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Multiple sclerosis in the province of Ferrara

Evidence for an increasing trend

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Abstract

Background

Epidemiological studies on the distribution of multiple sclerosis (MS) conducted in the Mediterranean area in the last two decades have disclosed a significant increase in frequency of the disease, indicating caution when a latitude-related model of MS is accepted. Previous descriptive surveys in the province of Ferrara, northern Italy, carried out by our own epidemiological research group, have established that this area is at high risk for MS.

Objective

To confirm the above assumption and to update MS frequency estimates in this area.

Design and setting

We conducted a community-based intensive prevalence and incidence study, by adopting a complete enumeration approach.

Results

On December 31, 2004, 423 patients (300 women and 123 men) suffering from definite or probable MS (Poser's criteria) living in the province of Ferrara, yielded a crude prevalence rate of 120.93 (95 % CI, 110.05–134.23) per 100,000, 164.26 for women and 73.59 for men. The average incidence from 1990 to 2003 was 4.35 per 100,000 (95 % CI, 3.77–4.99), 5.91 for women and 2.63 for men. The incidence rate,which was relatively stable during the previous 25 years (1965–1989) with a mean rate of 2.3 per 100,000, increased to a value of 3.39 per 100,000 in the period 1990–1994, 4.09 per 100,000 in the period 1995–1999 and 3.84 per 100,000 in the period 2000–2003.

Conclusions

These results confirm that in Ferrara MS occurs more frequently than suggested by the geographic- related distribution model and, based on other recent national surveys, support the view that northern Italy is a high-risk area for the disease. The marked increase in MS prevalence rate, in comparison with previous investigations, is in part due to the increasing survival of patients as a result of improved supportive care and the accumulation of new incidence cases owing to the reduction in diagnostic latency for better quality of neurological diagnostic procedures. The incidence in the province of Ferrara was found to slowly change with an incremental trend,which cannot only be attributed to improvements in diagnostic ability. Environmental risk factors in genetically predisposed people over time could be considered.

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References

  1. Granieri E, Casetta I, Tola MR (1995) Epidemiology of multiple sclerosis in Italy and southern Europe. Acta Neurol Scand 161 (Suppl):60–70

    CAS  Google Scholar 

  2. Compston DAS (1998) Distribution of multiple sclerosis. In: Compston DAS, Ebers G, Lassman H, McDonald I, Matthews B, Wekerle H (eds) McAlpine multiple sclerosis. 3rd ed. London: Churchill Livingston, pp 63–100

  3. Kurtzke JF (2000) Epidemiology of multiple sclerosis. Does this really point toward an etiology? Lectio doctoralis. Neurol Sci 21:383–403

    Article  PubMed  CAS  Google Scholar 

  4. Marrie RA (2004) Environmental risk factors in multiple sclerosis aetiology. Lancet Neurol 3:709–718

    Article  PubMed  Google Scholar 

  5. Poser CM (1994) The epidemiology of multiple sclerosis: a general overview. Ann Neurol 36 (Suppl 2):S180–S193

    Article  PubMed  Google Scholar 

  6. Ebers GC, Sadovnick AD (1997) Epidemiology. In: Paty DW, Ebers GC (eds) Multiple sclerosis. Philadelphia: FA Davis, pp 5–28

  7. Kurtzke JF (2005) Epidemiology and etiology of multiple sclerosis. Phys Med Rehabil Clin N Am 16:327–349

    PubMed  Google Scholar 

  8. Weinshenker BG, Rodriguez M (1994) Epidemiology of multiple sclerosis. In: Gorelic PB, Alter M (eds) Handbook of Neuroepidemiology. New York:Marcel Dekker; pp 533–567

    Google Scholar 

  9. Rosati G, Granieri E, Carreras M, et al. (1981) Multiple sclerosis in northern Italy: Prevalence in the province of Ferrara in 1978. Ital J Neurol Sci 2:17–23

    Article  PubMed  CAS  Google Scholar 

  10. Granieri E, Tola MR, Paolino E, Carreras M, Rosati G, Monetti VCl (1985) The frequency of multiple sclerosis in Italy: a descriptive study in Ferrara. Ann Neurol 17:80–84

    Article  PubMed  CAS  Google Scholar 

  11. Granieri E, Malagù S, Casetta I, et al. (1996) Multiple sclerosis in Italy. A reappraisal of incidence and prevalence in Ferrara. Arch Neurol 53:793–798

    PubMed  CAS  Google Scholar 

  12. Bodmer WF (1972) Population genetics of the HLA system: retrospect and prospect. In: Dausset J, Colombani J (eds) Histocompatibility testing. Copenhagen, Denmark:Munksgaard International Publisher Ltd; pp 611–677

  13. Poser CM, Paty DW, Sheinberg L, et al. (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

    Article  PubMed  CAS  Google Scholar 

  14. Kurtzke JF (2000) Natural history and clinical outcome measures for multiple sclerosis studies. Why at the present time does EDSS scale remain a preferred outcome measure to evaluate disease evolution? Neurol Sci 21:339–341

