Summary
Cross-sectional data from 1,793 cases of definite or probable multiple sclerosis (MS) identified in an extensive population survey in King and Pierce (K-P) Counties, Washington and Los Angeles (LA) County, California, were analyzed. Compared to the U.S. population as a whole, patients were more likely to be divorced and to have more years of schooling. The prevalence of MS was higher for females, and for northern-born, regardless of sex. Reconstructed age-, sex-specific incidence rate estimates for natives of the two areas showed a much higher peak annual incidence occurring in an older age group in K-P than in LA. Earliest symptoms in both areas were numbness in the legs, double vision, and loss of vision in one or both eyes. Weakness in arms, speech difficulties, and urinary incontinence tended to be late symptoms. The overall assessment of disability levels showed more than half of the patients to be fully ambulatory at the time of the first interview, with a somewhat higher proportion of each sex severely disabled in California. The ages of onset tended to be younger in LA than in K-P. The earlier onset of disease and the higher proportion of patients with high disability in Los Angeles County suggest that the course of disease is more malignant in this low-prevalence area.
Zusammenfassung
Es wurden Durchschnittsdaten von 1793 Fällen definitiver und wahrscheinlicher Multipler Sklerose (MS) analysiert, die in umfangreichen Bevölkerungserhebungen identifiziert wurden, in den Landkreisen King und Pierce (K-P) in Washington und in dem Landkreis Los Angeles (LA). Verglichen mit der Gesamtbevölkerung der Vereinigten Staaten, waren die Patienten häufiger geschieden und hatten mehr Jahre Schulung. Das Auftreten von MS war häufiger bei weiblichen Personen und bei solchen, die im Norden geboren waren, ungeachtet des Geschlechts. Die Schätzungen der Rate der rekonstruierten alters- und geschlechtsspezifischen Fälle für die Einwohner der zwei Gebiete zeigt einen viel höheren Höchstwert von jährlichem Fallauftreten bei den älteren Altersgruppen in K-P als in LA. Erste Symptome in beiden Gegenden waren Gefühllosigkeit in den Beinen, Doppelsichtigkeit und Verlust des Sehvermögens auf einem oder beiden Augen. Schwäche in den Armen, Sprachschwierigkeiten und Harnfluß waren mehr spätere Symptome. Die Gesamtbewertung der Behinderungsstadien zeigte, daß mehr als die Hälfte der Patienten zur Zeit des ersten Interviews völlig ambulant waren, mit einem etwas höheren Anteil an schwer behinderten bei Personen von beiderlei Geschlecht in Kalifornien. Das Alter bei Beginn neigte in LA jünger zu sein als in K-P. Das frühere Anfangsalter der Krankheit und der höhere Anteil von Patienten mit schwerer Behinderung in dem Landkreis Los Angeles weist auf einen bösartigeren Verlauf in diesem Gebiet mit geringer Verbreitung.
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References
Allison RS (1950) Survival in disseminated sclerosis. A clinical study of a series of cases first seen twenty years ago. Brain 73:103–120
Alter M, Okihiro M, Rowley W, Morris T (1971) Multiple sclerosis among Orientals and Caucasians in Hawaii. Neurology 21:122–130
Bauer HJ, Firnhaber W (1965) Prognostic criteria in multiple sclerosis. Ann NY Acad Sci 122:542–551
Broman T, Bergmann L, Andersen O, Lindberg-Broman AM (1972) Multiple sclerosis in Gothenburg: an intensive study during a 20-year period. In: Leibowitz U (ed) Progress in multiple sclerosis. Research and treatment. Academic Press, New York, pp 186–189
Detels R, Visscher BR, Haile RW, Malgren RM, Dudley JP, Coulson AH (1978) Multiple sclerosis and age at migration. Am J Epidemiol 108:386–393
Dixon WJ, Brown MB (1979) BMDP-79. University of California Press, Los Angeles
Gudmundsson KR (1971) Clinical studies of multiple sclerosis in Iceland. Acta Neurol Scand 47 (Suppl 48):1–78
Hyllested K (1961) Lethality, duration, and mortality of disseminated sclerosis in Denmark. Acta Psychiatr Neurol Scand 36:553–564
Kurland LT, Westlund KB (1954) Epidemiologic factors in the etiology and prognosis of multiple sclerosis. Ann NY Acad Sci 58:682–701
Kuroiwa Y (1973) Multiple sclerosis in Japan. National Registry (abstract). International Symposium on the Aetiology and Pathogenesis of the Demyelinating Diseases, September 2–4, 1973
Kurtzke JF (1966) An evaluation of the geographic distribution of multiple sclerosis. Acta Neurol Scand 42 (Suppl 19):91–117
Kurtzke JF, Beebe GW, Nagler B, Auth TL, Kurland LT, Nefzger MD (1972) Studies on the natural history of multiple sclerosis. 6. Clinical and laboratory findings at first diagnosis. Acta Neurol Scand 48:19–46
Leibowitz U, Alter M (1973) Multiple sclerosis as a clinical entity. In: Multiple sclerosis: Clues to its cause. American Elsevier Publishing Company, New York, pp 1–11
Leibowitz U, Kahana E, Alter M (1969) Survival and death in multiple sclerosis. Brain 92:115–130
Lerner W (1973) Pocket Data Book, USA, 1973. Washington DC: US Bureau of Census, US Government Printing Office
McAlpine D, Compston N (1952) Some aspects of the natural history of disseminated sclerosis. I. The incidence, course, and prognosis. II. Factors affecting the onset and course. Q J Med, New Series 21:135–167
McAlpine D, Lumsden CE, Acheson ED (1972) Multiple sclerosis: A reappraisal. Williams and Wilkins, Baltimore
Müller R (1949) Studies on disseminated sclerosis with special reference to symptomatology, course and prognosis. Acta Med Scand 133 (Suppl 222):1–214
National Center for Health Statistics (1966) 1959–1961 State Life Tables. Washington DC: Public Health Service Publication 12–52, Vol 2
Poser S (1978) Multiple sclerosis: An analysis of 812 cases by means of electronic data processing. Springer-Verlag, New York
Schumacher GA, Beebe G, Kibler RF, et al. (1965) Problems of experimental trials of therapy in multiple sclerosis. Report by the panel on the evaluation of experimental trials of therapy in multiple sclerosis. Ann NY Acad Sci 122:552–568
Stazio A, Kurland LT, Bell LG, Saunders MG, Rogot E (1964) Multiple sclerosis in Winnipeg, Manitoba: Methodological considerations of epidemiologic survey. J Chronic Dis 17:415–438
U.S. Bureau of the Census (1973) 1970 Census of population, United States Summary, detailed characteristics. Final report PC(1)-D1, Washington, D.C.
Visscher BR, Detels R, Coulson AH, Malmgren RM, Dudley JP (1977) Latitude, migration, and the prevalence of multiple sclerosis. Am J Epidemiol 106:470–475
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Supported by Grant 2R01 NS 10186 from the National Institute of Neurologic and Communicative Disorders and Stroke, National Institutes of Health. Computing assistance was obtained from the Hospital Data Processing Facility, University of California, Los Angeles (UCLA)
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Visscher, B.R., Clark, V.A., Detels, R. et al. Two populations with multiple sclerosis. J Neurol 225, 237–249 (1981). https://doi.org/10.1007/BF00313296
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DOI: https://doi.org/10.1007/BF00313296