RESUMEN La distribución geográfica de la esclerosis en placas ha cambiado notablemente en la segu... more RESUMEN La distribución geográfica de la esclerosis en placas ha cambiado notablemente en la segunda mitad del siglo pasado con un lento crecimiento de un origen aparente en escandinavia hacia una alta frecuencia uniforme en toda europa, una disminución en la diferencia de incidencia norte-sur en norteamérica y frecuencias medias en el norte de África, sudamérica y aún en Japón. Los migrantes de regiones de alta frecuencia a la baja mantienen su riesgo si se cambian después de los 15 años, mientras que los que cam-bian de zonas de baja a alta frecuencia aumentan su riesgo, si se cambian entre el nacimiento y los 40 años. En las Islas Faroe aparecieron epidemias sucesivas después de la ocupación por tropas británicas en la Segunda Guerra Mundial. Esto parece indicar que la esclerosis múltiple es el resultado de una infección única y desconocida que se adquiere entre los 11 y 45 años con un largo periodo de incubación, a la aparición de la enfermedad. Palabras clave: esclerosis múltip...
Thin-section computed tomographic (CT) scans of 3 and 1.5 mm thickness were obtained using the Ph... more Thin-section computed tomographic (CT) scans of 3 and 1.5 mm thickness were obtained using the Philips Tomoscan 310 and General Electric 8800 CT/T scanners in the study of 10 consecutive patients with progressive supranuclear palsy (PSP) and 31 patients with other diseases. Marked midbrain and moderate pontine atrophy, a dilated third ventricle, and enlarged quadrigeminal plate cisterns were observed in all PSP cases. The aqueduct was dilated in several. In six of the PSP cases, there was a striking midbrain abnormality in the form of a low-density area extending from the interpeduncular cistern toward the aqueduct. Thin-section metrizamide-enhanced cisternography of three of the six PSP cases showed that the low-density abnormality was the result of the interpeduncular cistern invaginating the atrophic midbrain.
Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelograph... more Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelography. We saw a patient with cortical blindness, seizure, organic psychosis, and asterixis after undergoing attempted metrizamide myelography via C1-2 puncture. Computed tomography demonstrated early penetrance of metrizamide into the brain parenchyma, most prominently in the occipital lobes. A mechanism of direct metrizamide neurotoxicity was proposed.
Incidence and prevalence studies of neurological disorders play an important role in assessing th... more Incidence and prevalence studies of neurological disorders play an important role in assessing the burden of disease and planning services. However, the assessment of disease estimates is hindered by problems in reporting for such studies. Despite a growth in published reports, existing guidelines relate to analytical rather than descriptive epidemiological studies. There are also no userfriendly tools (e.g., checklists) available for authors, editors and peer-reviewers to facilitate best practice in reporting of descriptive epidemiological studies for most neurological disorders. The Standards of Reporting of Neurological Disorders (STROND) is a guideline that consists of recommendations and a checklist to facilitate better reporting of published incidence and prevalence studies of neurological disorders. A review of previously developed guidance was used to produce a list of items required for incidence and prevalence studies in neurology. A threeround Delphi technique was used to identify the 'basic minimum items' important for reporting, as well as some additional 'ideal reporting items'. An e-consultation process was then used in order to gauge opinion by external neuroepidemiological experts on the appropriateness of the items included in the checklist. Of 38 candidate items, 15 items and accompanying recommendations were developed along with a user-friendly checklist. The introduction and use of the STROND checklist should lead to more consistent, transparent and contextualised reporting of descriptive neuroepidemiological studies resulting in more applicable and comparable findings and ultimately support better healthcare decisions.
