Clinical features of multiple sclerosis in north-east Scotland

The clinical features of multiple sclerosis (MS) in north-east Scotland have been examined along with an epidemiological study to determine the prevalence of the disease on 1st December, 1970. Patient information was collected from all available diagnostic indices, both retrospectively and prospectively from 1965. Every family doctor in the region contributed. The age and sex specific prevalence rates for MS in north-east Scotland on 1st December, 1970, are the highest ever recorded. Among the 80,000 women aged 40 to 69, one in every 340 had the disease. The mean incidence rate for a 12-year period was 5.0/100,000. A significantly better prognosis with regard to disability was found for onset with sensory symptoms, a relapsing/remitting type of course, men with long disease duration, and an initial remission period of 4 or more years. The occurrence of various abnormal neurological signs and symptoms has rarely been recorded in a large epidemiological study. The findings in this study, however, are similar to previous non-epidemiological studies.     

A further study on the prevalence of multiple sclerosis in Sicily: Caltanissetta city

The prevalence of probable multiple sclerosis (MS) in Caltanissetta city, Sicily, is at least 51 per 100,000. If possible multiple sclerosis patients are included, it is 54 per 100,000. This value is similar to that found in other cities in Sicily: Enna, Monreale and Agrigento. The high prevalence of multiple sclerosis in Caltanissetta confirms the previous data on Sicily and emphasises the importance of small population studies in the epidemiology of MS.     

Factors in the rising prevalence of multiple sclerosis in the north-east of Ireland

BACKGROUND: Northern Ireland is recognized as an area of high risk for multiple sclerosis. The original study of Allison and Millar in 1951 found a prevalence of 51/100,000 and mean annual incidence of 2.74/100,000/year. Subsequent studies in 1961, 1986, and 1996 suggested rising prevalence--80, 138, and 168.2/100,000, respectively. METHODS: In 2004, we surveyed the North-East of Northern Ireland (population 160,446, area 2030 km(2)) using multiple sources of case ascertainment, all satisfying the Poser criteria for definite or probable multiple sclerosis (MS) or the McDonald criteria. RESULTS: From a provisional list of 469 cases, 370 (123 males, 247 females) were identified. The prevalence was 230.6 per 100,000 (95% CI 207.0-255.4) with significantly higher prevalence in females (300.8/100,000) than males (157.0/100,000). Direct standardization to the 1961 Northern Ireland population reduced the overall prevalence rate to 200.5/100,000 (95% CI 193.2-208.0), in females to 270.2/100,000 (95% CI 258.8-282.4) and in males to 131.1/100,000 (95% CI 122.8-139.9). In 1996, incidence had risen to 9.3/100,000/year (14 cases in population of 151,000) with a higher incidence in females (10.3/100,000/year) than males (8.3/100,000/year). CONCLUSIONS: Northern Ireland continues to have a rising prevalence of MS. The increase in incidence suggests a true increase in the disease.     

A prevalence survey of multiple sclerosis in Sussex.

A first survey of the Brighton and Mid-Downs health districts in Sussex showed a prevalence of multiple sclerosis of 111 per 100,000 (95% confidence interval (95% CI) 103-120) in a population of 596,594 on prevalence day, 1 July 1991. Cases were notified by multiple sources and to maximise case notification patients were not contacted. Cases were classified by hospital and family practitioner notes. The Poser criteria were used for classification. These criteria are precise and exclude cases of isolated spinal cord syndrome. The Allison and Millar criteria used in the surveys in Scotland may lack specificity and it is concluded that the high prevalence of multiple sclerosis in Scotland needs to be reassessed with the more precise criteria. Until this is done, the latitude effect within the United Kingdom remains not proved.     

A prevalence study of multiple sclerosis in L'Aquila, central Italy

We report the results of an epidemiologic study in the Municipality of L'Aquila, Abruzzo, Central Italy, undertaken to estimate the prevalence rate of Multiple Sclerosis (MS). On December 31, 1984, the prevalence was 33.2 per 100,000 (34.2 when age and sex is standardized to the Italian population). In agreement with recent intensive surveys from different regions in the North and South of Italy, our data indicate that the prevalence of MS in Italy is higher than 30 per 100,000, and emphasize the importance of small population studies in the epidemiology of MS. Our findings suggest that in Italy the risk for MS is higher than recorded before.     

Seasonality of admissions with multiple sclerosis in Scotland

Background and purpose: Previous studies have described a seasonal pattern of MS relapse risk. Vitamin D and infectious triggers are two major candidate environmental risk factors proposed to account for this effect. We aimed to assess MS admissions in Scotland for a possible effect of seasonality. Methods: Acute admissions with MS were obtained from the Scottish Morbidity Register between 1997 and 2009. We compared the pattern of these to admissions with other diagnoses. Results: We obtained data on 7098 MS and 6 243 690 non‐MS acute and day‐case admissions. We found a significant difference in acute MS admissions compared with admissions with other diagnoses (P = 0.0015). There was a significant excess of Scottish MS admissions in April and June with nadirs in March and October. Conclusions: Admissions with MS show a significant seasonal variation throughout the year. Further work will be needed to identify candidate environmental factors with certainty.     

