The prevalence of multiple sclerosis in the north–west Italian province of Genoa

The objective of this study was to assess the prevalence of multiple sclerosis (MS), calculated as point prevalence on 31 December 1997, in the province of Genoa, North–western Italy. Methods The province of Genoa is located in North–western Italy, an area of 1835 km². On the point prevalence day the population consisted of 913,218 inhabitants. MS cases were identified by analysing archives of the hospitals with neurological or rehabilitation wards, neurologists serving the community, files of local chapters of the Italian MS society, all requests for oligoclonal bands analysis on CSF in the studied area. Patients included in the study were MS cases diagnosed before 31 December 1997 according to the Poser criteria resident in the province under study. Results A total of 857 subjects were alive and residing in the province of Genoa on the prevalence day. The overall crude prevalence rate was 94 per 100,000 (95% CI 88–100); 291 were males (34%) with a crude prevalence of 67 per 100,000 (95 % CI 60–76) and 566 were females (66%) with a prevalence of 118 per 100,000 (95% CI 108–128). The female/male ratio was 1.9. When age and sex were adjusted to the Italian standard population of 1991 prevalence was 85 per 100,000. Five hundred and thirty two out of the 857 patients agreed to be interviewed. The interviewed sample was representative of the prevalence sample: sex and gender distributions were identical in the two samples. The overall mean age was 48 (± 13) years (48 ± 12 years in males; 48 ± 14 years in females). Mean disease duration was 15 (± 10) years for males and 16 (± 11) years for females. Two hundred and ninety one (55 %) subjects had a relapsing remitting (RR) clinical course, 150 (28%) were secondary progressive (SP) and 91 (17%) were primary progressive (PP). Mean EDSS score was 5 (± 2; median 5). The mean age at time of onset was 33 (±10) years for males and 32 (± 11) years for females. The disease onset was monosymptomatic in 76% (n = 407) patients and polysymptomatic in 24% (n = 125). The mean length of time between clinical onset and diagnosis was 5 (± 6) years. Conclusion We confirmed that the province of Genoa is a very high risk area for MS. We found a high rate of patients with a PP course; also the proportion of patients with high disability scores is greater compared to previous studies.     

Multiple sclerosis in Jordan: a clinical and epidemiological study

Objectives To characterize the clinical, demographic and epidemiological features of multiple sclerosis (MS) in Jordan. Methods Data for consecutive Jordanian patients, fulfilling the McDonald criteria for clinically definite and clinically probable MS, during the time period 2004–2005 were collected and analyzed in the three major referral centers for MS in Jordan. Results We identified a total of 224 patients (165 females, 87%; 59 males, 13%). The mean (±SD) age of onset was 29.3 (±9.6) years, and mean (±SD) duration of illness was 3.9 (±9.3) years. The prevalence of MS in the city of Amman was 39/100,000. The prevalence of MS in Irbid, north Jordan, was 38/100,000. The most frequent presentation was weakness (30.8%), followed by optic neuritis (20.1%), sensory impairment (19.6%), and ataxia (14.3%). A relapsing remitting pattern was identified in 90.2% of patients, the rest being primary and secondary progressive, and one patient had a progressive relapsing course. Family history of MS was found in 9.4% of the cases. About 60% of the patients were using interferon beta. The degree of physical disability was determined using the Expanded Disability Status Scale (EDSS). Younger age of onset, shorter duration of illness, a relapsing remitting pattern, and use of interferon were identified as statistically significant predictors of less disability. Conclusion Jordan is a medium-high risk country for MS, with prevalence higher than what has previously been reported, possibly representing an increase in incidence. Clinical and demographic characteristics are similar to most reports worldwide. Received in revised form: 17 December 2005     

