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Predictive factors of physical component of quality of life in multiple sclerosis patients
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Abstracts / Journal of the Neurological Sciences 333 (2013) e358–e421
signs of temporal dispersion. In 1 case the P100 latency increased despite the therapy from 189 ms to 237 ms. Conclusion: Our measurements show that the acute retrobulbar neuritis episode in patients with neuromyelitis optica cannot be explained with mere demyelination. The absence of P100 response in acute recidive in most cases demonstrates the more prominent axonal damage of optic nerve. These severe causes of neuromyelitis optica in Mongolia should be studied thoroughly in future, and the management of recidive prophylactic treatment must be improved. doi:10.1016/j.jns.2013.07.1406
Abstract — WCN 2013 No: 2069 Topic: 6 — MS & Demyelinating Diseases Spinal cord expression of stathmin-1, SCLIP and SCG10 in experimental autoimmune encephalomyelitis (EAE) O. Touloumia, T. Irinopouloub, R. Lagoudakia, P. Theotokisa, A. Lourbopoulosa, C. Cifuentes-Diazb, E. Nousiopouloua, E. Kofidoua, D. Karacostasa, N. Grigoriadisa. aAHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece; bINSERM, Institut du Fer à Moulin, Paris, France Background: The role of stathmins is the regulation of microtubule equilibrium and cytoskeleton reorganization. They alternate between assembly and disassembly of the cell with the purpose of correct formation of mitotic spindle. Objective: We studied the stathmin expression in the spinal cord in EAE. Material and methods: EAE mice were examined at three timepoints (D10, acute, chronic) and compared with controls (D0). Stathmin1, SCG10 and SCLIP mRNA and protein expression was studied using Real Time-PCR and optical and confocal microscopy. Results: There was reduced mRNA expression in acute phase of stathmin1 (p b 0.05); SCLIP was reduced both in acute and chronic phase of EAE (p b 0.01). An overall decrease of spinal cord stathmin1 and SCG10 protein expression was noticed in acute phase (p b 0.001, p b 0.05). However, our sub-analysis in the inflamed white matter showed increased expression of all stathmins (p b 0.05, p b 0.001, p b 0.01). Moreover, stathmin1 was predominantly expressed in NG2+ (p b 0.001) and O4+ (p b 0.05) cells whereas in lower levels in CNPase+ (p b 0.05) cells during the acute phase. SCG10 and SCLIP were expressed in axons already during the acute phase and throughout the entire EAE course though not in controls. In addition, inside the inflammatory lesions SCG10 was co-expressed with APP (p b 0.05), a marker of acute axonal damage whereas SCLIP followed the opposite course and was co-expressed with GAP-43 (p b 0.05), a marker of axonal regeneration. Conclusions: The stathmin protein family kinetic in inflammatory demyelinating areas indicates their potential involvement in the underlying pathology and reorganization of the degenerative spinal cord during EAE. doi:10.1016/j.jns.2013.07.1407
Abstract — WCN 2013 No: 2044 Topic: 6 — MS & Demyelinating Diseases Connectivity patterns obtained by emulated vs. conventional resting state fMRI in clinical cohorts — Can parts tell the whole story? M. Loitfelder, D. Pinter, C. Langkammer, M. Jehna, S. Ropele, F. Fazekas, R. Schmidt, C. Enzinger. Medical University of Graz, Graz, Austria Background: Resting state (RS) fMRI has received considerable interest in clinical neuroscientific research, as it also allows concluding
on patterns of spatiotemporally consistent neural activity while the brain is at “rest”. With regard to this, Fair et al. (2007) suggested a method how existing datasets could be re-analyzed via extracting specific volumes of conventional (c) block design fMRI data to emulate (e) RS-fMRI. Objective: We here aimed to investigate the similarity or diversity of results obtained with this approach (eRS) compared to cRS regarding connectivity network identification in a clinical cohort. Patients and methods: 12 Multiple Sclerosis patients (MS, age: x = 30.82 ± 10.8) and 18 healthy controls (HC, age: x = 32.28 ± 6.8) underwent conventional task-related fMRI and cRS in the same imaging session. In the first step, the total cognitive paradigm has been treated as a RS-dataset, and both datasets were analyzed in total length. Then, the cognitive paradigm was truncated according to the criteria by Fair to emulate RS. The cRS dataset was truncated equally. Results: Whereas visual inspection of seed based analyses of functional connectivity from the anterior cingulate cortex suggested almost identical patterns in MS patients and HC, higher-level within and between group analyses of eRS vs. cRS revealed distinct differences in connectivity networks. Conclusion: Generally, using the eRS approach allows the identification of connectivity networks (similar to those obtained using cRS-data) also in diseased brains. However, results of higher-level contrasts yielded different results and thus have to be interpreted with caution. doi:10.1016/j.jns.2013.07.1408
