Clinical features and disability progression in multiple sclerosis in Tunisia: Do we really have a more aggressive disease course?

Sidhom, Youssef; Damak, Mariem; Riahi, A.; Hizem, Yosr; Mrissa, Ridha; Mhiri, Chokri; Gouider, Riadh

doi:10.1016/j.jns.2014.05.049

Cited by 16 publications

(7 citation statements)

References 38 publications

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“…Their disease course was relapsing remitting in 91% of patients and primary progressive in 9%. The most frequent symptoms at onset were motor (28%), optic neuritis (20%), and sensory (16%) dysfunction [67] .…”

Section: Tunisiamentioning

confidence: 99%

Multiple Sclerosis Epidemiology in Middle East and North Africa: A Systematic Review and Meta-Analysis

et al. 2015

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Background: Multiple sclerosis (MS) is one of the most common neurological disorders and a leading cause of nontraumatic disability in young adults in many countries. Recent reports from the Middle East and North Africa have suggested a moderate to high risk of MS in these countries. Methods: A literature search was performed in August 2014 in MEDLINE, EMBASE, and IMEMR to retrieve original population-based studies on MS epidemiology in the Middle East and North African countries published between 1st January 1985 and 1st August 2014. We designed search strategies using the key words: MS, prevalence, incidence, and epidemiology. According to the inclusion criteria, 52 studies were included in this systematic review. Results: McDonald's criteria were the most widely used diagnostic criteria in the studies. Most studies were conducted in single hospital-based centers with a defined catchment area. The female/male ratio ranged from 0.8 in Oman to 4.3 in Saudi Arabia. MS prevalence ranged from 14.77/100,000 population in Kuwait (2000) to 101.4/100,000 in Turkey (2006). The overall MS prevalence in the region was 51.52/100,000. The mean age at disease onset ranged from 25.2 years in Kuwait to 32.5 years in Northeastern Iran, with an overall estimate of 28.54 years. Conclusions: Recent advances in MS registries will allow nation-wide studies and temporal comparisons between countries, provided that age- and sex-standardized estimates are available.

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Section: Tunisiamentioning

confidence: 99%

Multiple Sclerosis Epidemiology in Middle East and North Africa: A Systematic Review and Meta-Analysis

et al. 2015

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“…3 Hypothesized factors leading to increased MS incidence in MENA countries include diet and physical activity changes, industrial growth, and urbanization 3,5,6 in addition to other known environmental factors such as smoking, high body mass index, low serum vitamin D levels, and prior Epstein-Barr virus infection. 7 To date, there have been limited studies investigating disease activity and severity in people living with MS in MENA countries 4,8,9 and available data are inconsistent. A study evaluating 1581 individuals with MS in Egypt found that the clinical phenotype is similar to what is described in classic MS.…”

Section: Introductionmentioning

confidence: 99%

“…Similar observations have been reported for MS populations in Tunisia, Jordan, and other countries in the MENA region. 4,[8][9][10][11] On the other hand, a recent study that assessed over 6000 MS patients from the Middle East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) registry found that MS patients from MENA regions had an earlier age at onset and a more aggressive clinical course with earlier disability accrual compared to the "Western" MS phenotype. 12 Immigration studies pose a unique opportunity to evaluate both genetic and environmental factors related to MS disease onset and progression.…”

Section: Introductionmentioning

confidence: 99%

Clinical and MRI characteristics of multiple sclerosis in patients of Middle Eastern and North African ancestry residing in Ontario, Canada

et al. 2020

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Background: Multiple sclerosis (MS) incidence is rising in traditionally low-burden regions, including the Middle East and North Africa (MENA). Objectives: Our objective was to evaluate disease characteristics in MS patients of MENA descent (MENA-MS). Methods: MENA-MS patients and age- and sex-matched MS patients of European descent (EUR-MS) were identified through the MS Clinic Registry of St. Michael’s Hospital in Toronto, Canada. Disease activity and severity were evaluated by the annualized relapse rate (ARR), magnetic resonance imaging (MRI) activity, change in the Expanded Disability Status Scale (EDSS), progression index (PI), and MS Severity Score (MSSS). Results: All MS patients within the registry identified to be of MENA origin ( n = 192), and age- and sex-matched EUR-MS patients were included. Mean age was 42.9 years, 67% female. A total of 25% and 24% of EUR-MS and MENA-MS had progressive disease, with similar mean disease durations (11.5 and 11.4 years, respectively). Clinical and radiological disease activity (ARR, proportion with new/enlarging MRI lesions) was similar. MENA-MS showed greater disability progression over time (EDSS change = 0.24 vs. 0.06, p = 0.01), a higher MSSS (3.12 vs. 2.67, p = 0.04), and higher PI (0.34 vs. 0.27, p = 0.07). Conclusion: MENA-MS patients demonstrate higher disease severity compared to EUR-MS patients, despite having similar inflammatory measures of disease activity, with disability progression in the absence of relapses. These observations illustrate the importance of the intersections of environmental, socioeconomic, and genetic determinants in optimizing individualized MS care.

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“…Tunisia is currently qualified as an area of average prevalence for multiple sclerosis with an incidence of 1.34/100,000 and the disease is characterized by a monosymptomatic initial presentation in the majority of cases (96% of cases) [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…In the Tunisian series of Sidhom et al 20% of adult patients with multiple sclerosis began their disease with isolated optic neuritis [9].…”

Section: Discussionmentioning

confidence: 99%

Bilateral and Simultaneous Retrobulbar Optic Neuritis Revealing Multiple Sclerosis

Bouomrani¹,

Belgacem²,

Rekik³

et al. 2017

J Mult Scler

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Optic neuritis is a common manifestation of multiple sclerosis. It occurs in two thirds of patients at some point in the course of this disease and is usually unilateral, acute and often recurrent. However, optic neuritis can be the first manifestation of this demyelinating disease in 15 to 20% of cases.Bilateral, simultaneous and retrobulbar forms of optic neuritis inaugurating multiple sclerosis remain exceptional and unusual. They represent a real diagnostic challenge and require special attention from the clinician Herein we report the case of bilateral simultaneous and isolated retrobulbar optic neuritis inaugurating multiple sclerosis in a 24 year old woman.

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Clinical features and disability progression in multiple sclerosis in Tunisia: Do we really have a more aggressive disease course?

Cited by 16 publications

References 38 publications

Multiple Sclerosis Epidemiology in Middle East and North Africa: A Systematic Review and Meta-Analysis

Multiple Sclerosis Epidemiology in Middle East and North Africa: A Systematic Review and Meta-Analysis

Clinical and MRI characteristics of multiple sclerosis in patients of Middle Eastern and North African ancestry residing in Ontario, Canada

Bilateral and Simultaneous Retrobulbar Optic Neuritis Revealing Multiple Sclerosis

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