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Epidemiology of multiple sclerosis in vinnytsia oblast, South-West Ukraine
ROLE OF A BASELINE ACTIVlTYOFREL.APSUUG-
EPIDEMIOLOGY OF MULTIPLE SCLEROSIS IN VINNYTSIA OBIAST, SOUTH-WEST UKRAINE
T. Koudriavtseva, Bozzao, A. Pismi,
A.G.Komiychuk, O.V.Zheliba Neurological Clinic Vinnytsia Medical University, Ukraine
SCAN
IN
PREDICTING GMSPATfENlS
CLINICAL
AND
MRl
A. J. Thompson*, C. Pozzilli, C. Gasperini, S. Bastianello, J. Far&, C. Pi”, C. Pies&
Department of Neurological Sciences, University “La Sapien&‘, Institute of Neurology, Queen Square, London UK l * Deprutment of Neurology, S. Camillo Hospit& Rome, Italy
A.
Rome, Italy
l
Vinnytsia oblast is the largest and densely populated agricultural province in South-West Ukraine. Its geoclimatic conditions (latitude location, many rivers and pools, temperate climate) seem to be favourable for MS occurrence. The epidemiological survey of MS was carried out in 1990 and in 1994. MS cases were identified from Neurological Clinic Vinnytsia Medical University archives and from all district neurologists. At the first study were registered 513, at the second - 582 MS patients. The men/women ratio was 1:1,14. The age of the majority of patients ranged from 30 to 49 years. The MS prevalence was 30,8 per 100000 population. The prevalence rate in 28 districts was demonstrated as low as 16,3 to high as 66,8 per 100000. The MS cases clustered predominantly in North-Western districts. The mean armual MS incidence in the 5-year period was 0,73 per 100000. The obtained data confirm the validity of renewed Kurtzke (1993) geographical scheme of worldwide MS distribution which includes Ukraine to the areas with medium frequency of MS. This confirmation is important for the necessity to focus on the medical and socioeconomic position of MS patients in Ukraine.
Object of the study. The aim of the present investigation was to evaluate the relevance of L baseline reference MRI scan to improve identification of active patients suitable for therapeutical trta.ls in h45. Material and Methudr: We examined 68 patiultswith relapsing remitting MS included in an opa comparative study of rhlNP betk They were 21 males and 47 females, mean age 30.5i7.3 years, mean diaaaae duration 5.at2.9 years and mean EDSS 21i0.9. The mesn number of &pses in the two previous years was 3.1f1.3 and the mean time interval between the lsst rekpse and study entry was 5.W.2 montha. Chical evaluation (no of relapses) and monthly MRl data of these patients were examined during an observation period (6 months)
preceded by a baseline MRI. The mean number and volume of enhuuing lesions over the six month period were calculated on Tl weighted images after j+sdolinitun a-tion. Patients were divided in two subgroups according to thepresmceorabsenceofatlcastoneenhandnglerionatUlebPdelinescan. RaauIts. An enhmdng bssdlne scan was found in 33 out of 68 patients examined. These patients showed no slgnifkant diffexence in age, sex, disease duration, ED5S at entry and number of relapses in 2 previous years when compared with those with unenhmvkg scan at baseline. However the time interval between the hat relapse and study entry was significantly lower in patients with an enhpncine baseline The mean numbar
were sigdfhmdy
National Institute
hospital
for Neurology
of Neurology,
and ~e~rosurge~.
period
scan than in those with unenhurdng baselim acan (numba 4.77 vs 1.04,p=Oo.WOZ and volume 744.2 vs 181.8 mm3, p=O.oaoS). A higher mean number of relapses during the observation period was found in pt*nts with enhunkg base&w scan compared to patients with lmmhndng sun (1.14 “8 OSS, pdl.cQ86). CCQW~~OIL
higher in pattents with enhan*
Our data show
of clinical
and biological therapeutic trial.
VARIABLES AFFECTING THE OUTCOME OF NEUROREHABILITATION OF PATIENTS WITH MULTIPLE SCLEROSIS D. W. Lanadon. A. J. Thompson.
scan (Iima interval 4.24 va 6.06 months,p=O.OZ). and volume of &ancing lestcns during the observation
baseline
that m ache
activity
MRI SCM b a useful
predictor
in patients with MS being considered
COGNITIVE DYSFUNCTION ADVANCED MULTIPLE SCLEROSIS (MS).
for a
IN
u K
u. K.
D. W. Lanadon. A. J. Thompson.
The diverse physlcal and cognitive impamnents seen in advanced multiple sclerosis (MS), make it difftcult lo tdentify the factors th#t inftuence neumrehebilitation outcome. A change in scorn on a motor dbabtlity scsle must be considered in the context of the patient’s physical and cognitive starting points. if the process of rehabilitation is to he proper& understood
National tnstnute
Hospit@
for Neurology
of Naurology,
and Neurosurgery,
U. K.
u. K.