The origin of EDSS, the Expanded Disability Status Scale for multiple sclerosis, was some 30 year... more The origin of EDSS, the Expanded Disability Status Scale for multiple sclerosis, was some 30 years before its only publication in 1983 when we were trying to assess a potential treatment and found no published methods. Findings from the complete neurologic examinations in over 200 patients were consolidated into mutually exclusive but all-inclusive neurophysiologic entities called Functional Systems (FS), and these provided the basis for an 11 step 0-10 rank order scale, the Disability Status Scale (DSS). This was used successfully, as well as in the first two Class I treatment trials performed, with the second one also incorporating the 8 FS. Both measures were part of an assessment of a natural history series derived from men hospitalized for MS in the US Army in World War II and followed for some 20 years. Describing each of the 8 FS as affected (1) or normal (0) defined 256 possible patterns of involvement for all patients. Half the patients at diagnosis had one of the 14 most c...
European journal of neurology : the official journal of the European Federation of Neurological Societies, 2015
Susceptibility to multiple sclerosis (MS) is determined by environmental and genetic factors, but... more Susceptibility to multiple sclerosis (MS) is determined by environmental and genetic factors, but the cause remains unknown. Changes to the proteome prior to first symptom onset may reflect the underlying pathophysiology of the disease. This preliminary study utilized pre-symptomatic and post-symptomatic serum from a sample of 100 incident population-based US military veterans with MS along with 100 matched healthy controls. All samples were obtained from the Department of Defense Serum Repository. Multidimensional protein identification technology tandem mass spectrometry analysis was performed on tryptic peptides of lectin-captured glycosylated serum proteins following albumin/immunoglobulin G depletion. Identified proteins were analyzed with the Ingenuity Pathway Analysis program. The mean intervals between first symptom onset and the collection of pre-symptomatic and post-symptomatic sera were -6.0 and +1.1 years, respectively. Pre-symptomatic proteins from the MS group were dif...
A 37-year-old man with a history of seizures developed periodic alternating nystagmus (PAN) along... more A 37-year-old man with a history of seizures developed periodic alternating nystagmus (PAN) along with other signs of primidone/phenobarbital toxicity. The PAN gradually diminished in cycle length and intensity, finally resolving with gradual discontinuation of the drugs.
Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk... more Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk to develop neurologic disease. An incident cohort of multiple sclerosis (MS) and other demyelinating disease (ODD) was assembled from the US military comprising the Gulf War era (1990-2007). Cases of MS and ODD meeting standard diagnostic criteria were matched to a database of all active duty personnel from the Department of Defense. Relative risk (RR) estimates for MS and all demyelinating disease based on onset, deployment status, and exposures were calculated. For GW1, a total of 1,841 incident cases of definite MS and ODD were identified, with 387 among 696,118 deployed and 1,454 among 1,786,215 nondeployed personnel. The RR for MS alone among those deployed compared to those nondeployed was 0.69 (confidence interval, CI: 0.61-0.78), with 0.72 (CI: 0.62-0.83) in men and 0.96 (CI: 0.75-1.22) in women. Deployment was also nonsignificant or protective as an MS risk factor across racial groups, all age groups, and each military service. RRs for MS by service were: Air Force 0.71 (CI: 0.53-0.96), Army 0.80 (CI: 0.67-0.96), Marines 0.96 (CI: 0.63-1.47), and Navy 0.56 (CI: 0.43-0.74). Military deployment to GW1 was not a risk factor for developing MS.
To review published clinical studies on neurocysticercosis (NCC) in the United States over the pa... more To review published clinical studies on neurocysticercosis (NCC) in the United States over the past two decades and comment on epidemiologic trends and treatment. This review is based on a search of the literature citing NCC cases diagnosed in the United States utilizing PUBMED for the years 1980 through early 2004. Case series, case reports, epidemiologic studies, and treatment of NCC were evaluated. A total of 1,494 patients with NCC were reported in the United States among large case series (n > 20) between 1980 and early 2004. Common onset symptoms for these patients included seizures (66%), hydrocephalus (16%), and headaches (15%). The majority presented with parenchymal NCC (91%), with the remainder having ventricular cysts (6%), subarachnoid cysts (2%), and spinal cysts (0.2%). A total of 76 cases of NCC were likely acquired within the United States during the period of this review. A higher risk for acquiring NCC has been documented in patients who have traveled to endemic regions, are of Hispanic ethnicity, and have contact with Taenia solium tapeworm carriers. An increasing number of NCC cases have been reported in the US literature over the past 50 years, suggesting that the prevalence of this disease may be on the rise. Because neurologists are often involved with the diagnosis and management of NCC in the United States, it is important that they become familiar with this disorder, as they will play an important role in efforts to control the disease.