    Article  PubMed  CAS  Google Scholar 

  15. Schoenberg BS (1983) Calculating confidence intervals for rates and ratios: simplified method utilizing tabular values based in the Poisson distribution. Neuroepidemiology 2:257–265

    Article  Google Scholar 

  16. Waterhause J, Muir C, Shanmungarataham K, Powell J (1982) Cancer incidence in five continents. IARC Sci Publ 4:673

    Google Scholar 

  17. Armitage P (1955) Tests for linear trends in proportions and frequencies. Biometrics 11:375–386

    Article  Google Scholar 

  18. Kahn HA, Sempos CT (1980) Statistical methods in epidemiology. Oxford: the University Press

  19. Rosati G (2001) The prevalence of multiple sclerosis in the world: an update. Neurol Sci 22:117–139

    Article  PubMed  CAS  Google Scholar 

  20. Granieri E, Monaldini C, De Gennaro R, et al. (2007) Multiple sclerosis in the Republic of San Marino: a prevalence and incidence study. Mult Scler (in press)

    Google Scholar 

  21. Ranzato F, Perini P, Tzintzeva E, et al. (2003) Increasing frequency of multiple sclerosis in Padova, Italy: a 30 year epidemiological survey. Mult Scler 9:387–392

    Article  PubMed  CAS  Google Scholar 

  22. Sironi L, Mamoli A, D’Alessandro G, Camerlingo M, Bottacchi E (1991) Frequency of multiple sclerosis in Valle d’Aosta, 1971–1985. Neuroepidemiology 10:66–69

    Article  PubMed  CAS  Google Scholar 

  23. Rosati G, Aiello I, Pirastru MI, et al. (1996) Epidemiology of multiple sclerosis in Northwestern Sardinia: further evidence for higher frequency in Sardinians compared to other Italians. Neuroepidemiology 15:10–19

    Article  PubMed  CAS  Google Scholar 

  24. Granieri E, Casetta I, Govoni V, et al. (2000) The increasing incidence and prevalence of MS in a Sardinian province. Neurology 55:842–848

    PubMed  CAS  Google Scholar 

  25. Nicoletti A, Lo Bartolo ML, Lo Fermo S, et al. (2001) Prevalence and incidence of multiple sclerosis in Catania, Sicily. Neurology 56:62–66

    PubMed  CAS  Google Scholar 

  26. Savettieri G, Salemi G, Ragonese P, Aridon P, Scola G, Randisi G (1998) Prevalence and incidence of multiple sclerosis in the city of Monreale, Italy. J Neurol 245:40–43

    Article  PubMed  CAS  Google Scholar 

  27. Guidetti D, Cavalletti S, Morelli E, et al. (1995) Epidemiological survey of multiple sclerosis in the provinces of Reggio Emilia and Modena, Italy. Neuroepidemiology 14:7–13

    Article  PubMed  CAS  Google Scholar 

  28. Ragonese P, Salemi G, D’Amelio M, Gammino M, Aridon P, Savettieri G (2004) Multiple sclerosis in southern Europe:Monreale City, Italy. A twentyyear follow-up incidence and prevalence study. Neuroepidemiology 23:306–309

    Article  PubMed  Google Scholar 

  29. Solaro C, Allemani C, Messmer Uccelli M, et al. (2005) The prevalence of multiple sclerosis in the north-west Italian province of Genoa. J Neurol 252:436–440

    Article  PubMed  CAS  Google Scholar 

  30. Granieri E, Casetta I, Tola MR, Rosati G (2001) Epidemiologia della sclerosi multipla. In: Canal N, Ghezzi A, Zaffaroni M, Zibetti A (eds) Sclerosi Multipla. Attualità e prospettive. Milano Parigi Barcellona:Masson, pp 2–39

    Google Scholar 

  31. Rothwell PM, Charlton D (1998) High incidence and prevalence of multiple sclerosis in south east Scotland: evidence of a genetic predisposition. J Neurol Neurosurg Psychiatry 64:730–735

    PubMed  CAS  Google Scholar 

  32. Forbes RB, Wilson SV, Swingler RJ (1999) The prevalence of multiple sclerosis in Tayside, Scotland: do latitudinal gradients really exist? J Neurol 246:1033–1040

    Article  PubMed  CAS  Google Scholar 

  33. McDonnell GV, Hawkins SA (1998) An epidemiologic study of multiple sclerosis in Northern Ireland. Neurology 50:423–428

    PubMed  CAS  Google Scholar 

  34. Govoni V, Vasetta I, Granieri E, et al. (1993) Mortality study on multiple sclerosis in the province of Ferrara, northern Italy, 1968 through 1989. Acta Neurol (Napoli) 15:161–176

    CAS  Google Scholar 

  35. Poser S (1994) The epidemiology of multiple sclerosis in southern lower Saxony. In: Firnhaber W, Lauer K (eds) Multiple sclerosis in Europe: An Epidemiological Update. Alsbach/ Bergstrasse, Germany: Leuchtturm Verlag, pp 130–133

  36. Compston DAS (1994) The epidemiology of multiple sclerosis: principles, achievements, and recommendations. Ann Neurol 36 (Suppl 2):S211–S217

