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MS research update - Prevalence of MS still going up in the north of Scotland - 16 May 2012

The proportion of people with MS in a population is called the prevalence and the figure usually given is the number of people with MS in every 100,000 people. The distribution of MS around the world is uneven. Generally, the prevalence increases as you travel further north or south from the equator.

30 years ago, a high prevalence of MS was recorded in northern Scotland. This study looked at whether there had been any change. Medical records were used to identify 590 people with MS living in Aberdeen, Shetland and Orkney in 2009. The average age was 53 and, on average, they'd had MS for just under 20 years.

The researchers calculated that the prevalence rates were 229 people per 100,000 in Aberdeen, 295 in Shetland and 402 in Orkney. The rate for the UK as a whole is thought to be about 160.

As in other areas, women were more likely (two and a half times more likely) to have MS than men. The highest prevalence overall was for women in Orkney where one in 170 were affected by MS. Orkney has the highest prevalence of MS in the world.

The researchers concluded that the prevalence of MS has increased over 30 years in all the study areas but most markedly in Orkney followed by Shetland. The reasons for this are unclear but probably include the rising ratio of women with MS but also interactions between genetic factors in the population and environmental factors. Research by other groups has suggested that vitamin D levels may explain the geographic differences in the prevalence of MS so this may be a factor in the high levels of MS seen in the north of Scotland.

Visser EM, Wilde K, Wilson JF, et al.
A new prevalence study of multiple sclerosis in Orkney, Shetland and Aberdeen city.
J Neurol Neurosurg Psychiatry. 2012 May 10. [Epub ahead of print]


Diagnosis and misdiagnosis of MS

Three papers published this week from research teams in the USA address the complexities of getting a diagnosis of MS and making sure this is the correct diagnosis.

Diagnosing MS is often difficult and can take some considerable time to achieve. This can be distressing for the person who is experiencing symptoms and would like a definite diagnosis so that treatment options can be discussed.

It is also not easy for health care professionals who have to make judgements based on tests, such as MRI scans, which don't always give clear results either way and have to be interpreted using personal experience.

Two research groups in the USA looked at whether an incorrect diagnosis of MS could be given, what the reasons were behind this and what action was taken by neurologists.

In surveys of MS specialist neurologists, the vast majority said that they had evaluated someone in the previous year who was diagnosed with MS but that they felt did not have MS. Many of these people were on disease modifying treatments. The neurologist was placed in a difficult situation but, in the vast majority of cases, the patient was informed of the difference of opinion but in some cases (14%) this did not happen.

Suspect diagnosis was most commonly because of difficulties interpreting the MRI scans. Changes seen on MRI scans were not always due to MS but could be seen in, for example, people with cardiovascular risk factors or migraine.

A third study in the USA, has highlighted the pressure that neurologists may feel under from some people attending their clinic, to give a diagnosis of MS when the neurologist is not confident that this is the correct diagnosis.

Rudick RA, Miller AE.
Multiple sclerosis or multiple possibilities: The continuing problem of misdiagnosis.
Neurology. 2012 May 11. [Epub ahead of print]

Solomon AJ, Klein EP, Bourdette D.
"Undiagnosing" multiple sclerosis: The challenge of misdiagnosis in MS.
Neurology. 2012 May 11. [Epub ahead of print]

Boissy AR, Ford PJ.
A touch of MS: Therapeutic mislabeling.
Neurology. 2012 May 11. [Epub ahead of print]

Research by topic areas...


Waubant E.
Early recognition and diagnosis of multiple sclerosis.
J Clin Psychiatry. 2012 Apr;73(4):e14.

Disease modifying treatments

Rinaldi F, Calabrese M, Seppi D, et al.
Natalizumab strongly suppresses cortical pathology in relapsing-remitting multiple sclerosis.
Mult Scler. 2012 May 8. [Epub ahead of print]

Kamm CP, El-Koussy M, Humpert S, et al.
Atorvastatin added to interferon beta for relapsing multiple sclerosis: a randomized controlled trial.
J Neurol. 2012 May 9. [Epub ahead of print]

Gasperini C, Ruggieri S.
Emerging oral drugs for relapsing-remitting multiple sclerosis.
Expert Opin Emerg Drugs. 2011 Dec;16(4):697-712.


Adelöw C, Andersson T, Ahlbom A, et al.
Unprovoked seizures in multiple sclerosis and systemic lupus erythematosus: A population-based case-control study.
Epilepsy Res. 2012 May 8. [Epub ahead of print]

Rudick RA.
The elusive biomarker for personalized medicine in multiple sclerosis: The search continues.
Neurology. 2012 May 9. [Epub ahead of print]

Assessment tools

Schwartz CE, Bode RK, Quaranto BR, et al.
The symptom inventory disability-specific short forms for multiple sclerosis: construct validity, responsiveness, and interpretation.
Arch Phys Med Rehabil. 2012 May 9. [Epub ahead of print]

Amtmann D, Bamer AM, Cook KF, et al.
UW-SES: A new self-efficacy scale for people with disabilities.
Arch Phys Med Rehabil. 2012 May 7. [Epub ahead of print]

Causes of MS

Mueller BA, Nelson JL, Newcomb PA, et al.
Intrauterine environment and multiple sclerosis: a population- based case-control study.
Mult Scler. 2012 May 8. [Epub ahead of print]


Filippi M, Rocca MA, Barkhof F, et al.
Association between pathological and MRI findings in multiple sclerosis.
Lancet Neurol. 2012 Apr;11(4):349-60.

Bone health

Josyula S, Mehta BK, Karmon Y, et al.
The nervous system's potential role in multiple sclerosis associated bone loss.
J Neurol Sci. 2012 May 10. [Epub ahead of print]


Zivadinov R, Cutter G, Marr K, et al.
No association between conventional brain MR imaging and chronic cerebrospinal venous insufficiency in multiple sclerosis.
AJNR Am J Neuroradiol. 2012 May 10. [Epub ahead of print]

Baracchini C, Atzori M, Gallo P.
CCSVI and MS: no meaning, no fact.
Neurol Sci. 2012 May 9. [Epub ahead of print]

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