Prevalence of multiple sclerosis in Valladolid, northern Spain

The aim of this study was to ascertain the prevalence of multiple sclerosis (MS) in a northern Spanish region and to compare it with that from the most recent epidemiological studies in the country. MS prevalence was studied for a period of 2 years using multiple sources of information in the province of Valladolid, with a sample comprising a total population of 92,632. Patients were classified according to the Poser criteria. The crude prevalence of definite and probable MS was 58.3 per 100,000 (95% confidence interval: 43.7–75.7). The same methods have been used in ascertaining similar prevalence rates in Vélez-Málaga, Osona, and Gijón and a slightly lower rate in Teruel. Our survey confirms Spain as a high-risk area for MS, with prevalence rates over 50 per 100,000. Received: 4 March 1998 Received in revised form: 13 May 1998 Accepted: 10 June 1998     

Prevalence of multiple sclerosis in the province of Teruel, Spain

There have been few reports about the frequency of multiple sclerosis (MS) in Spain. We undertook a prevalence study in the province of Teruel, which is served by two hospitals as referral centres for a population of 143,680. We found a total of 46 patients who fulfilled Poser’s criteria for clinically definite or probable MS with a prevalence rate of 32/100,000 [95% confidence interval (CI): 22.8–41.3]. The prevalence rates for males and females were 23.5 (95% CI: 12.3– 34.7) and 40.6 (95% CI: 25.8–55.4) respectively. We found an incidence rate of 2.2/year per 100,000 in the last 5 years. The sex ratio (females/ males) was 1.7. The mean age on prevalence day was 40.6 years (range: 15–76). The clinical course was relapsing-remitting in 82% of patients, progressive in 9% and secondary progressive in the other 9%. The mean EDSS score was 3.73 (range: 1–8.5). Our results confirm the hypothesis that Spain is an area at high risk for MS. Received: 7 May 1996 Received in revised form: 17 September 1996 Accepted: 23 September 1996     

Trends in prevalence and incidence of multiple sclerosis in Bajo Aragón, Spain

OBJECTIVE: Recent reports provide consistent evidence that Spain is an area of high risk for multiple sclerosis (MS) according to prevalence surveys. However, the studies of incidence are scarce. The objective of the current work is to analyse whether the increased prevalence of MS is accompanied by increasing incidence in the area of Bajo Aragón, northeastern Spain. METHODS: The data of both prevalence and incidence were retrieved from a prospective register created in 1994 and which included patients with probable or definite MS. Crude and age-standardised rates were calculated from 1994 to 2002 and compared with those found retrospectively in the previous period of 1984-1993. RESULTS: In January 2003, we found a prevalence rate of 75/100,000 (95% CI: 52-97) whereas it was 35/100,000 (95% CI: 20-50) in 1994. In a period of 9 years, 25 new cases were diagnosed in the area with a mean annual incidence rate of 4.6/100,000 (95% CI: 2.8-6.5; range: 1.6-13.6) in comparison to 17 new cases from 1984 to 1993 with a mean incidence rate of 3/100,000 (95% CI: 1.6-4.5). The standardised ratio of incidences was 1.44 (95% CI: 0.95-2.17) and, therefore, the difference of rates was not significant. CONCLUSION: We conclude that the increase in prevalence of MS is more likely to be due to improvement on case ascertainment than to increasing incidence. Nonetheless, further prospective incidence studies in larger populations are warranted in Spain to elucidate whether the frequency of this disease is truly increasing.     

Epidemiology of multiple sclerosis in the Canary Islands (Spain): a study on the island of La Palma

Objective: To determine the prevalence of multiple sclerosis (MS) on the Island of La Palma, Canary Islands, Spain. Methods: A population-based transverse study was carried out on the Island of La Palma (population: 81,507), from 1995 to 1998. The 15 December 1998 was established as prevalence day. Sources of information were periodically obtained from case records from public primary care centres, private hospitals, private centres, magnetic resonance units and others. In accordance with the Poser criteria all cases of definite or probable MS were included. Results: 34 cases of MS were found on prevalence day (9 male and 25 female): 32 cases were clinically definite and 2 were clinically probable MS. Crude prevalence was 42/100,000. Incidence during time of study was 2.25/100,000. Conclusions: The island of La Palma could be considered as an area of medium-high risk, the risk being higher than that expected because of the geographical latitude of the island. This study confirms the hypothesis of the high prevalence of MS in Spain. We have not found significant clinical differences in MS patients from those in other studies. Received: 7 August 2000, Received in revised form: 22 November 2001, Accepted: 16 April 2002 Correspondence to M. A. Hernández     

