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2.
Wiad Lek ; 73(8): 1780-1784, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055351

RESUMO

OBJECTIVE: Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system of a chronic nature, most often with periods of exacerbation and remission, mainly affecting people between 20-40 years of age, with a slight prevalence of women. The aim of the study was to collect and analyze materials published in the literature regarding the prevalence and co-occurrence of mental disorders in patients with multiple sclerosis. Current reports show that as many as 75% of patients with this chronic disease experience various mental disorders, and the incidence of mental diseases - including mood disorders and anxiety disorders - is statistically higher than in the general population. CONCLUSION: Conclusions: Depending on the literature, depressive symptoms appear in 6.94% -70.1% of patients with MS. Diagnosis of anxiety disorders affects 11.1% of patients, while bipolar disorder affects up to 16.2%. Co-occurrence of MS with schizophrenia is estimated at 1.28%. The incidence of other psychoses is 2-4% in patients with MS. Only in the case of schizophrenia, men with MS are more likely to develop it, while other psychiatric disorders are more common among women. Co-occurrence of mental disorders in the course of multiple sclerosis adversely affects the treatment process and the functioning of patients and their families.


Assuntos
Transtorno Bipolar , Esclerose Múltipla , Transtornos de Ansiedade , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Esclerose Múltipla/complicações , Esclerose Múltipla/epidemiologia , Prevalência
4.
Rev. neurol. (Ed. impr.) ; 71(4): 151-158, 16 ago., 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-195463

RESUMO

INTRODUCCIÓN: La esclerosis múltiple es una enfermedad crónica, de origen inflamatorio y degenerativo, del sistema nervioso central. Se caracteriza en la mayoría de los casos por la aparición de manera recurrente de brotes de déficit neurológico focal, que con el tiempo puede tornarse progresivo. Dado el carácter crónico de la enfermedad, los pacientes pueden presentar enfermedades adicionales (comorbilidades), que impactan de diferentes maneras en la historia natural de la enfermedad y en su tratamiento. OBJETIVO: Resumir la evidencia disponible respecto a la influencia de las comorbilidades en la historia natural de la esclerosis múltiple. DESARROLLO: Los pacientes con esclerosis múltiple tienen un riesgo mayor que la población general de desarrollar comorbilidades tanto agudas como crónicas. Se ha demostrado que las comorbilidades pueden retrasar el diagnóstico de esclerosis múltiple después del inicio clínico, incrementar la tasa de brotes y aumentar la tasa de acumulación de la discapacidad. Las comorbilidades también influyen en aspectos relacionados con la elección del tratamiento y la adhesión terapéutica. Finalmente, las comorbilidades también aumentan la tasa de mortalidad y la calidad de vida de los pacientes con esclerosis múltiple. CONCLUSIONES: El cribado, el diagnóstico y el tratamiento de las comorbilidades son un aspecto clave del cuidado de los pacientes con esclerosis múltiple para mejorar su pronóstico a largo plazo en cuanto a discapacidad, calidad de vida y mortalidad


INTRODUCTION: Multiple sclerosis is a chronic, inflammatory and degenerative disease of the central nervous system. In most cases it is characterised by the recurring focal neurological deficit, which may become progressive over time. Given the chronic nature of the disease, patients may present with additional diseases (comorbidities), which affect the natural history of the disease and its treatment in different ways. AIM: To summarise the available evidence regarding the influence of comorbidities on the natural history of multiple sclerosis. DEVELOPMENT: Patients with multiple sclerosis are at greater risk than the general population of developing both acute and chronic comorbidities. It has been shown that comorbidities can delay the diagnosis of multiple sclerosis after clinical onset, increase the rates of relapses and of accumulation of disability. Comorbidities also influence aspects of the choice of treatment and therapy adherence. Finally, comorbidities also increase the mortality rate and reduce the quality of life of patients with multiple sclerosis. CONCLUSIONS: Screening, diagnosis and treatment of comorbidities are a key aspect of caring for patients with multiple sclerosis to improve their long-term prognosis in terms of disability, quality of life and mortality