Conventional measures of reasoning in multiple sclerosis are confounded hy sensorimotor dysfunction and coincident cognitive impairments This study aimed to validate a new ruasoning test in a sample of MS patients with a high level of physical dlsahtltty.
METHOD Data was collected fmm 38 patients (mean age 41 yean, 16 men) with clinically definite MS (of whom 85% were secondary proglsssive), consecutively admitted to a rehabilitation unit. Patients’ phyakat disabiltty was assessed on the Functional Independence Measum (FM) m Scab on admission and discharge. Cognitive and neurological hattmieswer9 completed on admission.
METHOD. Data was collected from 38 consecutive patients (mean age 41 years, 18 men) with dinically definite moderate or severe MS (85% were secondety progressive). The median Kurtzke swm was 7.5 (range 5.0 - Q.0). The pattiants wet’0 asses& dn a co@tive bsttery, induding the Wechsler Adult Intelligence Scale-Revised (WAISR), the Recognition Memory Test (RMT) and the Verbal and Spatial Reasoning Test (VESPAR). a new tesf of reasoning for neumfogttl patients, which requires no manual dexteMy or fine visual discrimination.
RESULTS. The median improvement on the FIM was 6 points. A multiple regression analysis was Performed to determine which cognitiie and neurological variables ret&d to reduced disabtlii after neumrehabil#atttn. To take account of each pattint’s starting paint. the model in&&d their FlM admission score. This vdriabte, together with vocabulary skills ad cerehettar function, accuunted for 57% of the varlence in the fMiw impmvement
RESULTS. Pm-motttldly, the patients Walt estimated to have had a meen Verbal IQ (VtQ) of 102. with a standard deviation (s.d.)of 14. The cufmnt mean VIQ was 93, with a s.d. of 13, indicating a fahiy mild but significant deterioration in verbal lntetligence. Atthough less reliant on fine sensorimotor fundion. the novel pmbbms of the MSPAR still defeated pattents.
CONCLUSlONS A methodology has Men developed fefexaminirtQ the pmc8ss of neurorehahiMtatttn in MS. This initial study sugge& that verbal intelligenoe and cerebetlar functiin are influentttl in determining outcome. Although these findings will be unmng to dinictans, thi!~ is the Rmt quantitative demonstration of these effects
CONCLUSIONS. Refinements in metfiodoh~~y and test materials revealed impatrments in both verbal and spatial reasoning tasks, which could not easily he attrtbuted to sensorimotor dysfunction.
-41-
EPIDEMIOLOGY OF MULTIPLE SCLEROSIS IN VINNYTSIA OBIAST, SOUTH-WEST UKRAINE
T. Koudriavtseva, Bozzao, A. Pismi,
A.G.Komiychuk, O.V.Zheliba Neurological Clinic Vinnytsia Medical University, Ukraine
SCAN
IN
PREDICTING GMSPATfENlS
CLINICAL
AND
MRl
A. J. Thompson*, C. Pozzilli, C. Gasperini, S. Bastianello, J. Far&, C. Pi”, C. Pies&
Department of Neurological Sciences, University “La Sapien&‘, Institute of Neurology, Queen Square, London UK l * Deprutment of Neurology, S. Camillo Hospit& Rome, Italy
A.
Rome, Italy
l
Vinnytsia oblast is the largest and densely populated agricultural province in South-West Ukraine. Its geoclimatic conditions (latitude location, many rivers and pools, temperate climate) seem to be favourable for MS occurrence. The epidemiological survey of MS was carried out in 1990 and in 1994. MS cases were identified from Neurological Clinic Vinnytsia Medical University archives and from all district neurologists. At the first study were registered 513, at the second - 582 MS patients. The men/women ratio was 1:1,14. The age of the majority of patients ranged from 30 to 49 years. The MS prevalence was 30,8 per 100000 population. The prevalence rate in 28 districts was demonstrated as low as 16,3 to high as 66,8 per 100000. The MS cases clustered predominantly in North-Western districts. The mean armual MS incidence in the 5-year period was 0,73 per 100000. The obtained data confirm the validity of renewed Kurtzke (1993) geographical scheme of worldwide MS distribution which includes Ukraine to the areas with medium frequency of MS. This confirmation is important for the necessity to focus on the medical and socioeconomic position of MS patients in Ukraine.