    Article  PubMed  Google Scholar 

  37. Mindrhoud JM, Zwanikken CP (1994) Increasing prevalence and incidence of multiple sclerosis: an epidemiological study in the province of Groningen, the Netherlands. In: Firnhaber W, Lauer K (eds) Multiple sclerosis in Europe: An Epidemiological Update. Alsbach/Bergstrasse, Germany: Leuchtturm Verlag, pp 113–121

  38. Benedikz J, Magnusson H, Gudmundsson G (1994) Multiple sclerosis in Iceland, with observations on the alleged epidemic in the Faroe Islands. Ann Neurol 36 (Suppl 2):S175–S179

    Article  PubMed  Google Scholar 

  39. Larsen JP, Aarli JA, Nyland H, Riise T (1984) Western Norway, a high-risk area for multiple sclerosis: a prevalence/ incidence study in the county of Hordaland. Neurology 34:1202–1207

    PubMed  CAS  Google Scholar 

  40. Grønning M, Riise T, Kvale G, Nyland H, Larsen JP, Aarli JA (1991) Incidence of multiple sclerosis in Hordaland, western Norway: a fluctuating pattern. Neuroepidemiology 10:53–61

    Article  PubMed  Google Scholar 

  41. Midgard R, Riise T, Svanes C, Kvale G, Nyland H (1996) Incidence of multiple sclerosis in More and Romsdal, Norway from 1950 to 1991. An age-periodcohort analysis. Brain 119:203–211

    Article  PubMed  Google Scholar 

  42. Sumelahti ML, Tienari PJ, Hakama M, Wikstrom J (2003) Multiple sclerosis in Finland: incidence trends and differences in relapsing remitting and primary progressive disease courses. J Neurol Neurosurg Psychiatry 74:25–28

    Article  PubMed  Google Scholar 

  43. Celius EG, Vandvik B (2001) Multiple sclerosis in Oslo, Norway: prevalence on 1 January 1995 and incidence over a 25-year period. Eur J Neurol 8:463–469

    Article  PubMed  CAS  Google Scholar 

  44. Grimaldi LME, Salemi G, Grimaldi G, et al. (2001) High incidence and increasing prevalence of MS in Enna (Sicily), southern Italy. Neurology 57:1891–1893

    PubMed  CAS  Google Scholar 

  45. Pryse-Phillips WE (1986) The incidence and prevalence of multiple sclerosis in Newfoundland and Labrador, 1960–1984. Ann Neurol 20:323–328

    Article  PubMed  CAS  Google Scholar 

  46. Wynn DR, Rodriguez M, O’Fallon WM, Kurland LT (1990) A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota. Neurology 40:780–786

    PubMed  CAS  Google Scholar 

  47. Sloka JS, Pryse-Phillips WE, Stefanelli M (2005) Incidence and prevalence of multiple sclerosis in Newfoundland and Labrador. Can J Neurol Sci 32:37–42

    PubMed  CAS  Google Scholar 

  48. Hammond SR, English D, de Wytt C, et al. (1988) The clinical profile of MS in Australia: a comparison between medium- and high-frequency prevalence zones. Neurology 38:980–986

    PubMed  CAS  Google Scholar 

  49. Hammond SR, English DR, McLeod JG (2000) The age-range of risk of developing multiple sclerosis: evidence from a migrant population in Australia. Brain 123:968–974

    Article  PubMed  Google Scholar 

  50. Skegg DCG, Corwin PA, Craven RS, Malloch JA, Pollock M (1987) Occurrence of multiple sclerosis in the north and south of New Zealand. J Neurol Neurosurg Psychiatry 50:134–139

    Article  PubMed  CAS  Google Scholar 

  51. Granieri E (2000) Exogenous factors in the aetiology of multiple sclerosis. J Neurovirol 6 (Suppl 2):S67–S75

    Google Scholar 

  52. Cocco E, Sardu C, Lai M, Spinicci G, Contu P, Marrosu MG (2004) Anticipation of age at onset in multiple sclerosis: a Sardinian cohort study. Neurology 25(62):1794–1798

    Google Scholar 

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Authors and Affiliations

  1. Sezione di Clinica Neurologica, Dipartimento di Discipline Medico-Chirurgiche della Comunicazione e delComportamento, Centro Sclerosi Multipla, University of Ferrara, Italy, Corso della Giovecca 203, 44100, Ferrara, Italy

    E. Granieri MD, N.-T. Economou MD, R. De Gennaro MD, M. R. Tola MD, L. Caniatti MD, V. Govoni MD, E. Fainardi MD & I. Casetta MD

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  1. E. Granieri MD
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  2. N.-T. Economou MD
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  3. R. De Gennaro MD
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  4. M. R. Tola MD
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  5. L. Caniatti MD
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  6. V. Govoni MD
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  7. E. Fainardi MD
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  8. I. Casetta MD
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Correspondence to E. Granieri MD.

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Granieri, E., Economou, NT., De Gennaro, R. et al. Multiple sclerosis in the province of Ferrara. J Neurol 254, 1642–1648 (2007). https://doi.org/10.1007/s00415-007-0560-5

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  • DOI: https://doi.org/10.1007/s00415-007-0560-5

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