Assuntos
Humanos , Esclerose Múltipla/epidemiologia , Comorbidade , Diagnóstico Tardio/mortalidade , Cooperação e Adesão ao Tratamento , Qualidade de Vida , Fatores de Risco , História Natural , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/mortalidade
5.
CNS Drugs ; 34(9): 879-896, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32780300

RESUMO

The coronavirus 2019 (COVID-19) pandemic is expected to linger. Decisions regarding initiation or continuation of disease-modifying therapy for multiple sclerosis have to consider the potential relevance to the pandemic. Understanding the mechanism of action and the possible idiosyncratic effects of each therapeutic agent on the immune system is imperative during this special time. The infectious side-effect profile as well as the route and frequency of administration of each therapeutic agent should be carefully considered when selecting a new treatment or deciding on risk mitigation strategies for existing therapy. More importantly, the impact of each agent on the future severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) vaccine should be carefully considered in treatment decisions. Moreover, some multiple sclerosis therapies may have beneficial antiviral effects against SARS-CoV-2 while others may have beneficial immune-modulating effects against the cytokine storm and hyperinflammatory phase of the disease. Conventional injectables have a favorable immune profile without an increased exposure risk and therefore may be suitable for mild multiple sclerosis during the pandemic. However, moderate and highly active multiple sclerosis will continue to require treatment with oral or intravenous high-potency agents but a number of risk mitigation strategies may have to be implemented. Immune-modulating therapies such as the fumerates, sphinogosine-1P modulators, and natalizumab may be anecdotally preferred over cell-depleting immunosuppressants during the pandemic from the immune profile standpoint. Within the cell-depleting agents, selective (ocrelizumab) or preferential (cladribine) depletion of B cells may be relatively safer than non-selective depletion of lymphocytes and innate immune cells (alemtuzumab). Patients who develop severe iatrogenic or idiosyncratic lymphopenia should be advised to maintain social distancing even in areas where lockdown has been removed or ameliorated. Patients with iatrogenic hypogammaglobulinemia may require prophylactic intravenous immunoglobulin therapy in certain situations. When the future SARS-CoV-2 vaccine becomes available, patients with multiple sclerosis should be advised that certain therapies may interfere with mounting a protective immune response to the vaccine and that serological confirmation of a response may be required after vaccination. They should also be aware that most multiple sclerosis therapies are incompatible with live vaccines if a live SARS-CoV-2 vaccine is developed. In this article, we review and compare disease-modifying therapies in terms of their effect on the immune system, published infection rates, potential impact on SARS-CoV-2 susceptibility, and vaccine-related implications. We propose risk mitigation strategies and practical approaches to disease-modifying therapy during the COVID-19 pandemic.


Assuntos
Antirreumáticos/farmacologia , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus , Sistema Imunitário/efeitos dos fármacos , Esclerose Múltipla , Pandemias , Pneumonia Viral , Vacinas Virais/farmacologia , Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/imunologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Risco Ajustado
6.
Artigo em Inglês | MEDLINE | ID: mdl-32686774

RESUMO

This paper reviews currently available data on the novel coronavirus and clinical features of COVID-19, followed by a detailed section on possible modifications of immunomodulatory therapy in multiple sclerosis patients with COVID-19, based on what we know so far. There are discussed: (i) The COVID-19 disease (Epidemiological background SARS-CoV-1 coronavirus; Autoimmune response to COVID-19; Asymptomatic course; SARS-CoV-2 test; COVID-19 symptoms), (ii) Treatment of COVID-19 (Experimental plasma treatment; Antiviral therapy; Antimalarial treatment scheme; Biological treatment; Corticosteroid treatment; Symptomatic treatment; Vaccine preparation) and (iii) Multiple sclerosis and SARS-CoV-2 infection (Epidemiological recommendation).


