk of any type of stroke [RR = 3.48, 95% CI (1.59, 7.64), P = 0.002 for 1 year; RR = 2.45, 95% CI (1.90, 3.16), P < 0.00001 for 10-13 years]. The total prevalence of stroke (any type) in patients with MS exceeded expectations compared to different groups [Comparing with general veteran: RR = 2, 95% CI (1.19, 3.38), P = 0.009. Comparing with general population: RR = 2.93, 95% CI (1.13, 7.62), P = 0.03]. Furthermore, ischemic stroke was particularly more common in the MS population than in people without MS [RR = 6.09, 95% CI (3.44, 10.77), P < 0.00001]. CONCLUSION: Compared with the general population, people with MS have an increased risk of developing any type of stroke and ischemic stroke in particular. Consistent results were obtained from patients of different sexes and age groups. Preventative measures and treatments should be administered at earlier time points to improve patient outcomes.


Assuntos
Comorbidade , Esclerose Múltipla/epidemiologia , Acidente Vascular Cerebral/epidemiologia , China/epidemiologia , Humanos , Acidente Vascular Cerebral/mortalidade
16.
Mult Scler Relat Disord ; 33: 158-161, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203146

RESUMO

BACKGROUND: As the prevalence and incidence of Multiple Sclerosis (MS) are increasing remarkably in Iran, gathering standardized information regarding the individual's diagnosis, care, and outcomes through a uniform registry system would enable policy-makers to systematically plan for care quality improvements. OBJECTIVE: To design a valid and reliable Persian version of a minimum data set to be utilized and integrated into the national MS registry system of Iran. METHOD: The minimum data set consisted of six domains including patient identification, family history of MS, diagnosis, disease course, disability status, and medications. The content validity was assessed based on 27 experts' opinions. Item-Content Validity Index (I-CVI) and Scale-Content Validity Index (S-CVI) were used to assess the questions and their validities. Reliability was evaluated using the intra-class correlation coefficient (ICC) of the test-retest results. RESULTS: For validity appraisal, 27 experts reviewed the developed minimum data set. All the items had I-CVI values higher than the critical value of 0.78 in terms of relevance, clarity, and simplicity, except for "medication start date" and "medication end date" in relevance (I-CVI = 0.75 and 0.73, respectively) and "MS type" in simplicity (I-CVI = 0.76). The total S-CVI scores for relevance, clarity, and simplicity were higher than 0.9. In reliability assessment, 27 patients (out of 74 interviewed patients) were re-interviewed to assess the test-retest reliability. All ICCs were higher than the critical value of 0.7 (in 14 items out of 16), except for "progression to secondary-progressive MS" with the ICC = 0.68 and "the reason for medication discontinuance" with the ICC = 0.64. CONCLUSION: The use of standardized validated minimum data set has the potential to enable the researchers and policy-makers to systematically compare and analyze patient information. The Persian version of the minimum data set found to be valid and reliable in Iran.


Assuntos
Conjuntos de Dados como Assunto/normas , Esclerose Múltipla , Sistema de Registros/normas , Humanos , Irã (Geográfico)/epidemiologia , Esclerose Múltipla/epidemiologia , Reprodutibilidade dos Testes
17.
Rev. neurol. (Ed. impr.) ; 68(11): 468-479, 1 jun., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180792