Age at onset of multiple sclerosis (MS) symptoms was ascertained for subsets of some 4,400 vetera... more Age at onset of multiple sclerosis (MS) symptoms was ascertained for subsets of some 4,400 veterans of World War II who had been adjudged 'service-connected' for this condition. Average age at onset was 27.0 years for white men, 27.7 for white women, and 27.5 for black men. The unexpectedly older age for women is attributed to their older age at entry into service. When the coterminous United States was divided into three horizontal tiers of states, we found a strong effect of geography on age at onset. By state of residence at entry into active duty (EAD), white men had an average age at onset of 26.4 years in the northern tier, 27.3 years in the middle, and 28.8 years in the south. Trends were similar for white women and black men. Migrants, defined as those whose birth and EAD tiers differed, showed increasing ages at onset with southward moves. A statistical model used to discriminate between the influence of birth and EAD tiers on age at onset confirmed the significant effect of EAD alone. These data are compatible with the theses that the cause of MS is less common (or less efficient) in locations where the clinical disease is less common, and that its acquisition therefore occurs at an older age in those locales.
The first class 1 treatment trial ever conducted in multiple sclerosis (MS) was a Veterans Admini... more The first class 1 treatment trial ever conducted in multiple sclerosis (MS) was a Veterans Administration Cooperative Study. This led us to explore MS in the military-veteran populations of the United States in three main series: Army men hospitalized with final diagnoses of MS in World War II, all veterans of World War II and the Korean Conflict, and veterans of later service up to 1994. In each series, all cases had been matched with pre-illness military peers. These series provide major information on its clinical features, course and prognosis, including survival, by sex and race (white men and women; black men), as well as risk factors for occurrence, course, and survival. They comprise the only available nationwide morbidity distributions of MS in the United States. Veterans who are service-connected for MS by the Department of Veterans Affairs and matched with their military peers remain a unique and currently available resource for further clinical and epidemiological study of this disease.
The Disability Status Scale for multiple sclerosis was the direct result of World War II, in whic... more The Disability Status Scale for multiple sclerosis was the direct result of World War II, in which 16.4 million persons served in the US military. Thereafter academic medicine enabled the modernization of the Veterans Administration in patient care, research, and training. Under the GI Bill, I attended Cornell University Medical College, where there was an intensive course in neurological diagnosis requiring detailed recording of positive and negative findings. This was used in junior and senior clinical clerkships and residency training, all of which I took at the Bronx VA Hospital. During my residency we assessed a possible treatment for MS, which required a comparison group and a means of measuring change. The former comprised the records of over 300 MS patients, whose neurological deficits were then consolidated into mutually exclusive Functional Systems, each with grades for severity. As rank-order scales they could not be summed or compared directly, but they were used as the basis for the DSS, which ranged from 0 (normal) to 10 (death due to MS). This scale was later expanded into the EDSS by halving each step 1 through 9. This bifid system is applicable to all patients with MS regardless of type or severity of neurological impairment.