Modafinil in treatment of fatigue in multiple sclerosis. Results of an open-label study

Background Modafinil is a unique wake-promoting agent that is chemically distinct from traditional stimulants. Results of a placebo-controlled study showed it to improve fatigue in multiple sclerosis (MS) at a dose of 200 mg daily, but not at a dose of 400 mg daily. Objective To establish the efficacy, safety and appropriate dose of modafinil in the treatment of fatigue and sleepiness in patients with multiple sclerosis. Method A total of 50 patients diagnosed with MS (mean age 40.4 ± 10.3 years, 30 females/20 males; MS type: 36 relapsing remitting, 1 primary progressive, 13 secondary progressive; mean disability level 3.8 ± 1.5 on the Kurtzke EDSS) and complaining of chronic fatigue were enrolled in a prospective 3-month, two-center, open-label study. Efficacy was evaluated with the Fatigue Severity Scale (FSS, score range 0-42), the Epworth Sleepiness Scale (ESS, score range 0-24) and by subjective patient appraisal of change of fatigue, quality of life and overall satisfaction with treatment. Adverse effects (AEs) were recorded throughout the study. Treatment was started with a single daily dose of 100 mg in all patients. In non-responders the dose was increased by 100 mg increments up to a maximum daily dose of 400 mg. Results Three patients discontinued modafinil because of AEs (nervousness, dizziness). Two patients (4 %) were treated with 50 mg, 25 (50 %) with 100 mg, 21 (42 %) with 200 mg and 2 (4 %) with 300 mg daily. No patient required 400 mg daily. Mean FSS scores were 30.3 ± 8.5 at baseline and 25.4 ± 3.7 at 3 months (p < 0.0001). Mean ESS scores were 9.7 ± 3.9 at baseline and 4.9 ± 2.9 at 3 months (p < 0.0001). Self-appraisal of change of fatigue showed clear improvement in 41 patients (87.2 %), some improvement in 4 (8.5 %) and no change in 2 (4.3 %). Overall clinical condition was clearly improved in 43 patients (91.5 %), somewhat improved in 1 patient (2.1 %), and unchanged in 3 patients (6.4 %). No patient reported worsening of overall clinical condition. Conclusions Treatment with modafinil significantly improves fatigue and sleepiness and is well tolerated by patients with MS. Unlike the higher dose regimen required in narcolepsy, a low-dose regimen of modafinil is effective in MS. Received: 10 August 2001 Received in revised form: 22 January 2002 Accepted: 25 January 2002     

Multiple sclerosis in Vest-Agder County, Norway

Vatne A., Mygland Å., Ljøstad U. Multiple sclerosis in Vest‐Agder county, Norway.
Acta Neurol Scand: 2011: 123: 396–399.
© 2010 John Wiley & Sons A/S. Objective – To examine multiple sclerosis (MS) prevalence, rate of immunomodulatory treatment and frequency of Borrelia Burgordorferi (Bb) antibodies in Vest‐Agder, Norway. Materials and methods – Patients in the period 1996–2006 who met the Poser criteria for definitive or probable MS were included. Clinical and demographical data, and presence of Bb antibodies were registered. Results – A total of 295 patients were identified. The crude prevalence was 180 per 100,000 population (95% CI = 160.9–218.0), age‐adjusted prevalence was 186 per 100,000 population (95% CI = 166.3–225.3). The age‐adjusted incidence rates were 7.5 and 8.0 for 1996–2000 and 2001–2006, respectively. Thirty‐eight per cent were treated with immunomodulatory agents when compared to 28% in the rest of the country. Bb serum antibodies were detected in 7% of patients with MS. Conclusions – Vest‐Agder county has the highest prevalence of MS reported in Norway, and a high treatment rate. Bb antibodies were not more prevalent than in healthy individuals.     

