Co-occurrence of multiple sclerosis and myasthenia gravis in British Columbia

We describe eight patients with associated multiple sclerosis (MS) and myasthenia gravis (MG). Patients were less than 50 years old at the time of onset, and seven were female. The clinical course of both MS and MG was mild in most patients. To our knowledge, this represents the largest reported series. We provide further evidence for a nonrandom association of these two diseases and discuss common mechanisms of pathogenesis.     

Prevalence of multiple sclerosis in Rochdale.

The prevalence of multiple sclerosis in the Rochdale Metropolitan Borough in the north east of Greater Manchester has been established. Case ascertainment was partly prospective via a neurological register from 1979 and by contact with general practitioners, therapists, and social services. On prevalence day, 1 January 1989, 254 patients with multiple sclerosis were living in Rochdale. The overall prevalence was 122/100,000 population and 96/100,000 population for probable cases only. The peak rate for women aged 35 to 44 years was 437/100,000 population and for men aged 45 to 54 years 221/100,000. Familial multiple sclerosis was present in 10.8% of families. In this, the first study in north west England, the prevalence of multiple sclerosis in Rochdale is similar to that in southern England and Wales but lower than that in Scotland.     

Interferon beta in multiple sclerosis: experience in a British specialist multiple sclerosis centre

BACKGROUND: The efficacy of interferon beta (IFN beta) is well established in relapsing-remitting multiple sclerosis (MS). However, the use of this drug in clinical practice is complex, especially because it is only partially effective, its long term efficacy and side effects are unknown, its efficacy may be abrogated by the development of neutralising antibodies, compliance is variable, and its cost effectiveness is controversial. Objectives and Methods: Analysis of a prospectively followed up series of 101 MS patients treated with IFN beta was undertaken to: (1) monitor the outcome of IFN beta treatment in clinical practice; (2) compare the immunogenicity of the three commercial IFN beta preparations available; (3) assess the proportion of patients fulfilling the current guidelines of the Association of British Neurologists for stopping IFN beta therapy. RESULTS: During a median treatment period of 26 months (range 2-85), the relapse rate decreased by 41%. Although the reduction in the relapse rate was similar for all three commercial products, none of the Avonex treated patients were relapse free, compared with 19% of the Betaferon treated and 27% of the Rebif treated patients (p=0.02). Neutralising antibodies were not detected in Avonex treated patients (0 of 18), compared with 12 of 32 (38%) Betaferon treated and 10 of 23 (44%) Rebif treated patients (p=0.02). Forty of 101 (40%) patients satisfied the current (2001) Association of British Neurologists criteria for stopping IFN beta treatment at some stage during their treatment. CONCLUSION: IFN beta is effective in reducing the relapse rate in patients with relapsing-remitting MS in routine clinical practice. However, after a median treatment duration of 26 months, 40% of initially relapsing-remitting MS patients seem to have ongoing disease activity, presenting as disabling relapses or insidious progression.     

Prevalence of multiple sclerosis in Isfahan, Iran

BACKGROUND: The prevalence of multiple sclerosis (MS) shows considerable variability all over the world. According to Kurtzke, Iran is considered to have a low prevalence. OBJECTIVE: To estimate the period prevalence and risk factors of MS in Isfahan, central part of Iran. METHODS: A cross-sectional case register study conducted between 2004 and 2005. In the province of Isfahan, Iran, all patients known to have definite MS during 2004 and 2005, being alive and resident within Isfahan as well as being a member of the Isfahan MS Association were included in the study. Demographic and case-related information was recorded. 1,391 definite MS patients (308 men and 1,083 women) from the Isfahan MS Association, Iran, have been identified. The disease was confirmed using clinical information and MRI findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. Population data were obtained from the year 1999 Iran Census. The mean (SD) age of the participants was 32.5 (9.3) years with a mean (SD) duration of the disease of 6.4 (5.1) years for men and 6.9 (5.3) years for women. RESULTS: The period prevalence of MS was 35.5 per 100,000 [95% confidence interval (CI) 33.6-37.3] in a population of 3,923,255, with a higher rate in women than men [54.5 (95% CI: 51.1-57.8) for women and 14.9 (95% CI: 13.3-16.6) for men]. The female/male ratio was 3.6 (95% CI: 3.2-4.1). The direct age-adjusted period prevalence was 59.5 per 100,000 (95% CI: 44.8-75.2) for women and 17.0 per 100,000 (95% CI: 8.9-25.1) for men. MS rates were highest among 30- to 39-year-olds and decreased with increasing age. Sensory and visual disturbances were the most common initial presentations with a prevalence of 51.1% (95% CI: 48.4-53.7) and 47.0% (95% CI: 44.4-49.7), respectively. CONCLUSION: Isfahan could be considered as an area with a medium to high risk of MS. This is in sharp contrast with the gradient hypothesis.     