Assuntos
Infecções por Coronavirus , Fatores Imunológicos/farmacologia , Imunomodulação/imunologia , Esclerose Múltipla , Pandemias , Pneumonia Viral , Doenças Assintomáticas/epidemiologia , Autoimunidade , Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Humanos , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/imunologia , Esclerose Múltipla/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia
9.
Mult Scler Relat Disord ; 45: 102377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698095

RESUMO

SARS-CoV-2 infection can produce neurological features. The most common are headache, anosmia and dysgeusia but patients may also develop other central nervous system (CNS) injuries. We present a patient affected by Covid-19 who initially consulted for decreased visual acuity. The MRI showed inflammation in the right optic nerve and demyelinating lesions in the CNS. We speculate that an immune mechanism induced by SARS-CoV-2, which can activate lymphocytes and an inflammatory response, plays a role in the clinical onset of the disease. This pathogen may be associated with either the triggering or the exacerbation of inflammatory/demyelinating disease.


Assuntos
Infecções por Coronavirus/complicações , Esclerose Múltipla/epidemiologia , Pneumonia Viral/complicações , Adulto , Betacoronavirus , Feminino , Humanos , Esclerose Múltipla/patologia , Pandemias
11.
Neurol Sci ; 41(7): 1647-1650, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32617741

RESUMO

We assessed the prevalence and impact of COVID-19 among multiple sclerosis (MS) patients across Europe by leveraging participant data collected as part of the ongoing EU IMI2 RADAR-CNS major programme aimed at finding new ways of monitoring neurological disorders using wearable devices and smartphone technology. In the present study, 399 patients of RADAR-MS have been included (mean age 43.9 years, 60.7% females) with 87/399 patients (21.8%) reporting major symptoms suggestive of COVID-19. A trend for an increased risk of COVID-19 symptoms under alemtuzumab and cladribine treatments in comparison to injectables was observed. Remote monitoring technologies may support health authorities in monitoring and containing the ongoing pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/virologia , Pneumonia Viral/epidemiologia , Adulto , Alemtuzumab/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Europa (Continente) , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Pandemias , Pneumonia Viral/tratamento farmacológico , Prevalência
12.
Rev. neurol. (Ed. impr.) ; 71(1): 19-25, 1 jul., 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-195440

RESUMO

INTRODUCCIÓN: La esclerosis múltiple es una enfermedad inflamatoria y neurodegenerativa del sistema nervioso central, que afecta fundamentalmente a personas jóvenes en edad laboral y reproductiva, y que representa la primera causa de discapacidad no traumática en este rango etario de la población. Se reconoce un gradiente de latitud norte-sur, con un aumento de las tasas de prevalencia a medida que nos alejamos del ecuador. Este gradiente probablemente representa la predisposición genética transmitida desde las regiones escandinavas a través de las invasiones vikingas y podría presuponer una influencia del déficit de vitamina D en relación con un menor número de horas de sol anuales. OBJETIVO: Determinar la prevalencia e incidencia de la esclerosis múltiple en la ciudad de Ourense, Galicia. PACIENTES Y MÉTODOS: La ciudad de Ourense tiene una coordenada de latitud de 42° 34 N. Se ha realizado un estudio epidemiológico retrospectivo que abarca desde 2002 a 2016. La fecha de prevalencia fue el 31 de diciembre de 2016. El censo de la población de la ciudad de Ourense a 1 de enero de 2016 era de 105.892 habitantes. RESULTADOS: Se registraron 195 casos, lo que representa una prevalencia de 184,1 casos/100.000 habitantes. En el período 2002-2016 se diagnosticaron 127 casos de esclerosis múltiple, lo que supone una incidencia media de 7,86 casos/ 100.000 habitantes/año. CONCLUSIÓN: La ciudad de Ourense presenta la tasa de prevalencia de esclerosis múltiple más alta de las estudiadas hasta la actualidad en la Península Ibérica, con una cifra que la aproxima a los datos comunicados en áreas más septentrionales de influencia nórdica y anglosajona