Abstract — WCN 2013 No: 2042 Topic: 6 — MS & Demyelinating Diseases Predictive factors of physical component of quality of life in multiple sclerosis patients S. Sabanagic-Hajric, N. Subasic, A. Alajbegovic. Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina Background: Multiple sclerosis is a chronic progressive disease with multiple neurological and psychological impairments that can affect all aspects of quality of life. Objective: The objective of this study was to investigate the predictive factors of physical component of quality of life in MS patients. Patients and methods: 100 MS patients treated at the Neurology Clinic in Sarajevo were involved. Each patient underwent a complete clinical assessment, including disability status (EDSS), cognitive function (MMSE) and measurement of quality of life (MSQOL-54). Linear regression analyses were performed to identify significant predictors from sociodemographic and clinical characteristics in predicting MSQOL-54 physical and mental composite scores. Results: The mean age of 100 patients (69% female and 31% male) was 39.88 ± 10.03. The mean EDSS score was 3.57 ± 1.73 and 72% were of the relapsing–remitting clinical subtype. Linear multivariate regression analyses revealed that presence of pain (eta square = 0.29), EDSS (eta square = 0.27), sphincterial disorders (eta square = 0.19), employment status (eta squared = 0.15), type of disease (eta square = 0.10) and age (eta square = 0.06) proved to be main predictors of MSQOL-54 physical composite scores (r2 = 0.83). Among the patients with relapsingremitting type of disease number of relapses (eta squared = 0.260), EDSS score (eta squared = 0.24), sphincterial disorders (eta squared = 0.17), presence of pain (eta squared = 0.16), employment status (eta squared = 0.15) and age (eta squared = 0.08) proved to be main predictors of MSQOL-54 physical composite scores (r2 = 0.87). Conclusion: Assessment of quality of life in MS patients provides additional information on the patient status. Management of pain
Abstracts / Journal of the Neurological Sciences 333 (2013) e358–e421
and sphincterial disorders is highly important in treatment of MS patients. doi:10.1016/j.jns.2013.07.1409
Abstract — WCN 2013 No: 2028 Topic: 6 — MS & Demyelinating Diseases Reduced intrathecal IgG synthesis in the cerebrospinal fluid from natalizumab-treated patients with active multiple sclerosis A. Harrera, G. Pilza, P. Wipflera, K. Oppermanna, B. Holla, W. Hitzlb, S. Afazelc, E. Haschke-Becherc, E. Trinkaa, J. Krausa. aDepartment of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, Salzburg, Austria; bResearch Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria; cCentral Laboratory, Paracelsus Medical University, Christian-Doppler-Klinik, Salzburg, Austria Oligoclonal bands (OCB) have been reported to disappear from the cerebrospinal fluid (CSF) in natalizumab (NZB)-treated patients with multiple sclerosis (MS) although OCB are considered to persist in MS. Detection of OCB is qualitative evidence of intrathecally produced IgG. We investigated if this NZB-effect on intrathecal IgG synthesis can be quantitatively assessed by analyzing the fraction of intrathecally produced IgG (IgGIF). We included 31 MS patients, 17 were untreated (first diagnosis) and from 14 patients CSF was collected to rule out progressive multifocal leukoencephalopathy (PML) during NZB treatment. From 6 of the 14 NZB-treated patients CSF data from the first diagnosis were also available. IgG and albumin concentrations of CSF and serum samples were measured by immunonephelometry and used to calculate the CSF/serum quotients and IgGIF (in %) according to Reiber (1998). Quantification of intrathecal IgG synthesis showed a reduced IgGIF in NZB-treated patients compared to untreated MS patients (p = 0.0026). Intraindividual comparisons of baseline and follow-up data in the NZBtreated group of 6 showed disappearance of intrathecal IgG production in 2 and an overall reduction of the IgGIF (p = 0.018). Quantifying intrathecal IgG synthesis revealed a pronouncedly reduced IgGIF in NZB-treated MS patients. This corroborates previous reports about disappearing OCB and suggests effectiveness of NZB therapy on intrathecal IgG production. Since lumbar punctures were performed to rule out PML this observation is limited to NZB-treated patients with active disease. Clarification of the underlying mechanisms will provide important knowledge about the clinical relevance of this finding and the pathogenesis of NZB-associated PML. doi:10.1016/j.jns.2013.07.1410