Previous epidemiological studies have indicated that the county of Värmland in western Sweden may... more Previous epidemiological studies have indicated that the county of Värmland in western Sweden may be a high-risk zone for multiple sclerosis (MS). The objective of this study was to determine the prevalence in the area. Hospital and general practice medical files were scrutinized. The diagnostic criteria of Poser were used, with 31 December 2002 as prevalence day. The prevalence was 170.07 per 100,000 inhabitants. The average annual incidence was 6.39 to 6.46 per 100,000 (1991-1995, 1996-2000). Multiple sclerosis was 2.3 times more common among women than men. There was a variation in prevalence among the 16 municipalities, however it was not statistically significant. The rates seemed highest in the southwestern part of the county, roughly similar in location to findings some 70 years earlier. When the prevalence ratios by geographical units for the county in 1933 were applied to the current prevalence, the distribution from these estimated cases differed from homogeneity with very high significance (p < 0.00001 ). In conclusion, this study supports previous reports indicating that Värmland continues to be a high-risk zone for MS and shares in the diffusion of the disease at the county level which we had presented for the country as a whole.
To report clinical and epidemiological data of Devic's disease in... more To report clinical and epidemiological data of Devic's disease in Mexico. Retrospective study of hospital case records. The medical records were those of the National Institute for Neurology and Neurosurgery (INNN), a tertiary care referral center in Mexico City. There were 424 medical histories available for review among 561 discharges with diagnoses of multiple sclerosis (MS), neuromyelitis optica (NMO), or equivalents. 390 met the diagnostic criteria of MS and 34 the NMO criteria. We recorded clinical signs, visual acuities, and the Expanded Disability Status Scale (EDSS) at the initial diagnostic admission and during follow-up. All patients had examination of cerebrospinal fluid (CSF) at diagnosis; head and spine magnetic resonance imaging (MRI) were performed at diagnosis and at follow-up. All 34 patients were Mexican Mestizos, who comprise 79 % of the residents of Mexico City. There were 23 monophasic and 11 relapsing cases. Intervals between initial and defining events for the 8 ON and 12 myelitis onsets were 17 and 24 months (means) and 15 and 17 months (medians), respectively. Mean follow- up from onset was 70.2 months and 42.9 months from diagnostic examination. No patient showed improvement in EDSS scores. Visual loss was severe. A provisional prevalence rate of about 1 per 100,000 population for NMO in Mexican Mestizos might be offered. The disease seems more severe in our population than in other recent series.
RESUMEN La distribución geográfica de la esclerosis en placas ha cambiado notablemente en la segu... more RESUMEN La distribución geográfica de la esclerosis en placas ha cambiado notablemente en la segunda mitad del siglo pasado con un lento crecimiento de un origen aparente en escandinavia hacia una alta frecuencia uniforme en toda europa, una disminución en la diferencia de incidencia norte-sur en norteamérica y frecuencias medias en el norte de África, sudamérica y aún en Japón. Los migrantes de regiones de alta frecuencia a la baja mantienen su riesgo si se cambian después de los 15 años, mientras que los que cam-bian de zonas de baja a alta frecuencia aumentan su riesgo, si se cambian entre el nacimiento y los 40 años. En las Islas Faroe aparecieron epidemias sucesivas después de la ocupación por tropas británicas en la Segunda Guerra Mundial. Esto parece indicar que la esclerosis múltiple es el resultado de una infección única y desconocida que se adquiere entre los 11 y 45 años con un largo periodo de incubación, a la aparición de la enfermedad. Palabras clave: esclerosis múltip...
Thin-section computed tomographic (CT) scans of 3 and 1.5 mm thickness were obtained using the Ph... more Thin-section computed tomographic (CT) scans of 3 and 1.5 mm thickness were obtained using the Philips Tomoscan 310 and General Electric 8800 CT/T scanners in the study of 10 consecutive patients with progressive supranuclear palsy (PSP) and 31 patients with other diseases. Marked midbrain and moderate pontine atrophy, a dilated third ventricle, and enlarged quadrigeminal plate cisterns were observed in all PSP cases. The aqueduct was dilated in several. In six of the PSP cases, there was a striking midbrain abnormality in the form of a low-density area extending from the interpeduncular cistern toward the aqueduct. Thin-section metrizamide-enhanced cisternography of three of the six PSP cases showed that the low-density abnormality was the result of the interpeduncular cistern invaginating the atrophic midbrain.
Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelograph... more Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelography. We saw a patient with cortical blindness, seizure, organic psychosis, and asterixis after undergoing attempted metrizamide myelography via C1-2 puncture. Computed tomography demonstrated early penetrance of metrizamide into the brain parenchyma, most prominently in the occipital lobes. A mechanism of direct metrizamide neurotoxicity was proposed.
Incidence and prevalence studies of neurological disorders play an important role in assessing th... more Incidence and prevalence studies of neurological disorders play an important role in assessing the burden of disease and planning services. However, the assessment of disease estimates is hindered by problems in reporting for such studies. Despite a growth in published reports, existing guidelines relate to analytical rather than descriptive epidemiological studies. There are also no userfriendly tools (e.g., checklists) available for authors, editors and peer-reviewers to facilitate best practice in reporting of descriptive epidemiological studies for most neurological disorders. The Standards of Reporting of Neurological Disorders (STROND) is a guideline that consists of recommendations and a checklist to facilitate better reporting of published incidence and prevalence studies of neurological disorders. A review of previously developed guidance was used to produce a list of items required for incidence and prevalence studies in neurology. A threeround Delphi technique was used to identify the 'basic minimum items' important for reporting, as well as some additional 'ideal reporting items'. An e-consultation process was then used in order to gauge opinion by external neuroepidemiological experts on the appropriateness of the items included in the checklist. Of 38 candidate items, 15 items and accompanying recommendations were developed along with a user-friendly checklist. The introduction and use of the STROND checklist should lead to more consistent, transparent and contextualised reporting of descriptive neuroepidemiological studies resulting in more applicable and comparable findings and ultimately support better healthcare decisions.
The origin of EDSS, the Expanded Disability Status Scale for multiple sclerosis, was some 30 year... more The origin of EDSS, the Expanded Disability Status Scale for multiple sclerosis, was some 30 years before its only publication in 1983 when we were trying to assess a potential treatment and found no published methods. Findings from the complete neurologic examinations in over 200 patients were consolidated into mutually exclusive but all-inclusive neurophysiologic entities called Functional Systems (FS), and these provided the basis for an 11 step 0-10 rank order scale, the Disability Status Scale (DSS). This was used successfully, as well as in the first two Class I treatment trials performed, with the second one also incorporating the 8 FS. Both measures were part of an assessment of a natural history series derived from men hospitalized for MS in the US Army in World War II and followed for some 20 years. Describing each of the 8 FS as affected (1) or normal (0) defined 256 possible patterns of involvement for all patients. Half the patients at diagnosis had one of the 14 most c...
European journal of neurology : the official journal of the European Federation of Neurological Societies, 2015
Susceptibility to multiple sclerosis (MS) is determined by environmental and genetic factors, but... more Susceptibility to multiple sclerosis (MS) is determined by environmental and genetic factors, but the cause remains unknown. Changes to the proteome prior to first symptom onset may reflect the underlying pathophysiology of the disease. This preliminary study utilized pre-symptomatic and post-symptomatic serum from a sample of 100 incident population-based US military veterans with MS along with 100 matched healthy controls. All samples were obtained from the Department of Defense Serum Repository. Multidimensional protein identification technology tandem mass spectrometry analysis was performed on tryptic peptides of lectin-captured glycosylated serum proteins following albumin/immunoglobulin G depletion. Identified proteins were analyzed with the Ingenuity Pathway Analysis program. The mean intervals between first symptom onset and the collection of pre-symptomatic and post-symptomatic sera were -6.0 and +1.1 years, respectively. Pre-symptomatic proteins from the MS group were dif...
A 37-year-old man with a history of seizures developed periodic alternating nystagmus (PAN) along... more A 37-year-old man with a history of seizures developed periodic alternating nystagmus (PAN) along with other signs of primidone/phenobarbital toxicity. The PAN gradually diminished in cycle length and intensity, finally resolving with gradual discontinuation of the drugs.
Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk... more Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk to develop neurologic disease. An incident cohort of multiple sclerosis (MS) and other demyelinating disease (ODD) was assembled from the US military comprising the Gulf War era (1990-2007). Cases of MS and ODD meeting standard diagnostic criteria were matched to a database of all active duty personnel from the Department of Defense. Relative risk (RR) estimates for MS and all demyelinating disease based on onset, deployment status, and exposures were calculated. For GW1, a total of 1,841 incident cases of definite MS and ODD were identified, with 387 among 696,118 deployed and 1,454 among 1,786,215 nondeployed personnel. The RR for MS alone among those deployed compared to those nondeployed was 0.69 (confidence interval, CI: 0.61-0.78), with 0.72 (CI: 0.62-0.83) in men and 0.96 (CI: 0.75-1.22) in women. Deployment was also nonsignificant or protective as an MS risk factor across racial groups, all age groups, and each military service. RRs for MS by service were: Air Force 0.71 (CI: 0.53-0.96), Army 0.80 (CI: 0.67-0.96), Marines 0.96 (CI: 0.63-1.47), and Navy 0.56 (CI: 0.43-0.74). Military deployment to GW1 was not a risk factor for developing MS.
To review published clinical studies on neurocysticercosis (NCC) in the United States over the pa... more To review published clinical studies on neurocysticercosis (NCC) in the United States over the past two decades and comment on epidemiologic trends and treatment. This review is based on a search of the literature citing NCC cases diagnosed in the United States utilizing PUBMED for the years 1980 through early 2004. Case series, case reports, epidemiologic studies, and treatment of NCC were evaluated. A total of 1,494 patients with NCC were reported in the United States among large case series (n > 20) between 1980 and early 2004. Common onset symptoms for these patients included seizures (66%), hydrocephalus (16%), and headaches (15%). The majority presented with parenchymal NCC (91%), with the remainder having ventricular cysts (6%), subarachnoid cysts (2%), and spinal cysts (0.2%). A total of 76 cases of NCC were likely acquired within the United States during the period of this review. A higher risk for acquiring NCC has been documented in patients who have traveled to endemic regions, are of Hispanic ethnicity, and have contact with Taenia solium tapeworm carriers. An increasing number of NCC cases have been reported in the US literature over the past 50 years, suggesting that the prevalence of this disease may be on the rise. Because neurologists are often involved with the diagnosis and management of NCC in the United States, it is important that they become familiar with this disorder, as they will play an important role in efforts to control the disease.
Age at onset of multiple sclerosis (MS) symptoms was ascertained for subsets of some 4,400 vetera... more Age at onset of multiple sclerosis (MS) symptoms was ascertained for subsets of some 4,400 veterans of World War II who had been adjudged 'service-connected' for this condition. Average age at onset was 27.0 years for white men, 27.7 for white women, and 27.5 for black men. The unexpectedly older age for women is attributed to their older age at entry into service. When the coterminous United States was divided into three horizontal tiers of states, we found a strong effect of geography on age at onset. By state of residence at entry into active duty (EAD), white men had an average age at onset of 26.4 years in the northern tier, 27.3 years in the middle, and 28.8 years in the south. Trends were similar for white women and black men. Migrants, defined as those whose birth and EAD tiers differed, showed increasing ages at onset with southward moves. A statistical model used to discriminate between the influence of birth and EAD tiers on age at onset confirmed the significant effect of EAD alone. These data are compatible with the theses that the cause of MS is less common (or less efficient) in locations where the clinical disease is less common, and that its acquisition therefore occurs at an older age in those locales.
The first class 1 treatment trial ever conducted in multiple sclerosis (MS) was a Veterans Admini... more The first class 1 treatment trial ever conducted in multiple sclerosis (MS) was a Veterans Administration Cooperative Study. This led us to explore MS in the military-veteran populations of the United States in three main series: Army men hospitalized with final diagnoses of MS in World War II, all veterans of World War II and the Korean Conflict, and veterans of later service up to 1994. In each series, all cases had been matched with pre-illness military peers. These series provide major information on its clinical features, course and prognosis, including survival, by sex and race (white men and women; black men), as well as risk factors for occurrence, course, and survival. They comprise the only available nationwide morbidity distributions of MS in the United States. Veterans who are service-connected for MS by the Department of Veterans Affairs and matched with their military peers remain a unique and currently available resource for further clinical and epidemiological study of this disease.