Prevalence of multiple sclerosis in Västerbotten County in northern Sweden

Objective – To estimate the prevalence and clinical characteristics of multiple sclerosis (MS) in Västerbotten County in northern Sweden. Methods–Individuals with MS were identified from several sources. A follow‐up interview and/or examination was performed in 94% of cases still living in the area during 1997–99. Onset adjusted prevalence and a definition of onset symptoms were applied. Results– A total of 313 cases were identified, resulting in an onset adjusted crude prevalence of MS for January 1990 of 125/10⁵ (95% confidence interval (CI): 112–140). Female predominance was evident (163/10⁵ (95% CI: 142–187) vs 86/10⁵ (95% CI: 71–104)). Diagnostic coding registers were the most important source for identification of cases. Conclusions– The crude prevalence of MS in Västerbotten was higher than previous reports from other major areas in Scandinavia. The adjusted prevalence was significantly higher when compared with a previous study from Göteborg, south‐western Sweden. The methodology used in this study gives a high degree of case ascertainment and increases the comparability of multiple sclerosis epidemiological studies.     

Frequency of multiple sclerosis in Menorca, Balearic islands, Spain

OBJECTIVE: To establish prevalence and incidence of multiple sclerosis (MS) in Menorca (Balearic Islands, Spain; population: 67,009). METHODS: An extensive epidemiological study was undertaken using all available information sources. Patients were classified according to Poser's criteria. RESULTS: The prevalence rate of definite and probable MS was 68.6/100,000 (95% confidence interval 50.3-91.6). The incidence rate was 3.4/100,000/year (95% CI 2.2-5.3). The time lag between the first symptom and diagnosis was 10.2 years for patients with disease onset before 1987 and 2.1 years for patients with onset between 1987 and 1996. CONCLUSION: Menorca's population has a moderately high MS risk, with a prevalence rate the highest reported for a Spanish region.     

Increasing incidence of multiple sclerosis among women in Buenos Aires: a 22 year health maintenance organization based study

Studies in multiple sclerosis (MS) suggest a trend of increasing disease prevalence and incidence, and especially, a disproportional increase in the incidence of multiple sclerosis in women. The objective of this study was to evaluate the incidence of MS over 22 years and to determine the ratio in incidence of men to women in a health maintenance organization from Buenos Aires, Argentina. The population was made up of all members of a hospital-based HMO affiliated between January 1992 and December 2013. Each person was followed contributing time at risk. Cases with definite diagnosis of MS were included. Incidence density was calculated with 95 % confidence intervals and compared between women and men. 165,456 subjects were followed for a total of 1,488,575 person–years, of whom 42 developed MS. Incidence density was 3/100,000 person–years (95 % CI 2.1–3.5/100,000 person–years). During this period (1992–2013), the incidence rate in women increased from 1/100,000 (95 % CI 0.8–1.6) to 4.9/100,000 (95 % CI 4.1–5.4) (p < 0.001), while in men the incidence ranged from 1.4/100,000 (95 % CI 1–1.7) to 1.8 (1.3–2.1) (p = 0.16). Incidence density during the study period increased significantly in women but not in men. This is the first report of this phenomenon in Latin America region.     