Abstract — WCN 2013 No: 2004 Topic: 6 — MS & Demyelinating Diseases Incidence of multiple sclerosis in the region of Sarajevo before and after the war events J. Djelilovic-Vranic, A. Alajbegovic, M. Tiric-Campara, S. Salcic, E. Djozic, E. Eljubovic. Neurology Clinic, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina Introduction: Multiple sclerosis is an autoimmune demyelinating disease and degeneration of axons, in the appearance of which stress has an important role. The goal is to determine the incidence of multiple sclerosis in the region of Sarajevo in the period before and after the war (1986–2012). Material and methods: We analyzed all new cases of multiple sclerosis in the region of Sarajevo in the period January 1986–December 2012. Diagnostic criteria included anamnesis, clinical presentation, MRI
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findings and evaluation of the spine, evoked potentials-visual and cerebrospinal fluid examination. Results: During the period 1986–1990, there were 45 new cases of MS, in the period 1991–1995, there were 27 new MS cases, from 1996 to 2000 107 new cases were registered of MS, and from 2001–2005 there were 150 new cases of MS. In the period 2006–2010, there were 174 new cases of MS. In 2011 there were 34 new cases of MS and during the 2012, 41 new cases. Stress as provoking factor was present in the first five-year period at 11.1% in the second at 18.5%, in the third with 19.6%, in the fourth five-year period at 36.5% of cases and in the final at 43.8% of cases. Conclusions: In the period after the war, the MS in the region of Sarajevo has increased in incidence. Multiple sclerosis in the region of Sarajevo is more frequent in women than in men, most frequently in the age 20–40 years. But it also tends to occur in a relatively advanced age, after 50 years. doi:10.1016/j.jns.2013.07.1411
Abstract — WCN 2013 No: 1996 Topic: 6 — MS & Demyelinating Diseases Multiple sclerosis prevalence study: The comparison of two coastal cities, located in the Black Sea and the Mediterranean Sea in Turkey Ü. Türk Börüa, A. Dumana, A.Ş. Kulualpa, N. Gülerb, M. Taşdemirc. a Neurology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey; bNeurology, Artvin State Hospital, Marmara University, Istanbul, Turkey; cPublic Health, Marmara University, Istanbul, Turkey Background: The studies about Multiple Sclerosis (MS) epidemiology have increased in the last years. The studies, we conducted in Turkey, which have been compared with new studies were made in Turkey. These studies show that there are also distinct variations between the same geographical areas. Objective: We carried out this study in order to determine the prevalence and to compare the difference between Mediterranean and Black Sea regions. Patients and metods: This descriptive, cross-sectional, door-to-door survey was carried out in the Mediterranean coastal city Gazipaşa and the Black Sea coastal city Artvin in 2012. All people, who live in the city, were visited and interviewed in their houses. The center town of Artvin and Gazipaşa had been screened by door to door. A population of 16.116 people was screened in Artvin and 13.451 of the people were screened in Gazipaşa. Poser criteria were used as diagnostic criteria in the study. Results: Seven patients were diagnosed as clinically definitive MS with the definitive anamnesis and MR investigation. Female to male ratio was 1.33. The prevalence of MS was found to be 52.0/100.000 in Gazipaşa. Three female patients were diagnosed as clinically definitive MS. The prevalence of MS was found to be 18.6/100.000 in Artvin. Conclusion: According to the results, the countries in the Mediterranean area is also now in the high MS prevalence zone. More than 2 times of the difference was found between prevalences of Artvin and Gazipaşa. Our recent studies, conducted in Turkey, provide evidence that the latitude gradient in the distribution of MS is disappearing. doi:10.1016/j.jns.2013.07.1412
Abstract — WCN 2013 No: 2019 Topic: 6 — MS & Demyelinating Diseases Flow-cytometry and the detection of anti-natalizumab NAB in multiple sclerosis K. Oppermanna, A. Harrera, G. Pilza, P. Wipflera, B. Holla, F. Deisenhammerb, S. Afazelc, E. Haschke-Becherc, E. Trinkaa, J. Krausa.