The Disability Status Scale for multiple sclerosis was the direct result of World War II, in whic... more The Disability Status Scale for multiple sclerosis was the direct result of World War II, in which 16.4 million persons served in the US military. Thereafter academic medicine enabled the modernization of the Veterans Administration in patient care, research, and training. Under the GI Bill, I attended Cornell University Medical College, where there was an intensive course in neurological diagnosis requiring detailed recording of positive and negative findings. This was used in junior and senior clinical clerkships and residency training, all of which I took at the Bronx VA Hospital. During my residency we assessed a possible treatment for MS, which required a comparison group and a means of measuring change. The former comprised the records of over 300 MS patients, whose neurological deficits were then consolidated into mutually exclusive Functional Systems, each with grades for severity. As rank-order scales they could not be summed or compared directly, but they were used as the basis for the DSS, which ranged from 0 (normal) to 10 (death due to MS). This scale was later expanded into the EDSS by halving each step 1 through 9. This bifid system is applicable to all patients with MS regardless of type or severity of neurological impairment.
Previous epidemiological studies have indicated that the county of Värmland in western Sweden may... more Previous epidemiological studies have indicated that the county of Värmland in western Sweden may be a high-risk zone for multiple sclerosis (MS). The objective of this study was to determine the prevalence in the area. Hospital and general practice medical files were scrutinized. The diagnostic criteria of Poser were used, with 31 December 2002 as prevalence day. The prevalence was 170.07 per 100,000 inhabitants. The average annual incidence was 6.39 to 6.46 per 100,000 (1991-1995, 1996-2000). Multiple sclerosis was 2.3 times more common among women than men. There was a variation in prevalence among the 16 municipalities, however it was not statistically significant. The rates seemed highest in the southwestern part of the county, roughly similar in location to findings some 70 years earlier. When the prevalence ratios by geographical units for the county in 1933 were applied to the current prevalence, the distribution from these estimated cases differed from homogeneity with very high significance (p < 0.00001 ). In conclusion, this study supports previous reports indicating that Värmland continues to be a high-risk zone for MS and shares in the diffusion of the disease at the county level which we had presented for the country as a whole.
To report clinical and epidemiological data of Devic's disease in... more To report clinical and epidemiological data of Devic's disease in Mexico. Retrospective study of hospital case records. The medical records were those of the National Institute for Neurology and Neurosurgery (INNN), a tertiary care referral center in Mexico City. There were 424 medical histories available for review among 561 discharges with diagnoses of multiple sclerosis (MS), neuromyelitis optica (NMO), or equivalents. 390 met the diagnostic criteria of MS and 34 the NMO criteria. We recorded clinical signs, visual acuities, and the Expanded Disability Status Scale (EDSS) at the initial diagnostic admission and during follow-up. All patients had examination of cerebrospinal fluid (CSF) at diagnosis; head and spine magnetic resonance imaging (MRI) were performed at diagnosis and at follow-up. All 34 patients were Mexican Mestizos, who comprise 79 % of the residents of Mexico City. There were 23 monophasic and 11 relapsing cases. Intervals between initial and defining events for the 8 ON and 12 myelitis onsets were 17 and 24 months (means) and 15 and 17 months (medians), respectively. Mean follow- up from onset was 70.2 months and 42.9 months from diagnostic examination. No patient showed improvement in EDSS scores. Visual loss was severe. A provisional prevalence rate of about 1 per 100,000 population for NMO in Mexican Mestizos might be offered. The disease seems more severe in our population than in other recent series.
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Papers by John Kurtzke