RESUMO

La reunión Post-ECTRIMS se celebró por undécimo año consecutivo el pasado octubre de 2018 en Madrid, con el objetivo de analizar los avances en esclerosis múltiple destacados en el último congreso anual ECTRIMS. Fruto de esta reunión, formada por los líderes de opinión en esclerosis múltiple de ámbito nacional, se presentan dos artículos de revisión. En esta segunda parte, se incluye el creciente número de evidencias que confirman la seguridad de la exposición a los tratamientos modificadores de la enfermedad en mujeres que planifican un embarazo, y el efecto beneficioso de la lactancia, siempre y cuando la enfermedad no esté muy activa. Se abordan los datos que muestran cómo la aplicación de los criterios de McDonald de 2017 en población pediátrica ha mejorado considerablemente el diagnóstico en comparación con los criterios anteriores. En cuanto a la esclerosis múltiple progresiva, los resultados de los fármacos neuroprotectores son poco concluyentes, pero se proponen biomarcadores para mejorar la evaluación de la respuesta terapéutica. Los estudios sobre tratamientos de reparación de la mielina sugieren que la remielinización en la esclerosis múltiple es posible. De igual manera, se exponen indicios favorables sobre el trasplante de células madre hematopoyéticas, siempre que se seleccione adecuadamente a los pacientes. Por otro lado, se revisan las similitudes y diferencias de las recomendaciones de las nuevas guías de práctica clínica publicadas. Por último, los resultados positivos de la rehabilitación cognitiva y motora con el uso de las nuevas tecnologías vaticinan la incorporación sistemática de estas herramientas en el tratamiento de la enfermedad en un futuro próximo


The Post-ECTRIMS Meeting was held for the eleventh consecutive year in October 2018 in Madrid, with the aim of analysing the advances made in multiple sclerosis that were highlighted at the latest ECTRIMS annual congress. Based on the issues discussed at this meeting, attended by the nation’s foremost opinion leaders on multiple sclerosis, two review articles are presented. This second part includes the growing body of evidence confirming the safety of exposure to disease-modifying treatments in women planning a pregnancy, and the beneficial effect of breastfeeding, provided that the disease is not very active. It addresses data showing how the application of the 2017 McDonald criteria in the paediatric population has significantly improved diagnosis compared to the previous criteria. With regard to progressive multiple sclerosis, the results of neuroprotective drugs are inconclusive, but biomarkers are proposed to improve the evaluation of the therapeutic response. Studies on myelin repair treatments suggest that remyelination in multiple sclerosis is possible. Likewise, there are favourable indications for haematopoietic stem cell transplantation, provided that patients are selected appropriately. On the other hand, we also conduct a review of the similarities and differences of the recommendations in the new clinical practice guidelines. Finally, the positive results of cognitive and motor rehabilitation with the use of new technologies point to the systematic incorporation of these tools in the treatment of the disease in the near future


Assuntos
Humanos , Criança , Esclerose Múltipla/epidemiologia , Fármacos Neuroprotetores/uso terapêutico , Transplante de Células-Tronco/tendências , Resultado do Tratamento , Esclerose Múltipla/complicações , Esclerose Múltipla/reabilitação , Sociedades Médicas/normas , Farmacovigilância , Planejamento Familiar , Complicações na Gravidez , Aleitamento Materno , Transtornos Neurológicos da Marcha/reabilitação , Necessidades e Demandas de Serviços de Saúde
18.
Mult Scler Relat Disord ; 32: 70-73, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31054500

RESUMO

BACKGROUND: Radiologically isolated syndrome (RIS) is defined as the occurrence of incidental brain MRI lesions suggestive of multiple sclerosis (MS) in otherwise healthy subjects without any signs or symptoms that could indicate to the disease. We evaluated cognitive performance in a cohort of RIS patients. METHODS: A retrospective analysis of prospectively collected data from a population-based registry documenting demographic, clinical and imaging data of MS patients followed at our institution. Cognitive performance of subjects diagnosed with RIS according to Okuda's criteria was evaluated. Cognitive assessment was performed using MindStreams Global Assessment Battery to evaluate memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills, and compared to that of age- and education-matched healthy population. RESULTS: Thirty patients diagnosed with RIS, mean age at first MRI, 34.3 ±â€¯1.9 years, and disease follow up ranging from 1 to 15 years, were included in the study. Eight patients (26.6%) converted to MS within 4.2 ±â€¯1.4 years. Cognitive performance was relatively preserved with a mean global cognitive score of 98.4 ±â€¯1.6 (median, 100), but all cognitive measurements were below the mean performance for age- and education-matched healthy population. Similar to MS patients, information processing speed was the most impaired cognitive function, mean 94.7 ±â€¯2.04, median 94. Cognitive performance did not differ between RIS patients who converted to MS and those who remained with sustained RIS. CONCLUSIONS: Cognitive performance in RIS subjects was below average for age- and education-matched norms. Information processing speed was the most impaired cognitive test. Cognitive performance of RIS subjects should be followed closely in order to identify any changes that may indicate conversion to MS.