Abstracts / Journal of the Neurological Sciences 333 (2013) e358–e421
signs of temporal dispersion. In 1 case the P100 latency increased despite the therapy from 189 ms to 237 ms. Conclusion: Our measurements show that the acute retrobulbar neuritis episode in patients with neuromyelitis optica cannot be explained with mere demyelination. The absence of P100 response in acute recidive in most cases demonstrates the more prominent axonal damage of optic nerve. These severe causes of neuromyelitis optica in Mongolia should be studied thoroughly in future, and the management of recidive prophylactic treatment must be improved. doi:10.1016/j.jns.2013.07.1406
Abstract — WCN 2013 No: 2069 Topic: 6 — MS & Demyelinating Diseases Spinal cord expression of stathmin-1, SCLIP and SCG10 in experimental autoimmune encephalomyelitis (EAE) O. Touloumia, T. Irinopouloub, R. Lagoudakia, P. Theotokisa, A. Lourbopoulosa, C. Cifuentes-Diazb, E. Nousiopouloua, E. Kofidoua, D. Karacostasa, N. Grigoriadisa. aAHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece; bINSERM, Institut du Fer à Moulin, Paris, France Background: The role of stathmins is the regulation of microtubule equilibrium and cytoskeleton reorganization. They alternate between assembly and disassembly of the cell with the purpose of correct formation of mitotic spindle. Objective: We studied the stathmin expression in the spinal cord in EAE. Material and methods: EAE mice were examined at three timepoints (D10, acute, chronic) and compared with controls (D0). Stathmin1, SCG10 and SCLIP mRNA and protein expression was studied using Real Time-PCR and optical and confocal microscopy. Results: There was reduced mRNA expression in acute phase of stathmin1 (p b 0.05); SCLIP was reduced both in acute and chronic phase of EAE (p b 0.01). An overall decrease of spinal cord stathmin1 and SCG10 protein expression was noticed in acute phase (p b 0.001, p b 0.05). However, our sub-analysis in the inflamed white matter showed increased expression of all stathmins (p b 0.05, p b 0.001, p b 0.01). Moreover, stathmin1 was predominantly expressed in NG2+ (p b 0.001) and O4+ (p b 0.05) cells whereas in lower levels in CNPase+ (p b 0.05) cells during the acute phase. SCG10 and SCLIP were expressed in axons already during the acute phase and throughout the entire EAE course though not in controls. In addition, inside the inflammatory lesions SCG10 was co-expressed with APP (p b 0.05), a marker of acute axonal damage whereas SCLIP followed the opposite course and was co-expressed with GAP-43 (p b 0.05), a marker of axonal regeneration. Conclusions: The stathmin protein family kinetic in inflammatory demyelinating areas indicates their potential involvement in the underlying pathology and reorganization of the degenerative spinal cord during EAE. doi:10.1016/j.jns.2013.07.1407
Abstract — WCN 2013 No: 2044 Topic: 6 — MS & Demyelinating Diseases Connectivity patterns obtained by emulated vs. conventional resting state fMRI in clinical cohorts — Can parts tell the whole story? M. Loitfelder, D. Pinter, C. Langkammer, M. Jehna, S. Ropele, F. Fazekas, R. Schmidt, C. Enzinger. Medical University of Graz, Graz, Austria Background: Resting state (RS) fMRI has received considerable interest in clinical neuroscientific research, as it also allows concluding
on patterns of spatiotemporally consistent neural activity while the brain is at “rest”. With regard to this, Fair et al. (2007) suggested a method how existing datasets could be re-analyzed via extracting specific volumes of conventional (c) block design fMRI data to emulate (e) RS-fMRI. Objective: We here aimed to investigate the similarity or diversity of results obtained with this approach (eRS) compared to cRS regarding connectivity network identification in a clinical cohort. Patients and methods: 12 Multiple Sclerosis patients (MS, age: x = 30.82 ± 10.8) and 18 healthy controls (HC, age: x = 32.28 ± 6.8) underwent conventional task-related fMRI and cRS in the same imaging session. In the first step, the total cognitive paradigm has been treated as a RS-dataset, and both datasets were analyzed in total length. Then, the cognitive paradigm was truncated according to the criteria by Fair to emulate RS. The cRS dataset was truncated equally. Results: Whereas visual inspection of seed based analyses of functional connectivity from the anterior cingulate cortex suggested almost identical patterns in MS patients and HC, higher-level within and between group analyses of eRS vs. cRS revealed distinct differences in connectivity networks. Conclusion: Generally, using the eRS approach allows the identification of connectivity networks (similar to those obtained using cRS-data) also in diseased brains. However, results of higher-level contrasts yielded different results and thus have to be interpreted with caution. doi:10.1016/j.jns.2013.07.1408