INTRODUCTION: Multiple sclerosis is an inflammatory neurodegenerative disease of the central nervous system, which mainly affects young people of working and reproductive age, and represents the first cause of non-traumatic disability in this age group of the population. A north-south latitude gradient is recognised, with prevalence rates increasing as we move away from the equator. This gradient probably represents the genetic predisposition transmitted from the Scandinavian regions through the Viking invasions and could presuppose an influence of the vitamin D deficit related to a lower number of hours of sunshine per year. AIMS: To determine the prevalence and incidence of multiple sclerosis in the city of Ourense, Galicia. PATIENTS AND METHODS: The latitude coordinate of the city of Ourense is 42° 34 N. A retrospective epidemiological study covering the period from 2002 to 2016 was conducted. The prevalence date was 31 December 2016. According to the latest census, the population of the city of Ourense was 105,892 on 1 January 2016. RESULTS: Altogether, 195 cases were recorded, representing a prevalence of 184.1 cases/100,000 inhabitants. In the period 2002-2016, 127 cases of multiple sclerosis were diagnosed, representing an average incidence of 7.86 cases/100,000 inhabitants/year. CONCLUSION: The city of Ourense has the highest prevalence rate of multiple sclerosis of those studied to date in the Iberian Peninsula, with a figure that brings it closer to the data reported in more northern areas under Nordic and Anglo-American influence


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Esclerose Múltipla/epidemiologia , Deficiência de Vitamina D/epidemiologia , Espanha/epidemiologia , Estudos Retrospectivos , Epidemiologia Descritiva , Estatísticas não Paramétricas
13.
PLoS One ; 15(7): e0235562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614900

RESUMO

INTRODUCTION: The incidence rate of MS is a valuable indicator of the recent changes in the risk of this disease, and it is widely implicated for health planning purposes. OBJECTIVES: This study aims to determine the MS incidence over the past eleven years in Mazandaran province and to compare it with the other parts of Iran and the world. MATERIALS AND METHODS: This retrospective study is conducted in Mazandaran province by using registered data in the files of the patients with their consent. The yearly crude incidence rates, age, and sex-specific incidence rates and directly standardized incidence rates of this population are calculated, and the temporal changes in the incidence rates are analyzed. RESULTS: 662 (26%) male patients with the mean (SD) age of 32.6 (9.48) and 1884 (74%) female patients with the mean (SD) age of 31.9 (9.15) are studied. The direct standardized incidence rate of MS was 3.28 in 100.000 in 2008 and reached 4.17 in 100.000 in 2018, and this increase was significant (p<0.05). Also, the yearly prevalence of MS increased from 24.4 to 72.5 in this period. CONCLUSIONS: The MS incidence has increased in Mazandaran. The potential role of some genetic or environmental factors needs further investigation.


Assuntos
Esclerose Múltipla/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
14.
Gene ; 758: 144959, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-32683075

RESUMO

Multiple sclerosis (MS) is a clinically heterogeneous multifactorial disorder which is one of the most prevalent neurological disorders of females and young people. Both genetic and environmental factors are playing an important role in the pathophysiology of MS. The main objective of this study is to identify the relationship between numbers of genetic variants within different candidate genes (IL7R, LAG3, and CD40) and the risk of developing MS in the Jordanian Arab population. This case-control study consists of 218 MS patients chosen from neurology clinics at different hospitals in Jordan and ethnically matched 227 healthy controls. Genomic DNA was extracted from blood samples. Genotyping of the candidate gene polymorphisms was conducted using the Sequenom MassARRAY system. Statistical analysis was performed to identify the genetic association of the studied SNPs with MS. Twenty-one variants were studied, three of them were found to be associated with MS (rs6897932 (P-value = 0.01) and rs13188960 (P-value = 0.005) within IL7R gene and LAG3 rs2365095, (P-value = 0.03) within LAG3 gene). Moreover, no significant association was found between MS and the genetic polymorphisms of the CD40 gene. After correction for multiple comparisons, only rs13188960 SNP remained significantly with MS. This is the first study of the genetic association with MS in the Jordanian Arab population to provided evidence of the genetic association of IL7R (rs6897932, rs13188960) and LAG3 (rs2365095) gene polymorphisms with MS. These findings may contribute to our understanding of MS and optimize the therapy protocol for individuals.


