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Is multiple sclerosis more disabling in North African patients?
Defining breakthrough disease: When to escalate accepted the societies offer for management of Egyptian M. S. patients with Beta Interferon and negotiations are running for oral disease modifying drugs (DMD). Also many M.S. centers had been established in Alexandria University, Cairo University, Ain Shams University for patient management, guidance and awareness. Lastly the activity of MS society with collaboration of Egyptian Society of Neurology, Psychiatry and Neurosurgery published at least 40 articles of different aspects of M.S, 15 Doctors Thesis and 20 Masters Thesis. http://dx.doi.org/10.1016/j.msard.2014.09.018
Are DMDs really more effective in CIS?
769 up of 88.8 months. The relapsing-remitting MS accounted for 82.1% and the primary progressive form represented 17.9%. The median MSSS was 6.39, fast progressor (MSSS45) represented 62.6%.The mean PI was 0.97 with 20% of Malignant forms (PI41.2). Time to reach an EDSS score of 6 was 18 years (16.5–19.5). Previous studies comparing the MS severity between Caucasian and NA migrants in Europe have concluded to more severe disease in NA population. Our study is the first conducted in the autochthone population (Morocco) founding a similar result with a rapidly disabling disease. Subsequent Multicenter study from Algeria corroborates these findings. The Authors review and discuss possible factors and bias that could explain these data. http://dx.doi.org/10.1016/j.msard.2014.09.020
Magd Zakaria Professor of Neurology, Ain Shams University Cairo, Egypt It is a common belief that DMDs are more effective when used early in the course of the disease especially in CIS. Although this may be true, yet, the evidence for this is lacking and misleading. This assumption is simply based on the fact that the Relative Risk Reduction of relapses is higher when DMDs are used in CIS than when used in MS. In this presentation, the value of the RRR as a true marker of clinical efficacy is challenged. The value of the RRR depends on the Risk, a very high RRR in a very low risk group can be clinically no significant. On the other hand, a low RRR in a very risky and frequently relapsing population can be more clinically meaningful. The statistical evidence for this will be fully explained. http://dx.doi.org/10.1016/j.msard.2014.09.019
Is multiple sclerosis more disabling in North African patients?
Ilham Slassi Professor of Neurology, Ibn Rochd Hospital Casablanca, Morocco Ethnic and environmental factors are major determinant of prevalence and severity of Multiple Sclerosis (MS). Data relating to the severity of MS in North-African are scarce and conflicting and concern mainly migrants to Europe. To Answer this question, the authors have conducted a multicenter study enrolling patients with MS (Revised Mc Donald Criteria 2005) seen between 1998 and 2010 in the university hospitals of Casablanca, Fes and Marrakesh. Severity of MS was evaluated by the Progression Index (PI), time to reach an EDSS of 6.0 and the Multiple Sclerosis Severity Score (MSSS). The study included 460 patients. The sex ratio was 2.1. The mean age of MS onset was 30.2 years, with a mean follow
Differential diagnosis of MS
Xavier Montalban Professor of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain Diagnostic criteria for MS rely on the demonstration of CNS disease in space and time and in reasonable exclusion of other causes. Since McDonald 2001, in patients with a first attack, MRI may provide evidence of diagnosis for dissemination in space and time. The 2010 McDonald criteria selected the Magnims criteria for dissemination in space (DIS). DIS is defined as the presence of Z1 asymptomatic T2 lesion(s) in at least two of four locations considered characteristic for MS in previous MRI criteria: juxtacortical, periventricular, infratentorial and spinal cord. These criteria simplify the previous Barkhof criteria and highlight the importance of lesion location for MS diagnosis. Moreover, this new definition relies on T2 lesions only. Noninclusion of gadolinium enhancing lesions seems appropriate since enhancing lesions per se provide information on disease activity and not on dissemination in space. For demonstration of dissemination in time (DIT), an MRI performed at any time demonstrating DIS and showing at least one or more asymptomatic gadolinium enhancing and non-enhancing lesions(s) (this being used as evidence for DIT) would be sufficient to diagnose MS. Although many studies have already shown the importance of CSF study in the diagnosis and differential diagnosis of MS, the presence of oligoclonal bands has not been included in the diagnosis algorithm. These criteria have been adapted to other populations such as patients with primary progressive MS or patients with paediatric MS. An overview of the past diagnostic criteria will also be performed as well as new directions for the future will be considered (intracortical lesions, 3 T MRI, other). One of the problems of the diagnosis of MS is that we should rule out other conditions and this is not always an easy task. Clinical cases to illustrate differential diagnoses will be presented. http://dx.doi.org/10.1016/j.msard.2014.09.021
Are DMDs really more effective in CIS?