Abstract — WCN 2013 No: 2042 Topic: 6 — MS & Demyelinating Diseases Predictive factors of physical component of quality of life in multiple sclerosis patients S. Sabanagic-Hajric, N. Subasic, A. Alajbegovic. Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina Background: Multiple sclerosis is a chronic progressive disease with multiple neurological and psychological impairments that can affect all aspects of quality of life. Objective: The objective of this study was to investigate the predictive factors of physical component of quality of life in MS patients. Patients and methods: 100 MS patients treated at the Neurology Clinic in Sarajevo were involved. Each patient underwent a complete clinical assessment, including disability status (EDSS), cognitive function (MMSE) and measurement of quality of life (MSQOL-54). Linear regression analyses were performed to identify significant predictors from sociodemographic and clinical characteristics in predicting MSQOL-54 physical and mental composite scores. Results: The mean age of 100 patients (69% female and 31% male) was 39.88 ± 10.03. The mean EDSS score was 3.57 ± 1.73 and 72% were of the relapsing–remitting clinical subtype. Linear multivariate regression analyses revealed that presence of pain (eta square = 0.29), EDSS (eta square = 0.27), sphincterial disorders (eta square = 0.19), employment status (eta squared = 0.15), type of disease (eta square = 0.10) and age (eta square = 0.06) proved to be main predictors of MSQOL-54 physical composite scores (r2 = 0.83). Among the patients with relapsingremitting type of disease number of relapses (eta squared = 0.260), EDSS score (eta squared = 0.24), sphincterial disorders (eta squared = 0.17), presence of pain (eta squared = 0.16), employment status (eta squared = 0.15) and age (eta squared = 0.08) proved to be main predictors of MSQOL-54 physical composite scores (r2 = 0.87). Conclusion: Assessment of quality of life in MS patients provides additional information on the patient status. Management of pain
Abstracts / Journal of the Neurological Sciences 333 (2013) e358–e421
and sphincterial disorders is highly important in treatment of MS patients. doi:10.1016/j.jns.2013.07.1409
Abstract — WCN 2013 No: 2028 Topic: 6 — MS & Demyelinating Diseases Reduced intrathecal IgG synthesis in the cerebrospinal fluid from natalizumab-treated patients with active multiple sclerosis A. Harrera, G. Pilza, P. Wipflera, K. Oppermanna, B. Holla, W. Hitzlb, S. Afazelc, E. Haschke-Becherc, E. Trinkaa, J. Krausa. aDepartment of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, Salzburg, Austria; bResearch Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria; cCentral Laboratory, Paracelsus Medical University, Christian-Doppler-Klinik, Salzburg, Austria Oligoclonal bands (OCB) have been reported to disappear from the cerebrospinal fluid (CSF) in natalizumab (NZB)-treated patients with multiple sclerosis (MS) although OCB are considered to persist in MS. Detection of OCB is qualitative evidence of intrathecally produced IgG. We investigated if this NZB-effect on intrathecal IgG synthesis can be quantitatively assessed by analyzing the fraction of intrathecally produced IgG (IgGIF). We included 31 MS patients, 17 were untreated (first diagnosis) and from 14 patients CSF was collected to rule out progressive multifocal leukoencephalopathy (PML) during NZB treatment. From 6 of the 14 NZB-treated patients CSF data from the first diagnosis were also available. IgG and albumin concentrations of CSF and serum samples were measured by immunonephelometry and used to calculate the CSF/serum quotients and IgGIF (in %) according to Reiber (1998). Quantification of intrathecal IgG synthesis showed a reduced IgGIF in NZB-treated patients compared to untreated MS patients (p = 0.0026). Intraindividual comparisons of baseline and follow-up data in the NZBtreated group of 6 showed disappearance of intrathecal IgG production in 2 and an overall reduction of the IgGIF (p = 0.018). Quantifying intrathecal IgG synthesis revealed a pronouncedly reduced IgGIF in NZB-treated MS patients. This corroborates previous reports about disappearing OCB and suggests effectiveness of NZB therapy on intrathecal IgG production. Since lumbar punctures were performed to rule out PML this observation is limited to NZB-treated patients with active disease. Clarification of the underlying mechanisms will provide important knowledge about the clinical relevance of this finding and the pathogenesis of NZB-associated PML. doi:10.1016/j.jns.2013.07.1410