Assuntos
Antígenos CD/genética , Predisposição Genética para Doença/genética , Subunidade alfa de Receptor de Interleucina-7/genética , Esclerose Múltipla/genética , Adulto , Árabes/genética , Antígenos CD40/genética , Estudos de Casos e Controles , Feminino , Estudos de Associação Genética , Genótipo , Humanos , Jordânia/epidemiologia , Masculino , Esclerose Múltipla/epidemiologia , Polimorfismo de Nucleotídeo Único/genética , Adulto Jovem
15.
Mult Scler ; 26(10): 1256-1260, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32662742

RESUMO

Here, we provide an extensive overview of all reported COVID-19 cases in multiple sclerosis (MS) patients in the Netherlands between 27 February and 9 June 2020, gathered by the Dutch MS Taskforce of the Netherlands Society of Neurology. A total of 86 MS patients were reported, 43 of whom tested positive for COVID-19. Of 43 patients who tested positive, 22 patients were hospitalized. Three intensive care unit (ICU) admissions and four deaths were reported. Our findings show no apparent difference in disease-modifying treatment (DMT) use and COVID-19 disease course in Dutch MS patients. In addition, a clear link between low lymphocyte count and severe disease was not observed.


Assuntos
Infecções por Coronavirus/fisiopatologia , Fatores Imunológicos/uso terapêutico , Linfopenia/sangue , Esclerose Múltipla/tratamento farmacológico , Pneumonia Viral/fisiopatologia , Adulto , Idoso , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Contagem de Linfócitos , Linfopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Países Baixos/epidemiologia , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Índice de Gravidade de Doença , Adulto Jovem
16.
PLoS One ; 15(7): e0236432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716953

RESUMO

OBJECTIVES: As there were only regional studies in Hungary about the prevalence of multiple sclerosis (MS), we aimed to estimate its epidemiological features using data of Hungary's single-payer health insurance system. METHODS: Pseudonymized database of claims reported by hospitals and outpatient services between 2004-2016 was analyzed and linked with an independent database of outpatient pharmacy refills between 2010-2016. We established an administrative case definition of MS and validated it on medical records of 309 consecutive patients. A subject was defined as MS-patient if received MS diagnosis (International Classification of Diseases, 10th edition, code G35) on three or more occasions at least in 2 calendar years and at least once documented by a neurologist. Patients were counted as incident cases in the year of the first submitted claim for MS. We allowed a 6-year-long run-in period, so only data between 2010-2015 are discussed. RESULTS: Sensitivity of the administrative case definition turned out to be 99%, while specificity was >99%. Crude prevalence of MS has increased from 109.3/100,000 in 2010 to 130.8/100,000 in 2015 (p-value = 0.000003). Crude incidence declined from 7.1/100,000 (2010) to 5.4/100,000 (2015) (p-value = 0.018). Direct standardization - based on European standard population and results of nationwide Hungarian census of 2011 - revealed that age standardized prevalence was 105.2/100,000 (2010), which has grown to 127.2/100,000 (2015) (p-value = 0.000001). Age standardized incidence rate declined from 6.7/100,000 (2010) to 5.1/100,000 (2015) (p-value = 0.016). The ratio of MS-patients receiving ≥1 prescription for disease modifying treatment increased from 0.19 (2010) to 0.29 (2015) (p-value = 0.0051). The female/male ratio of prevalent cases remained 2.6. DISCUSSION: The prevalence of MS in Hungary is higher than previously reported, the incidence rate is moderate. The prevalence is rising, the incidence rate shows decline. The proportion of patients receiving disease modifying treatment grows but was still around 30% in 2015.


