Amir-Hadi Maghzi

Multiple Sclerosis in Isfahan, Iran

BACKGROUND This survey was planned to study the prevalence and incidence of multiple sclerosis (MS) in Isfahan, Iran and to describe the clinical features of MS in general and in specific subgroups of patients (early-onset, late-onset, familial, and conjugal cases) and to compare our results with other reports. METHODS A cross-sectional study was conducted from April 5, 2003 to July 31, 2006. All patients known to have definite MS according to McDonalds criteria, alive, resident within Isfahan (a large province of Iran) and members of Isfahan MS Society (IMSS) were included in the study. Demographic and case-related information were recorded. A total number of 1718 definite MS patients (388 men and 1330 women) were identified from IMSS database. RESULTS The overall period prevalence of MS was 43.8/100,000. Among men the prevalence was 19.2 (95% CI: 17.4-21.2)/100,000 and among women 69.6 (95% CI: 66-73.4)/100,000. A female preponderance of 3.4 existed among these patients. In the year 2005, 143 new cases were diagnosed, resulting in an incidence rate of 3.64/100,000. The mean age of onset was 25.36 +/- 8.6 years (range 5-63 year), and mean duration of disease was 7.1 (+/-5.2) years for men and 6.7 (+/-5) years for women. Sensory and visual disturbances were the most common initial presentations with a prevalence of 51.7% and 47.5%, respectively. Cases identified include: early-onset MS (less than 15 years old at onset) with 87 cases (5%), late-onset MS (over 50 years old at onset) with 20 cases (1.1%), familial MS with 209 cases (12.2%), and conjugal MS with 6 cases (0.5%). CONCLUSION Isfahan is a medium- to high-risk area for MS, with prevalence higher than what has previously been reported, possibly because of an increase in the incidence rate. Clinical and demographic characteristics were similar to other reports; however, some differences existed.

Sharp increase in the incidence and prevalence of multiple sclerosis in Isfahan, Iran

Background: The epidemiology of multiple sclerosis (MS) has changed in recent decades. Objectives: This study aimed to give an update on the prevalence and incidence of MS in Isfahan, Iran. Methods: The study population was all residents of Isfahan province during the period from April 2003 to July 2010. In April 2003, a registry of MS patients was created at the Isfahan MS Society (IMSS), which is the only referral center for MS patients in the province. Nearly all MS patients in Isfahan province are now registered with IMSS and were included in the analysis. Results: Among the 3522 registered patients, 2716 were female and 806 were male (sex ratio: 3.37 : 1), and 431 were diagnosed in 2009. This results in a prevalence figure of 73.3 (95% CI: 70.9–75.8) and an incidence of 9.1 (95% CI: 8.3–10.0) per 100,000. Conclusion: The reported prevalence and incidence figures in our study were higher than in our previous report of 2007, in which the prevalence and incidence of MS were reported to be 43.8 and 3.64 per 100,000, respectively. This dramatic increase in the prevalence of MS puts Isfahan amongst the regions with the highest prevalence of MS in Asia and Oceania and is mostly due to changing environmental factors, amongst which vitamin D deficiency seems an important factor in our population.

Increasing female preponderance of multiple sclerosis in Isfahan, Iran: a population-based study

There is an overall increase in the worldwide prevalence and incidence of multiple sclerosis (MS). Studies from several countries also demonstrated an increase of female/male ratio over time denoting an increase in the incidence of MS particularly in women. In this study we sought to assess the trends in MS incidence and prevalence in males and females over recent decades in Isfahan, Iran, which differs from other regions in terms of environmental and lifestyle changes. We determined female/male ratio by year of birth (YOB) in 1584 patients with MS registered with Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to August 2007. A comparison of sex ratio of MS patients by YOB showed a significant, progressive, gradual increase, with an apparent interruption in the late 1960s. In this study year of birth is a significant predictor for sex ratio (p < 0.001, χ2 = 17.130, Spearman’s rank correlation r = 0.893). Our findings show that there is a significant increase in the incidence of MS among females for the the last decades in the Isfahan province of Iran. This rapid increase may be related to changes in environmental interactions rather than genetic factors, and among them vitamin D insufficiency, enhanced diagnosis, and lifestyle changes appear to be more plausible causative factors.

Oropharyngeal dysphagia in multiple sclerosis

Swallowing disorders are commonly observed in multiple sclerosis (MS) patients. The complications of dysphagia are common causes of morbidity and death in late stages of MS. However, dysphagia in MS usually receives limited attention. The purpose of this study was to determine the prevalence of different kinds of swallowing disorders in MS patients with mild to moderate disability; and to identify possible associations between clinical and demographic features of patients and the presence of dysphagia. The swallowing functions of 101 consecutive MS patients were screened by the Northwestern Dysphagia Patient Check Sheet. This is a screening test which identifies patients with pharyngeal stage disorders, aspiration, oral stage disorders and/or pharyngeal delay. ‘Dysphagia’ was defined as having at least one of the above mentioned four disorders. Among 101 MS patients, 32 (31.7%) were classified as having dysphagia. Pharyngeal stage disorders were the most common observed impairment (28.7%) and aspiration, oral stage disorders, and pharyngeal delay were observed in 6.9%, 5%, and 1% of patients, respectively. Dysphagic patients had a significantly longer disease duration (p = 0.031) and more neurological impairment in cerebellar functional system (p = 0.04) when compared with non-dysphagic patients. Moreover, dysphagia was significantly more prevalent in patients with more neurological disability as measured by Expanded Disability Status Scale (EDSS) scores (p = 0.04). These results emphasize the importance of assessment and management of swallowing function in MS patients, particularly in patients with a high EDSS score; more sever cerebellar dysfunction, and long disease duration.