Abstract — WCN 2013 No: 2004 Topic: 6 — MS & Demyelinating Diseases Incidence of multiple sclerosis in the region of Sarajevo before and after the war events J. Djelilovic-Vranic, A. Alajbegovic, M. Tiric-Campara, S. Salcic, E. Djozic, E. Eljubovic. Neurology Clinic, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina Introduction: Multiple sclerosis is an autoimmune demyelinating disease and degeneration of axons, in the appearance of which stress has an important role. The goal is to determine the incidence of multiple sclerosis in the region of Sarajevo in the period before and after the war (1986–2012). Material and methods: We analyzed all new cases of multiple sclerosis in the region of Sarajevo in the period January 1986–December 2012. Diagnostic criteria included anamnesis, clinical presentation, MRI
e389
findings and evaluation of the spine, evoked potentials-visual and cerebrospinal fluid examination. Results: During the period 1986–1990, there were 45 new cases of MS, in the period 1991–1995, there were 27 new MS cases, from 1996 to 2000 107 new cases were registered of MS, and from 2001–2005 there were 150 new cases of MS. In the period 2006–2010, there were 174 new cases of MS. In 2011 there were 34 new cases of MS and during the 2012, 41 new cases. Stress as provoking factor was present in the first five-year period at 11.1% in the second at 18.5%, in the third with 19.6%, in the fourth five-year period at 36.5% of cases and in the final at 43.8% of cases. Conclusions: In the period after the war, the MS in the region of Sarajevo has increased in incidence. Multiple sclerosis in the region of Sarajevo is more frequent in women than in men, most frequently in the age 20–40 years. But it also tends to occur in a relatively advanced age, after 50 years. doi:10.1016/j.jns.2013.07.1411
Abstract — WCN 2013 No: 1996 Topic: 6 — MS & Demyelinating Diseases Multiple sclerosis prevalence study: The comparison of two coastal cities, located in the Black Sea and the Mediterranean Sea in Turkey Ü. Türk Börüa, A. Dumana, A.Ş. Kulualpa, N. Gülerb, M. Taşdemirc. a Neurology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey; bNeurology, Artvin State Hospital, Marmara University, Istanbul, Turkey; cPublic Health, Marmara University, Istanbul, Turkey Background: The studies about Multiple Sclerosis (MS) epidemiology have increased in the last years. The studies, we conducted in Turkey, which have been compared with new studies were made in Turkey. These studies show that there are also distinct variations between the same geographical areas. Objective: We carried out this study in order to determine the prevalence and to compare the difference between Mediterranean and Black Sea regions. Patients and metods: This descriptive, cross-sectional, door-to-door survey was carried out in the Mediterranean coastal city Gazipaşa and the Black Sea coastal city Artvin in 2012. All people, who live in the city, were visited and interviewed in their houses. The center town of Artvin and Gazipaşa had been screened by door to door. A population of 16.116 people was screened in Artvin and 13.451 of the people were screened in Gazipaşa. Poser criteria were used as diagnostic criteria in the study. Results: Seven patients were diagnosed as clinically definitive MS with the definitive anamnesis and MR investigation. Female to male ratio was 1.33. The prevalence of MS was found to be 52.0/100.000 in Gazipaşa. Three female patients were diagnosed as clinically definitive MS. The prevalence of MS was found to be 18.6/100.000 in Artvin. Conclusion: According to the results, the countries in the Mediterranean area is also now in the high MS prevalence zone. More than 2 times of the difference was found between prevalences of Artvin and Gazipaşa. Our recent studies, conducted in Turkey, provide evidence that the latitude gradient in the distribution of MS is disappearing. doi:10.1016/j.jns.2013.07.1412
Abstract — WCN 2013 No: 2019 Topic: 6 — MS & Demyelinating Diseases Flow-cytometry and the detection of anti-natalizumab NAB in multiple sclerosis K. Oppermanna, A. Harrera, G. Pilza, P. Wipflera, B. Holla, F. Deisenhammerb, S. Afazelc, E. Haschke-Becherc, E. Trinkaa, J. Krausa.