High incidence and prevalence of multiple sclerosis in south east Scotland: evidence of a genetic predisposition

OBJECTIVE—To determine the incidence andprevalence of multiple sclerosis in the Lothian and Border Health BoardRegions of south east Scotland.
METHODS—Incidence study: all patients wereidentified in whom a diagnosis of Poser category probable or definitemultiple sclerosis was made by a neurologist between 1992 and 1995. Prevalence study: all patients known to have multiple sclerosis whowere alive and resident in the study area on 15 March 1995 were recorded.
RESULTS—The crude annual incidence rates ofprobable or definite multiple sclerosis per 100 000 population were thehighest ever reported: 12.2 (95% confidence interval (95% CI)10.8-13.7) in the Lothian Region and 10.1 (95% CI 6.6-13.6) in theBorder Region. A total of 1613 patients with multiple sclerosis wereresident in the study area, giving standardised prevalence rates per100 000 population of 203 (95% CI 192-214) in the Lothian Region and219 (95% CI 191-251) in the Border Region. Prevalent cases were morelikely than expected to have a Scottish surname (risk ratio 1.24, 95% CI 1.14-1.34).
CONCLUSIONS—Orkney and Shetland were previouslythought to have by far the highest prevalence of multiple sclerosis inthe world: about double that found in England and Wales. However, theprevalence in south east Scotland is equally high, suggesting that theScottish population as a whole has a genetic susceptibility to thedisease, and undermining the hypothesis that patterns of infectionspecific to small sparsely populated island communities are importantin the causation of multiple sclerosis.

     

Tuberous sclerosis: prevalence in the Grampian Region of Scotland

ABSTRACT. The prevalence of tuberous sclerosis in the Grampian region in 1973 was 2.93 and in 1983 2.63 perl 100 000, with about one in 20 000 of the population under 20 being affected. Only one family group was identified.     

Increasing prevalence of multiple sclerosis in Finland

Objectives – To follow‐up the prevalence trends of MS from 1983 to 1993 in western and southern Finland. MS epidemiology has been previously followed from 1964 to 1978 in these regions. The updated prevalences were correlated with incidence trends in the same period. Methods– Age‐adjusted and age‐specific MS prevalence rates were calculated for cases classified by Poser's criteria. Results– In the western health‐care districts, Seinäjoki and Vaasa, prevalences in 1993 were 202/10⁵ and 111/10⁵. In the southern district Uusimaa the respective figure was 108/10⁵. In Seinäjoki a significant 1.7‐fold increase was found in 1993 as compared to 1983, mainly due to increased incidence. In Uusimaa a significant 1.2‐fold increase in prevalence was found in the presence of stable incidence. In Vaasa prevalence was stable, although incidence was declining. Conclusion– The prevalence of MS is increasing in Seinäjoki and Uusimaa but not in Vaasa. Both the prevalence and incidence in Seinäjoki are now among the highest reported.     

The prevalence of multiple sclerosis in south east Wales.

A population-based survey of multiple sclerosis in the county of South Glamorgan has demonstrated a prevalence of 441/376718 (117/10(5)). Eighty six per cent of the patients (101/10(5)) had definite or probable disease and 14% (16/10(5)) had suspected multiple sclerosis on 1 January 1985. The estimated average incidence is 5.41/10(5)/year for the period 1947-84 and it has risen significantly over four decades. The prevalence is similar to that found in a recent survey from the south east of England but significantly lower than revised figures from Scotland.     

A prospective study of the incidence, prevalence and mortality of multiple sclerosis in Leeds