Object of the study. The aim of the present investigation was to evaluate the relevance of L baseline reference MRI scan to improve identification of active patients suitable for therapeutical trta.ls in h45. Material and Methudr: We examined 68 patiultswith relapsing remitting MS included in an opa comparative study of rhlNP betk They were 21 males and 47 females, mean age 30.5i7.3 years, mean diaaaae duration 5.at2.9 years and mean EDSS 21i0.9. The mesn number of &pses in the two previous years was 3.1f1.3 and the mean time interval between the lsst rekpse and study entry was 5.W.2 montha. Chical evaluation (no of relapses) and monthly MRl data of these patients were examined during an observation period (6 months)
preceded by a baseline MRI. The mean number and volume of enhuuing lesions over the six month period were calculated on Tl weighted images after j+sdolinitun a-tion. Patients were divided in two subgroups according to thepresmceorabsenceofatlcastoneenhandnglerionatUlebPdelinescan. RaauIts. An enhmdng bssdlne scan was found in 33 out of 68 patients examined. These patients showed no slgnifkant diffexence in age, sex, disease duration, ED5S at entry and number of relapses in 2 previous years when compared with those with unenhmvkg scan at baseline. However the time interval between the hat relapse and study entry was significantly lower in patients with an enhpncine baseline The mean numbar
were sigdfhmdy
National Institute
hospital
for Neurology
of Neurology,
and ~e~rosurge~.
period
scan than in those with unenhurdng baselim acan (numba 4.77 vs 1.04,p=Oo.WOZ and volume 744.2 vs 181.8 mm3, p=O.oaoS). A higher mean number of relapses during the observation period was found in pt*nts with enhunkg base&w scan compared to patients with lmmhndng sun (1.14 “8 OSS, pdl.cQ86). CCQW~~OIL
higher in pattents with enhan*
Our data show
of clinical
and biological therapeutic trial.
VARIABLES AFFECTING THE OUTCOME OF NEUROREHABILITATION OF PATIENTS WITH MULTIPLE SCLEROSIS D. W. Lanadon. A. J. Thompson.
scan (Iima interval 4.24 va 6.06 months,p=O.OZ). and volume of &ancing lestcns during the observation
baseline
that m ache
activity
MRI SCM b a useful
predictor
in patients with MS being considered
COGNITIVE DYSFUNCTION ADVANCED MULTIPLE SCLEROSIS (MS).
for a
IN
u K
u. K.
D. W. Lanadon. A. J. Thompson.
The diverse physlcal and cognitive impamnents seen in advanced multiple sclerosis (MS), make it difftcult lo tdentify the factors th#t inftuence neumrehebilitation outcome. A change in scorn on a motor dbabtlity scsle must be considered in the context of the patient’s physical and cognitive starting points. if the process of rehabilitation is to he proper& understood
National tnstnute
Hospit@
for Neurology
of Naurology,
and Neurosurgery,
U. K.
u. K.
Conventional measures of reasoning in multiple sclerosis are confounded hy sensorimotor dysfunction and coincident cognitive impairments This study aimed to validate a new ruasoning test in a sample of MS patients with a high level of physical dlsahtltty.
METHOD Data was collected fmm 38 patients (mean age 41 yean, 16 men) with clinically definite MS (of whom 85% were secondary proglsssive), consecutively admitted to a rehabilitation unit. Patients’ phyakat disabiltty was assessed on the Functional Independence Measum (FM) m Scab on admission and discharge. Cognitive and neurological hattmieswer9 completed on admission.
METHOD. Data was collected from 38 consecutive patients (mean age 41 years, 18 men) with dinically definite moderate or severe MS (85% were secondety progressive). The median Kurtzke swm was 7.5 (range 5.0 - Q.0). The pattiants wet’0 asses& dn a co@tive bsttery, induding the Wechsler Adult Intelligence Scale-Revised (WAISR), the Recognition Memory Test (RMT) and the Verbal and Spatial Reasoning Test (VESPAR). a new tesf of reasoning for neumfogttl patients, which requires no manual dexteMy or fine visual discrimination.
RESULTS. The median improvement on the FIM was 6 points. A multiple regression analysis was Performed to determine which cognitiie and neurological variables ret&d to reduced disabtlii after neumrehabil#atttn. To take account of each pattint’s starting paint. the model in&&d their FlM admission score. This vdriabte, together with vocabulary skills ad cerehettar function, accuunted for 57% of the varlence in the fMiw impmvement
RESULTS. Pm-motttldly, the patients Walt estimated to have had a meen Verbal IQ (VtQ) of 102. with a standard deviation (s.d.)of 14. The cufmnt mean VIQ was 93, with a s.d. of 13, indicating a fahiy mild but significant deterioration in verbal lntetligence. Atthough less reliant on fine sensorimotor fundion. the novel pmbbms of the MSPAR still defeated pattents.
CONCLUSlONS A methodology has Men developed fefexaminirtQ the pmc8ss of neurorehahiMtatttn in MS. This initial study sugge& that verbal intelligenoe and cerebetlar functiin are influentttl in determining outcome. Although these findings will be unmng to dinictans, thi!~ is the Rmt quantitative demonstration of these effects
CONCLUSIONS. Refinements in metfiodoh~~y and test materials revealed impatrments in both verbal and spatial reasoning tasks, which could not easily he attrtbuted to sensorimotor dysfunction.
-41-