P wave duration and dispersion in multiple sclerosis

Abstract Background Multiple sclerosis (MS) has been reported to be associated with extensive autonomic dysfunction as well as to involve the cardiovascular system. In this study we compared P wave duration and dispersion (PWD) of MS patients to healthy control subjects. Method Thirty-one MS patients (mean age 35±9 years) and 33 healthy control subjects (mean age 34±7 years) were included in the study. Twelve-lead surface ECG recording (paper speed of 50 mm/s) was obtained from all participants. The change in maximum and minimum P wave duration was measured manually and the difference between the two values was defined as PWD. Results There was no difference between the two groups in terms of baseline demographic characteristics. Maximum P wave duration was higher in MS patients than controls (126±6 vs. 122±5 ms, p=0.004). Minimum P wave duration was found to be similar in MS patients and healthy controls (72±8 vs. 75±8 ms, p=0.2).Mean PWD value of MS patients was also found to be higher than those of controls (53±10 vs. 47±10 ms, p=0.01). Conclusion P wave duration and PWD was found to be statistically different in patients with MS and control subjects.     

Hematopoietic stem cell transplantation for multiple sclerosis. A retrospective multicenter study

Rationale Phase I/II studies of autologous hematopoietic stem cell transplantation (HSCT) for multiple sclerosis (MS) were initiated, based on results of experimental transplantation in animal models of multiple sclerosis and clinical observations in patients treated concomitantly for malignant disease. Patients Eighty-five patients with progressive MS were treated with autologous HSCT in 20 centers and reported to the autoimmune disease working party of the European Group for Blood and Marrow Transplantation (EBMT). 52 (61 %) were female, median age was 39 [20-58] years. The median interval from diagnosis to transplant was 7 [1-26] years. Patients suffered from severe disease with a median EDSS score of 6.5 [4.5-8.5]. Active disease prior to transplant was documented in 79 of 82 evaluable cases. Results The stem cell source was bone marrow in 6 and peripheral blood in 79, and stem cells were mobilized into peripheral blood using either cyclophosphamide combined with growth factors or growth factors alone. Three patients experienced transient neurological complications during the mobilization phase. The high dose regimen included combination chemotherapy, with or without anti-lymphocyte antibodies or, with or without, total body irradiation. The stem cell transplants were purged of lymphocytes in 52 patients. Median follow-up was 16 [3-59] months. There were 7 deaths, 5 due to toxicity and infectious complications, 2 with neurological deterioration. The risk of death of any cause at 3 years was 10 (±7)% (95 % confidence interval). Neurological deterioration during transplant was observed in 22 patients; this was transient in most but was associated with MS progression in 6 patients. Neurological improvement by ≥ 1 point in the EDSS score was seen in 18 (21 %) patients. Confirmed progression-free survival was 74 (±12)% at 3 years being 66 (±23)% in patients with primary progressive MS but higher in patients with secondary progressive or relapsing-remitting MS, 78 (±13)%; p = 0.59. The probability of confirmed disease progression was 20 (±11)%. MRI data were available in 78 patients before transplant showing disease activity (gadolinium enhancing, new or enlarging lesions) in 33 %. Posttransplant MRI showed activity at any time in 5/61 (8 %) evaluable cases. Conclusion Autologous HSCT suggest positive early results in the management of progressive MS and is feasible. These multicentre data suggest an association with significant mortality risks especially in some patient groups and are being utilised in the planning of future trials to reduce transplant related mortality. Received: 21 August 2001 Received in revised form: 4 February 2002 Accepted: 6 February 2002     