Assuntos
Cognição/fisiologia , Imagem por Ressonância Magnética/métodos , Testes de Estado Mental e Demência , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/psicologia , Adulto , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Esclerose Múltipla/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos
19.
Mult Scler Relat Disord ; 32: 74-76, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055174

RESUMO

BACKGROUND: The national MS registry was established in 2010 to assess the change in epidemiological status. The last reported data of the prevalence and incidence in Kuwait was in 2013. OBJECTIVES: To update the prevalence and incidence rates of MS among Kuwaiti nationals. METHODS: Using the national MS registry, a cross sectional study was conducted to estimate the number of all patients diagnosed with MS and clinically isolated syndrome suggestive of MS. The diagnosis was based on the revised 2017 McDonald criteria. The population census was acquired from the Public Authority of Civil Information. RESULTS: On 30th June 2018, 1454 Kuwaiti MS patients fulfilled the diagnostic criteria. Women represented 66.8% of the analyzed cohort with female to male ratio of 2.01:1. The crude prevalence of MS was 104.88 (95% CI: 89.5-121.9) per 100,000 persons, which increased 1.6 times since 2013. Age-adjusted prevalence peaked in the 30-39 and 40-49 year age groups in both females and male, with a decreasing tendency beyond 50 years of age. The incidence of MS was 5.39 (95% CI: 4.3-6.8) per 100,000 persons. The 5-year incidence was 6.4 per 100,000, which has been stable since the last reported rate. CONCLUSION: The prevalence of MS in Kuwaiti nationals continued to increase reflecting a better case ascertainment and improved awareness and referrals across the country. However, the incidence has stabilized in the last 5 years which was mostly driven by a slight decline in newly diagnosed cases in women compared to men despite the increase in the overall female to male ratio.


Assuntos
Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Incidência , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Adulto Jovem
20.
J Neurol ; 266(7): 1789-1795, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31069528

RESUMO

BACKGROUND: Seizures and epilepsy may substantially add to the burden of disease in multiple sclerosis (MS), whereas the exact prevalence and prognosis of seizures and epilepsy in patients with MS remains largely unknown. OBJECTIVES: We aimed to investigate the epidemiology and prognosis of seizures and epilepsy in MS. METHODS: We retrospectively analyzed a cohort of 4078 MS patients from a single tertiary referral clinic. RESULTS: After excluding 37 patients with unconfirmed MS and alternative seizure etiologies, we found seizures attributable to MS in 1.5% and epilepsy in 0.9% of patients. 40.4% of patients with a follow-up of at least twelve months experienced only a single seizure and 59.6% had recurring seizures. 39% of patients with recurrent seizures were considered drug-resistant, with 9.7% experiencing status epilepticus. Seizure recurrence after a first seizure depended significantly on the MS subtype and was seen more often if the first seizure occurred simultaneously with a MS relapse than in the absence of a relapse. CONCLUSION: Our study shows a lower number of seizures and epilepsy in MS than previously reported. While a single seizure in MS usually has a good prognosis, relapse-associated seizures and established epilepsy in MS may not be as benign as previously assumed.


Assuntos
Epilepsia/diagnóstico , Epilepsia/epidemiologia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Convulsões/diagnóstico , Convulsões/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Centros de Atenção Terciária/tendências
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