A case-control study of risk factors for multiple sclerosis in Iran.

Background: Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. Objective: The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. Methods: A case–control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. Results: In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53–0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46–28.78), but not in men (OR: 0.72, 95% CI: 0.31–1.68) (p = 0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. Conclusions: Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.

Fatigue, depression, and health-related quality of life in patients with multiple sclerosis in Isfahan, Iran.

Background and purpose:  Quality of life (QoL) of patients with multiple sclerosis (MS) is worse than that of other chronic diseases. There is a need to examine the impact of fatigue and depression on the QoL independent of level of physical disability in MS. The aim of this study is to explore physical, psychological, and social aspects of health‐related QoL (HRQoL) of MS patients in association with physical disability, fatigue, and depression.

Multiple sclerosis and cerebral endothelial dysfunction: Mechanisms

Multiple sclerosis (MS) is believed to be an immune-mediated neurodegenerative disorder of the human central nervous system which usually affects younger adults with certain genetic backgrounds. The causes and cure for MS remain elusive. Based on the recent advances in our understanding of the pathogenic mechanisms of MS, it appears to represents a heterogeneous group of disorders with dissimilar pathophysiology and neuropathology. Currently, there is no unifying hypothesis to explain the pathogenesis of this complex disease. The three prevailing concepts on the pathogenesis of MS include viral, immunological, and vascular hypotheses. This review presents MS as a neuroinflammatory disease with a significant vascular component and examines the existing evidence for the role of cerebral endothelial cell dysfunction in the pathogenesis of this progressive central nervous system (CNS) inflammatory disorder.

Epidemiology of amyotrophic lateral sclerosis in Isfahan, Iran.

Background:  Few studies are carried out on the epidemiology of amyotrophic lateral sclerosis (ALS) in Middle East with no reports from Iran.

Features of Virchow-Robin spaces in newly diagnosed multiple sclerosis patients

BACKGROUND Virchow-Robin spaces (VRSs) are perivascular pia-lined extensions of the subarachnoid space around the arteries and veins as they enter the brain parenchyma. These spaces are responsible for inflammatory processes within the brain. OBJECTIVES This study was designed to shed more light on the location, size and shape of VRSs on 3mm slice thickness, 1.5 Tesla MRI scans of newly diagnosed MS patients in Isfahan, Iran and compare the results with healthy age- and sex-matched controls. METHODS We evaluated MRI scans of 73 MS patients obtained within 3 months of MS onset and compared them with MRI scans from 73 age- and sex-matched healthy volunteers. Three mm section proton density, T2W and FLAIR MR images were obtained for all subjects. The location, size and shape of VRSs were compared between the two groups. RESULTS The total number of VRSs was significantly more in the MS group (p<0.001). The distribution of VRSs were significantly more located in the high convexity areas in the MS group (p<0.001), while there was no significant differences in other regions. The round shaped VRSs were significantly more detected on MRI scans of MS patients, and curvilinear shapes were significantly more frequently observed in healthy volunteers, however there were no significant differences for oval shaped VRSs between the two groups. The number of VRSs with the size over than 2mm were significantly more observed in the MS groups compared to controls. We also observed some differences in the characteristics of VRSs between the genders in the MS group. CONCLUSION The results of this study shed more light on the usefulness of VRSs as an MRI marker for the disease. In addition, according to our results VRSs might also have implication to determine the prognosis of the disease. However, larger studies with more advanced MRI techniques are required to confirm our results.

Multiple sclerosis and amyotrophic lateral sclerosis: is there a link?

To date, there are no reports studying the rate of amyotrophic lateral sclerosis (ALS) in relatives of multiple sclerosis (MS) patients and vice versa. This study was designed to look into this issue using two population-based databases of MS and ALS in Isfahan province of Iran. We have searched for any first, second or third degree familial kinship between the Isfahan MS Society database and Isfahan ALS population. We compared the rate of ALS among the population of first degree relatives of MS patients, with the crude prevalence of ALS in the general population of Isfahan. On the other hand, a reverse analysis was carried out to compare the prevalence of MS in Isfahan with its rate amongst the first degree relatives of ALS patients. We found 10 families among which five had first degree kinship. The rate of the diseases was significantly higher in both comparisons among the family members (p < 0.00001) and an odds ratios of more than 67 in both calculations showed a several-fold increase of ALS occurrence in the first degree relatives of MS patients and vice versa. In our study relatives of MS patients were significantly more prone to ALS and vice versa. This could give clues about the common features that the two disease share. Both diseases have an environmental and genetic component and these results mostly point toward genetic similarities.