Incidence and prevalence of multiple sclerosis in Newfoundland and Labrador

BACKGROUND: The incidence and prevalence of multiple sclerosis (MS) in Newfoundland and Labrador (NL) had been reported in 1984 and was considered to be relatively low at that time. This study revisits the incidence and prevalence of MS in NL for the year 2001. METHODS: Case searches through patient files of neurologists in NL were conducted. A complete list of patients billed for MS in NL between 1996 and 2003 was obtained and all cases were confirmed via chart review. RESULTS: There were 493 living MS patients yielding a prevalence of 94.4/100,000 which is significantly higher than previously reported. Of the living patients, 330 had relapsing remitting (RRMS), 94 had secondary progressive, 66 had primary progressive (PPMS) and three had unspecified MS. The total female to male ratio was 2.7:1. There was no difference between the female to male ratios for RRMS vs PPMS. Patients with PPMS had a later onset compared to RRMS (p<0.00001). Yearly incidences were relatively constant from 1994 to 2001 (5.6/100,000). Significant delays between first symptoms and final diagnosis were common and the delay time has not changed over the past 15 years. A prevalence of 88.9/100,000 was estimated from survival and incidence trends and was not significantly different than the measured prevalence (p=0.38). CONCLUSIONS: The increase in incidence and prevalence are accounted for through both better access to diagnostic facilities and more practicing neurologists. The revised prevalence and incidence are more in keeping with recently reported values throughout Canada.     

Prevalence of multiple sclerosis in Barrhead County, Alberta, Canada.

A prevalence study of multiple sclerosis (MS) was carried out in the town of Barrhead and surrounding county of Barrhead, in Alberta, Canada. The prevalence rate for clinically probable/definite multiple sclerosis on January 1, 1990 was 196/100,000. The average annual incidence rates for patients living in the area at onset were 1.31/100,000 for 1950-59, 4.97/100,000 for 1960-69, 3.77/100,000 for 1970-79, and 4.22/100,000 for 1980-89. Fifty percent of the patients were relapsing-remitting. Sixty percent were still walking without assistance. The female-to-male ratio was 1:1. Mean current age, age at onset and duration of illness were 49, 27 and 22 years respectively. The majority of patients (40%) experienced multiple symptom onset. Fifty percent were of single ethnic origin (either British or German); the rest were predominantly North European combinations. Forty percent of patients reported another MS relative. MS had affected the work status of 60% of the patients, 15% of whom were confined to an extended care centre.     

Sympathetic skin response in amyotrophic lateral sclerosis

Objectives– The aim of our study was to verify the usefulness of the sympathetic skin response (SSR) as an instrument for assessing autonomic involvement in amyotrophic lateral sclerosis (ALS). Material and methods– We studied palmar and plantar SSR in 31 patients with ALS (mean age: 58.4±9.3 years); 48 age-matched healthy subjects constituted the control group. Results– Palmar SSR was elicitable in all patients, and its latency and amplitude did not significantly differ from that of the controls. Plantar response was evoked in all but 7 patients. The lack of response was significantly related to the functional disability and duration of the disease. Conclusions– We conclude that SSR, even the plantar response, cannot be considered a useful tool for detecting early autonomic involvement in ALS.     

Executive function is an important consideration for coping strategy use in people with multiple sclerosis

Introduction: Executive function deficits are prevalent in people with multiple sclerosis (PwMS), and PwMS use less adaptive coping than healthy controls. This cross-sectional study assessed whether there is a relationship between executive function and coping in PwMS. Method: One hundred and seven participants with relapsing remitting or secondary progressive MS (n = 83 and 24, respectively; age M = 48.8 ± 11.1 years) completed measures of coping and executive function. Results: A positive relationship was found between verbal fluency and use of active, emotional, and instrumental social support coping, and total executive function and substance abuse coping. There was a negative relationship between coping strategies and core (social support, acceptance, religion, restraint, and total coping), higher order (denial and humor), and total executive function indices (acceptance, religion, behavioral disengagement, denial, and total coping). Conclusion: These directional differences provide support for the importance of specific executive functions in coping strategy utilization. Understanding these relationships will assist psychologists and neuropsychologists with patient psychoeducation, adaptive coping strategy intervention and management for PwMS with reduced executive function ability.     