Assuntos
Análise de Dados , Assistência à Saúde/organização & administração , Esclerose Múltipla/epidemiologia , Registros , Fatores Etários , Algoritmos , Feminino , Humanos , Hungria/epidemiologia , Incidência , Masculino , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/tratamento farmacológico , Prevalência , Reprodutibilidade dos Testes
19.
JAMA Neurol ; 77(9): 1079-1088, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32589189

RESUMO

Importance: Risk factors associated with the severity of coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (MS) are unknown. Disease-modifying therapies (DMTs) may modify the risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities. Objective: To describe the clinical characteristics and outcomes in patients with MS and COVID-19 and identify factors associated with COVID-19 severity. Design, Setting, and Participants: The Covisep registry is a multicenter, retrospective, observational cohort study conducted in MS expert centers and general hospitals and with neurologists collaborating with MS expert centers and members of the Société Francophone de la Sclérose en Plaques. The study included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and May 21, 2020. Exposures: COVID-19 diagnosed with a polymerase chain reaction test on a nasopharyngeal swab, thoracic computed tomography, or typical symptoms. Main Outcomes and Measures: The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1 [not hospitalized with no limitations on activities] to 7 [death]) with a cutoff at 3 (hospitalized and not requiring supplemental oxygen). We collected demographics, neurological history, Expanded Disability Severity Scale score (EDSS; ranging from 0 to 10, with cutoffs at 3 and 6), comorbidities, COVID-19 characteristics, and outcomes. Univariate and multivariate logistic regression models were used to estimate the association of collected variables with COVID-19 outcomes. Results: A total of 347 patients (mean [SD] age, 44.6 [12.8] years, 249 women; mean [SD] disease duration, 13.5 [10.0] years) were analyzed. Seventy-three patients (21.0%) had a COVID-19 severity score of 3 or more, and 12 patients (3.5%) died of COVID-19. The median EDSS was 2.0 (range, 0-9.5), and 284 patients (81.8%) were receiving DMT. There was a higher proportion of patients with a COVID-19 severity score of 3 or more among patients with no DMT relative to patients receiving DMTs (46.0% vs 15.5%; P < .001). Multivariate logistic regression models determined that age (odds ratio per 10 years: 1.9 [95% CI, 1.4-2.5]), EDSS (OR for EDSS ≥6, 6.3 [95% CI. 2.8-14.4]), and obesity (OR, 3.0 [95% CI, 1.0-8.7]) were independent risk factors for a COVID-19 severity score of 3 or more (indicating hospitalization or higher severity). The EDSS was associated with the highest variability of COVID-19 severe outcome (R2, 0.2), followed by age (R2, 0.06) and obesity (R2, 0.01). Conclusions and Relevance: In this registry-based cohort study of patients with MS, age, EDSS, and obesity were independent risk factors for severe COVID-19; there was no association found between DMTs exposure and COVID-19 severity. The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of patients with MS during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adulto , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento
20.
Acta Neurol Scand ; 142(3): 200-209, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32500607

RESUMO

Finland is a high-risk region for multiple sclerosis (MS) with several epidemiological studies on the subject published since 1964, but these have not been comprehensively scrutinized. The objective of this study was to review previous studies of Finnish MS epidemiology, introduce new data on MS prevalence in western parts of Finland and do further analyses on data from previous studies. We performed a systematic search on articles regarding MS epidemiology in Finland in PubMed database, and all relevant articles were included in this review. MS prevalences in the western hospital districts of Vaasa, South Ostrobothnia and Pirkanmaa were calculated in 1980-2007 by using previously unpublished data obtained from a retrospective search from hospital administrative registries. To enhance comparability of the epidemiological figures, we calculated age-standardized prevalence of MS from the new data from western hospital districts and previous data from North Ostrobothnia, Southwest Finland and North Karelia. Marked regional differences in MS epidemiology were confirmed with concentration of the disease in the western and south-western parts of the country. The highest regional age-standardized MS prevalence of 288/100 000 was reported in South Ostrobothnia in 2007. A clear and stable increase in MS prevalence was observed through the decades, but the only marked increase in incidence happened in 1990s. Methodological differences hampered direct comparisons of different studies, highlighting the importance of common principles of reporting and standardizing the epidemiological figures. More comprehensive studies on MS epidemiology are still warranted to yield important information concerning the aetiology of the disease.


Assuntos
Esclerose Múltipla/epidemiologia , Finlândia/epidemiologia , Humanos , Incidência , Prevalência , Sistema de Registros
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