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Clinical study of primary progressive multiple sclerosis in Northern Ireland, UK
  1. G V McDonnella,
  2. S A Hawkinsb
  1. aNorthern Ireland Neurology Service, Royal Victoria Hospital, Belfast, bDepartment of Medicine, The Queen’s University of Belfast, UK
  1. Dr SA Hawkins, Northern Ireland Neurology Service, Quin House, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK. Telephone 0044 1232 240503 ext 4325; fax 0044 1232 235258.

Abstract

OBJECTIVE To investigate the clinical and demographic characteristics of primary progressive multiple sclerosis (PPMS) in Northern Ireland and to establish a database of such patients for genetic and immunological studies and future therapeutic trials.

METHODS Diagnosis and categorisation were performed by two neurologists, potential cases being identified from the following sources: neurology outpatient clinics; neurology inpatients; a review of hospital discharges; and an ongoing epidemiological study of multiple sclerosis in Northern Ireland. Only those with a progressive course from onset and a clear history of no prior relapses were accepted. Potential cases were invited for interview and assessment, the minimal record of disability (MRD) being established.

RESULTS One hundred and eleven cases of PPMS have been identified, 63 women and 48 men (ratio 1.3:1), with a mean age at onset of 39.5 (SD 11.0) (range 17–66)years, and mean disease duration of 13.6 (SD 9.3)years. The mean interval between onset and diagnosis was 4.7 (SD 4.2) years. Nineteen patients (17.1%) did not satisfy the requirements for any category in the Poser criteria. Motor disturbance was the commonest mode of onset (67.6%) with visual loss occurring only rarely at onset (3.6%). Kurtzke EDSS scores were concentrated at the upper end of the scale with a median of 6.0 and levels of unemployment and financial dependence were high.

CONCLUSIONS PPMS in Northern Ireland has a generally later age at onset, lower female preponderance, and predominantly motor onset compared with other subgroups of multiple sclerosis. The delay to diagnosis reflects the often insidious onset and the nature of the clinical course makes application of the Poser criteria difficult. Levels of neurological impairment, disability, and handicap as measured by the MRD are high.

  • multiple sclerosis
  • primary progressive multiple sclerosis
  • Northern Ireland
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