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Stressful events can induce immunological alterations and could possibly impact the course of multiple sclerosis (MS)1 ,2 Thus stress management may be important to prevent relapse and reduce brain lesions in MS.3 ,4 Although major natural disasters cause severe physical and psychological stresses, few studies have analysed the influence of such natural disasters on MS and neuromyelitis optica spectrum disorders (NMOSD).
The Great East Japan Earthquake that measured magnitude 9.0 and triggered tsunami on 11 March 2011, devastated the Pacific coastal regions of Eastern Japan, especially the Iwate, Miyagi and Fukushima prefectures. Numerous aftershocks followed. Meltdown at the Fukushima No.1 nuclear power plant also resulted from the disaster. A total of 18 000 people died or are still unaccounted for, and half of them were Miyagi residents. About 320 000 people had to be evacuated at least temporarily in Miyagi prefecture alone. We studied the impact of the disaster in people with MS and NMOSD in Sendai City, the Miyagi prefecture's capital with a population of one million.
Patients and methods
Two hundred and three patients (140 with MS fulfilling the 2010 McDonald Criteria and 63 with aquaporin 4-IgG-positive NMOSD fulfilling the 2015 International Consensus Diagnostic Criteria) seen at Tohoku University Hospital and three other major hospitals in Sendai, Japan, enrolled in the study (age: 42.8±11.9 in MS, 54.0±13.4 in NMOSD, disease duration: 12.7±9.9 in MS, 13.0±10.7 in NMOSD, annualised relapse rate: 0.68±0.57 in MS, 0.62±0.58 in NMOSD in the previous year of the disaster). They accounted for 62% of the patients registered in Miyagi prefecture for the national registry of MS and NMOSD.
We surveyed the survival, living conditions including refuge, continuation of therapy (interferon β for MS and oral corticosteroid and/or immunosuppressants for NMOSD), available healthcare services by a self-developed questionnaire and stress by the Visual Analogue Scale (VAS), …
Contributors YK, IN and KF were involved in the study's conception, data acquisition and analysis and drafting of the manuscript. YT, TM, HK, SN, TT, SS, JF, JH, YI and MA were involved in data acquisition and reviewing of the manuscript.
Funding This study was partially supported by a grant-in-aid for scientific research from the Japan Society for the Promotion of Science (KAKENHI), the Health and Labour Sciences Research Grant on Intractable Diseases (neuroimmunological diseases) from the Ministry of Health, Labour and Welfare of Japan.
Competing interests IN reports grants from Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, and from Ministry of Health, Labour and Welfare of Japan, personal fees from Mitsubishi Tanabe Pharma Corporation, Biogen Idec Japan, Novartis Pharmaceuticals Japan, Bayer Yakuhin, Ltd, and grants from LSI Medience Corporation; SN JSPS KAKENHI Grant (Grant-in-Aid for Young Scientists(B)) Number 26860656. TM has received speaker honoraria from Bayer Schering Pharma, Biogen Idec Japan, Mitsubishi Tanabe Pharma Corporation, Asahi Kasei Medical Co and Astellas Pharma Inc, and has received research support from Bayer Schering Pharma, Biogen Idec Japan, Asahi Kasei Kuraray Medical Co, The Chemo-Sero-Therapeutic Research Institute, Teva Pharmaceutical KK, Mitsubishi Tanabe Pharma Corporation, Teijin Pharma and Grants-in-Aid for Scientific Research from the Ministry of Education, Science and Technology, and the Ministry of Health, Labor and Welfare of Japan. HK received grants from the MEXT of Japan. MA has received research support from the Japanese Ministry of Health Labor and Welfare, NCNP, and the Japanese MEXT. KF serves on the scientific advisory boards for Bayer Schering Pharma, Biogen Idec, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Chugai Pharmaceutical, Ono Pharmaceutical, Nihon Pharmaceutical, Merck Serono, Alexion Pharmaceuticals and Medimmune and Medical Review; he has received funding for travel and speaker honoraria from Bayer Schering Pharma, Biogen Idec, Eisai Inc, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Astellas Pharma Inc, Takeda Pharmaceutical Company Limited, Asahi Kasei Medical Co, Daiichi Sankyo and Nihon Pharmaceutical; he serves as an editorial board member of Clinical and Experimental Neuroimmunology (2009-present) and is an advisory board member of Sri Lanka Journal of Neurology; has received research support from Bayer Schering Pharma, Biogen Idec Japan, Asahi Kasei Medical, The Chemo-Sero-Therapeutic Research Institute, Teva Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, Chugai Pharmaceutical, Ono Pharmaceutical, Nihon Pharmaceutical and Genzyme Japan; and is funded by the Grants-in-Aid for Scientific Research from the Ministry of Education, Science and Technology of Japan (#22229008, 2010–2015 and #26293205, 2014–2016) and by the Grants-in-Aid for Scientific Research from the Ministry of Health, Welfare and Labor of Japan (2010-present).
Ethics approval Ethics Committee of Tohoku University Graduate School of Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.