Prevalence of multiple sclerosis in Belgrade, Yugoslavia

OBJECTIVES: To estimate the distribution of multiple sclerosis in the Belgrade population. METHODS: All persons who were affected and/or died from multiple sclerosis (Poser's criteria), with residence in the Belgrade region had been collected from January 1, 1985 to December 31, 1996. Prevalence was adjusted by direct method, using world population. RESULTS: From 1985 to 1996, 823 patients were suffering from multiple sclerosis. Sex ratio was 1:1.9. The mean age at onset was 32.2 +/- 9.8 years. A relapsing-remitting course of multiple sclerosis was reported in 50.7% patients, secondary progressive in 36.4%, patients, and primary progressive in 12.9% patients. On December 31, 1996, age-adjusted prevalence of multiple sclerosis in Belgrade was 41.5/100,000, 28.2/100,000 for males, and 54.1/100,000 for females. During the period studied, statistically highly significant increasing trend of multiple sclerosis prevalence was observed (P = 0.0001). CONCLUSIONS: According to findings presented in this study, Belgrade is an area with high prevalence of multiple sclerosis.     

Prevalence of multiple sclerosis in the Parsis of Bombay

We carried out a door-to-door-survey to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases, and used defined diagnostic criteria to evaluate people who tested positive on the screening survey. There were three clinically definite cases of multiple sclerosis (21/100,000). This is the first prevalence survey for multiple sclerosis in a large developing country.     

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 sleep problems in individuals with multiple sclerosis

BackgroundSleep disturbance in multiple sclerosis has received little research attention despite the potential influence it may have on disease impact.ObjectiveTo estimate the prevalence of sleep disorders in a large community sample of individuals with multiple sclerosis.MethodsA cross-sectional self-report survey of 1063 persons with multiple sclerosis. Sleep was assessed using the Women's Health Initiative Insomnia Rating Scale and Medical Outcomes Study Sleep measure.ResultsThe prevalence of sleep problems in multiple sclerosis is significantly higher than in the general population or other chronic diseases and may affect women with multiple sclerosis more than men.ConclusionSleep disturbance should routinely be evaluated in patients with multiple sclerosis and new interventions developed.     

Prevalence of multiple sclerosis in Gypsies and Bulgarians.

There are occasional reports about the low prevalence of multiple sclerosis among Gypsies. To verify these reports of low prevalence of multiple sclerosis among Gypsies compared to the white population in Bulgaria, an epidemiological study was conducted in two small regions of Bulgaria. All patients with clinically or laboratory-supported, definite multiple sclerosis according to Poser's criteria were personally interviewed and examined. The study was begun on January 1, 1997 and March 31, 1998 was selected as prevalence day. For the white population, the prevalence ratio of multiple sclerosis per 100,000 population was 44.9 in the first region and 44.4 in the second. The prevalence of multiple sclerosis in Gypsies was found to be 19.1/100,000 in the first region and 18.4 in the second. It is concluded that multiple sclerosis is less common in Gypsies than in whites living in the same areas.     

Prevalence of multiple sclerosis in First Nations people of Alberta

BACKGROUND: Multiple Sclerosis (MS) is reported to be uncommon among North American aboriginals despite frequent intermarriage with people of European ancestry, but few population-based studies have been conducted. The purpose of this study was to determine the prevalence of MS among First Nations aboriginal people in Alberta, Canada compared to the general population. METHODS: All hospital in-patient and physician fee-for-service records between 1994 and 2002 where a diagnosis of MS was mentioned were extracted from government health databases in the province of Alberta. First Nations people can be identified since the federal government (Health Canada) pays health care insurance premiums on their behalf. Multiple Sclerosis prevalence per 100,000 population for both First Nations people and the general population of Alberta were calculated for each year during this time span. RESULTS: Among First Nations in Alberta, MS prevalence was 56.3 per 100,000 in 1994 and 99.9 per 100,000 in 2002, an increase of 43.6%. In 2002 prevalence was 158.1 and 38.0 for females and males respectively, a female to male ratio of 4.2:1. Multiple Sclerosis prevalence among the general population of Alberta was 262.6 per 100,000 in 1994 and 335.0 per 100,000 in 2002, an increase of 21.6%. In 2002 prevalence was 481.5 and 187.5 for females and males respectively, a female to male ratio of 2.6:1. Peak prevalence for both First Nations and general population females in 2002 was age 50-59, also 50-59 for both First Nations and general population males. CONCLUSION: While MS prevalence in First Nations people is lower than in the general population of Alberta, it is not rare by worldwide standards.