769 up of 88.8 months. The relapsing-remitting MS accounted for 82.1% and the primary progressive form represented 17.9%. The median MSSS was 6.39, fast progressor (MSSS45) represented 62.6%.The mean PI was 0.97 with 20% of Malignant forms (PI41.2). Time to reach an EDSS score of 6 was 18 years (16.5–19.5). Previous studies comparing the MS severity between Caucasian and NA migrants in Europe have concluded to more severe disease in NA population. Our study is the first conducted in the autochthone population (Morocco) founding a similar result with a rapidly disabling disease. Subsequent Multicenter study from Algeria corroborates these findings. The Authors review and discuss possible factors and bias that could explain these data. http://dx.doi.org/10.1016/j.msard.2014.09.020
Magd Zakaria Professor of Neurology, Ain Shams University Cairo, Egypt It is a common belief that DMDs are more effective when used early in the course of the disease especially in CIS. Although this may be true, yet, the evidence for this is lacking and misleading. This assumption is simply based on the fact that the Relative Risk Reduction of relapses is higher when DMDs are used in CIS than when used in MS. In this presentation, the value of the RRR as a true marker of clinical efficacy is challenged. The value of the RRR depends on the Risk, a very high RRR in a very low risk group can be clinically no significant. On the other hand, a low RRR in a very risky and frequently relapsing population can be more clinically meaningful. The statistical evidence for this will be fully explained. http://dx.doi.org/10.1016/j.msard.2014.09.019
Is multiple sclerosis more disabling in North African patients?
Ilham Slassi Professor of Neurology, Ibn Rochd Hospital Casablanca, Morocco Ethnic and environmental factors are major determinant of prevalence and severity of Multiple Sclerosis (MS). Data relating to the severity of MS in North-African are scarce and conflicting and concern mainly migrants to Europe. To Answer this question, the authors have conducted a multicenter study enrolling patients with MS (Revised Mc Donald Criteria 2005) seen between 1998 and 2010 in the university hospitals of Casablanca, Fes and Marrakesh. Severity of MS was evaluated by the Progression Index (PI), time to reach an EDSS of 6.0 and the Multiple Sclerosis Severity Score (MSSS). The study included 460 patients. The sex ratio was 2.1. The mean age of MS onset was 30.2 years, with a mean follow
Differential diagnosis of MS
Xavier Montalban Professor of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain Diagnostic criteria for MS rely on the demonstration of CNS disease in space and time and in reasonable exclusion of other causes. Since McDonald 2001, in patients with a first attack, MRI may provide evidence of diagnosis for dissemination in space and time. The 2010 McDonald criteria selected the Magnims criteria for dissemination in space (DIS). DIS is defined as the presence of Z1 asymptomatic T2 lesion(s) in at least two of four locations considered characteristic for MS in previous MRI criteria: juxtacortical, periventricular, infratentorial and spinal cord. These criteria simplify the previous Barkhof criteria and highlight the importance of lesion location for MS diagnosis. Moreover, this new definition relies on T2 lesions only. Noninclusion of gadolinium enhancing lesions seems appropriate since enhancing lesions per se provide information on disease activity and not on dissemination in space. For demonstration of dissemination in time (DIT), an MRI performed at any time demonstrating DIS and showing at least one or more asymptomatic gadolinium enhancing and non-enhancing lesions(s) (this being used as evidence for DIT) would be sufficient to diagnose MS. Although many studies have already shown the importance of CSF study in the diagnosis and differential diagnosis of MS, the presence of oligoclonal bands has not been included in the diagnosis algorithm. These criteria have been adapted to other populations such as patients with primary progressive MS or patients with paediatric MS. An overview of the past diagnostic criteria will also be performed as well as new directions for the future will be considered (intracortical lesions, 3 T MRI, other). One of the problems of the diagnosis of MS is that we should rule out other conditions and this is not always an easy task. Clinical cases to illustrate differential diagnoses will be presented. http://dx.doi.org/10.1016/j.msard.2014.09.021