Prevalence and incidence of multiple sclerosis in Las Palmas, Canary Islands, Spain

OBJECTIVES: To determine the prevalence and incidence of multiple sclerosis (MS) in the city of Las Palmas (Canary Islands, Spain), geographically belonging to north-western Africa, but with European ancestry. METHODS: This population-based survey was conducted for a period of 5 years (1998-2002) in a Sanitary District of Las Palmas city (28 degrees 20' N), with a population of 82,623 inhabitants. Multiple sources were periodically investigated for case ascertainment. Patients with definite and probable MS were included. RESULTS: Sixty-four patients with MS were identified on prevalence day, December 31, 2002. According to Poser's criteria the crude prevalence rate was 77.5 per 100,000 (95% CI: 59.7-98.9). This rate decreased to 73.8 (95% CI: 56.5-94.8) according to McDonald's criteria. Age-adjusted rates for the world and European standard populations were 61.6 (95% CI: 47.1-78.9) and 70.6 (95% CI: 55-89), respectively. Prevalence was higher for women aged 25-44 years. In 17 patients onset of MS occurred within the study period. Average annual incidence was 4.1 per 100,000 (95% CI: 2.4-6.6). CONCLUSIONS: The prevalence and incidence rates in Las Palmas city are close to those reported from Continental Spain and other countries of southern Europe with similar social and ethnic background. These results highlight the role of racial-ethnic factors in the genesis of MS.     

Axonal protection achieved in a model of multiple sclerosis using lamotrigine

Axonal degeneration is a major cause of permanent disability in multiple sclerosis (MS). Recent observations from our and other laboratories suggest that sodium accumulation within compromised axons is a key, early step in the degenerative process, and hence that limiting axonal sodium influx may represent a mechanism for axonal protection in MS. Here we assess whether lamotrigine, a sodium channel-blocking agent, is effective in preventing axonal degeneration in an animal model of MS, namely chronic-relapsing experimental autoimmune encephalomyelitis (CR-EAE). When administered from 7 days post-inoculation, lamotrigine provided a small but significant reduction in the neurological deficit present at the termination of the experiments (averaged over three independent experiments; vehicle: 3.5 ± 2.7; lamotrigine: 2.6 ± 2.0, P < 0.05) and preserved more functional axons in the spinal cord (measured as mean compound action potential area; vehicle: 31.7 μV.ms ± 23.0; lamotrigine: 42.9 ± 27.4, P < 0.05). Histological examination of the thoracic spinal cord (n = 71) revealed that lamotrigine treatment also provided significant protection against axonal degeneration (percentage degeneration in dorsal column; vehicle: 33.5 % ± 38.5; lamotrigine: 10.4 % ± 12.5, P < 0.01). The findings suggest that lamotrigine may provide a novel avenue for axonal protection in MS.     

Corpus callosum index and long-term disability in multiple sclerosis patients

Prediction of long-term disability in patients with multiple sclerosis (MS) is essential. Magnetic resonance imaging (MRI) measurement of brain volume may be of predictive value but sophisticated MRI techniques are often inaccessible in clinical practice. The corpus callosum index (CCI) is a normalized measurement that reflects changes of brain volume. We investigated medical records and 533 MRI scans at diagnosis and during clinical follow-up of 169 MS patients (mean age 42 ± 11 years, 86% relapsing-remitting MS, time since first relapse 11 ± 9 years). CCI at diagnosis was 0.345 ± 0.04 and correlated with duration of disease (p = 0.002; r = −0.234) and expanded disability status scale (EDSS) score at diagnosis (r = −0.428; p < 0.001). Linear regression analyses identified age, duration of disease, relapse rate and EDSS at diagnosis as independent predictors for disability after mean of 7.1 years (Nagelkerkes’ R:0.56). Annual CCI decrease was 0.01 ± 0.02 (annual tissue loss: 1.3%). In secondary progressive MS patients, CCI decrease was double compared to that in relapsing-remitting MS patients (p = 0.04). There was a trend of greater CCI decrease in untreated patients compared to those who received disease modifying drugs (p = 0.2). CCI is an easy to use MRI marker for estimating brain atrophy in patients with MS. Brain atrophy as measured with CCI was associated with disability progression but it was not an independent predictor of long-term disability.