Objective: To establish the prospective incidence of multiple sclerosis and mortality rates of people with multiple sclerosis in Leeds Health Authority and an updated prevalence of multiple sclerosis on 31 October 1999. Methods A population based prevalence register established on 30 April 1996 was maintained by prospectively registering all new cases of multiple sclerosis, flagging all cases with the National Health Service Central Register for notification of deaths and by registering all new clinical events. General practitioners notified patients with multiple sclerosis moving into or out of the area. Results 136 incident cases were prospectively registered from 30 April 1996 living in Leeds Health Authority (with an estimated resident population of 728 840). 57 deaths were notified. 792 people with multiple sclerosis were identified living in Leeds on 31 October 1999. The mean annual incidence rate for the three-year period 1996–1998 was 6.1/10⁵ (95 % CI: 5.1–7.2). The sex ratio of incident cases was 2.3 to 1 women to men. On 31 October 1999 the prevalence of multiple sclerosis in the Leeds Health Authority was 108.7/10⁵ (95 % CI: 101.2–116.5). This compares with a prevalence of 97.3/10⁵ (95 % CI: 90.3 –104.7) on 30 April 1996. The prevalence of definite and probable multiple sclerosis was 93.3/10⁵ (95 % CI: 86.4–100.6) and of suspected multiple sclerosis was 15.4/10⁵ (95 % CI 12.7 –18.5). Crude annual mortality rates of people with multiple sclerosis for 1997 and 1998 were 1.9/10⁵ (95 % CI: 1.1 to 3.2) and 3.2/10⁵ (95 % CI: 2.0 to 4.7). Multiple sclerosis was noted as the underlying cause of death in 8 (14 %) cases. Conclusion The incidence of multiple sclerosis in the Leeds Health Authority is similar to that in the south of the United Kingdom. The difference in successive prevalence figures is less than that published in other serial studies. Multiple sclerosis was notified as the underlying cause of death in a minority of deaths in people with multiple sclerosis. Received: 5 December 2000, Received in revised form: 23 March 2001, Accepted: 10 July 2001     

The use of standardized incidence and prevalence rates in epidemiological studies on multiple sclerosis. A meta-analysis study

OBJECTIVE: To demonstrate whether or not the age and sex adjustment of incidence and prevalence rates in multiple sclerosis (MS) could allow more reliable comparison between epidemiological studies performed in different areas of the world and to establish if the latitude gradient theory could be confirmed after the standardization for age and sex distribution. METHODS: A meta-analysis of population-based incidence and prevalence studies on MS from 1980 through 1998 using the terms 'multiple sclerosis', 'prevalence' and 'incidence' in the bibliographic databases MEDLINE and EMBASE was performed. We included studies that reported the diagnostic criteria, number of cases and the population studied, the date of the study, the latitude, and the age- and sex-specific crude incidence and prevalence rates. According to the inclusion criteria, 69 of 127 papers on prevalence and 22 of 70 papers on incidence were considered for age adjustment and 27 prevalence and 8 incidence studies for sex adjustment. The mean incidence and prevalencerates and the 95% confidence intervals age- and sex-adjusted to the World and the European standard populations were calculated. RESULTS: The Spearman rank correlation and the multiple regression analyses indicated that age adjustment to standard populations could overcome the limitations in comparing the crude prevalence and incidence rates of different epidemiological studies on MS. When the mean crude and age- and sex-adjusted prevalence and age-adjusted incidence rates were stratified by latitude (from south to north), the latitudinal gradient, which was highly significant for the crude rates, became less remarkable for the age- and sex-adjusted prevalence rates and not significant for the age-adjusted incidence rates. CONCLUSIONS: The crude incidence and prevalence rates in epidemiological studies on MS should be age- and sex-adjusted to a common standard population to permit a more reliable comparison among studies performed in different countries. Our findings support the opinion that the latitude does not play a key role in determining the onset of MS. Whenever possible, the crude incidence and prevalence rates should be adjusted to the ethnic origin and migration characteristics.     

A prevalence study of autism in tuberous sclerosis

An estimate of the prevalence of autism in tuberous sclerosis (TSC) was made by interviewing the parents of 21 children between ages 3 and 11 ascertained during a previous population study of the condition in the West of Scotland. Five of the children (24%) were rated autistic and a further four (19%), all of whom were girls, has socially impaired behavior categorized as pervasive developmental disorder, without fulfilling all the DSM-III-R criteria for autism. One further boy had disruptive attention-seeking behavior that had excluded him from his, normal school. The estimated prevalence from this study of autism in TSC is 1 in 4 children in general, and 1 in 2 of those with mental retardation. Tuberous sclerosis could be a significant cause of autism and pervasive developmental disorders, particularly in girls.This work was supported by a grant from the Tuberous Sclerosis Association of Great Britain. The authors thank Jennifer Dennis for discussions during the preparation of the questionnaire and for collaboration on validating the recorded interviews.     

Validation study of prevalence and correlates of depressive symptomatology in multiple sclerosis

OBJECTIVE: To validate previous research findings on the prevalence of and factors associated with depressive symptoms in a community-dwelling sample of individuals with multiple sclerosis (MS). METHOD: A cross-sectional survey study of 530 individuals with MS from Eastern Washington (EW) was conducted and compared to a previous cross-sectional survey study of 738 individuals with MS from Western Washington (WW). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and multivariate logistic regression was employed to detect related factors. RESULTS: Prevalence of depressive symptoms was similar in both populations (EW 51%, WW 45%). Factors associated with a clinically significant level of depressive symptoms (CES-D > or =16) in both groups were greater disease severity, shorter disease duration, lower education and less social support (all P<.01). Lower age was also associated with a significant level of depressive symptoms in the WW but not in the EW sample. CONCLUSIONS: Despite differences in disease-related and demographic factors, predictors of depressive symptoms were highly similar in both MS study populations.