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Abstract

Background:

Several reports indicate changes to prevalence, incidence, female-to-male ratio in multiple sclerosis. Diagnostic criteria, course definitions and clinical management of the disease have also undergone change during the recent decades.

Objective:

To investigate temporal trends in the diagnosis of primary progressive multiple sclerosis (PPMS) in Sweden.

Methods:

Through the Swedish MS registry we investigated the proportion of PPMS diagnosis in birth, diagnosis and age period cohorts using Poisson regression.

Results:

A total of 16,915 patients were categorised into six birth-cohorts from 1946 to 1975 and seven date-of-diagnosis-cohorts from 1980 to 2014. We observed a decrease in the uncorrected analysis of diagnosis of PPMS from 19.2% to 2.2% and an average decrease of 23% (p < 0.001) per 5-year birth-cohort in the adjusted analysis. An average 21% (p < 0.001) decrease per diagnosis-cohort was seen. In the age-specific diagnosis period cohorts the same decreasing trend of PPMS diagnosis was observed in almost all groups.

Conclusion:

The diagnosis of PPMS has significantly decreased in Sweden specifically after introduction of disease-modifying treatments. Such decrease can have severe impacts on the future research on PPMS. Our data also suggest that the current trend to emphasise presence or absence of inflammatory activity is already reflected in clinical practice.

Keywords

Multiple sclerosis chronic progressive prevalence incidence

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References

Miller

Leary

. Primary-progressive multiple sclerosis. Lancet Neurol 2007; 6(10): 903–912.

Lublin

Reingold

Cohen

. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology 2014; 83(3): 278–286.

Koch

Kingwell

Rieckmann

. The natural history of primary progressive multiple sclerosis. Neurology 2009; 73(23): 1996–2002.

Ebers

. Natural history of primary progressive multiple sclerosis. Mult Scler 2004; 10(Suppl. 1): S8–S13; discussion S13–S15.

Confavreux

Vukusic

. Age at disability milestones in multiple sclerosis. Brain 2006; 129(Pt 3): 595–605.

Koch-Henriksen

Sørensen

. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010; 9(5): 520–532.

Westerlind

Boström

Stawiarz

. New data identify an increasing sex ratio of multiple sclerosis in Sweden. Mult Scler 2014; 20:1578–1583.

Wallin

Page

Kurtzke

. Multiple sclerosis in US veterans of the Vietnam era and later military service: Race, sex, and geography. Ann Neurol 2004; 55(1): 65–71.

Grytten

Glad

Aarseth

. A 50-year follow-up of the incidence of multiple sclerosis in Hordaland County, Norway. Neurology 2006; 66(2): 182–186.

10.

Orton

S-M

Herrera

Yee

. Sex ratio of multiple sclerosis in Canada: A longitudinal study. Lancet Neurol 2006; 5(11): 932–936.

11.

Kister

Chamot

Bacon

. Trend for decreasing Multiple Sclerosis Severity Scores (MSSS) with increasing calendar year of enrollment into the New York State Multiple Sclerosis Consortium. Mult Scler 2011; 17(6): 725–733.

12.

Kingwell

Leung

Roger

. Factors associated with delay to medical recognition in two Canadian multiple sclerosis cohorts. J Neurol Sci 2010; 292(1–2): 57–62.

13.

Marrie

Cutter

Tyry

. Changes in the ascertainment of multiple sclerosis. Neurology 2005; 65(7): 1066–1070.

14.

Andersen

. From the Gothenburg cohort to the Swedish multiple sclerosis registry. Acta Neurol Scand Suppl 2012; 195: 13–19.

15.

Westerlind

Boström

Stawiarz

. New data identify an increasing sex ratio of multiple sclerosis in Sweden. Mult Scler 2014; 20(12): 1578–1583.

16.

Kampman

Aarseth

Grytten

. Sex ratio of multiple sclerosis in persons born from 1930 to 1979 and its relation to latitude in Norway. J Neurol 2013; 260(6): 1481–1488.

17.

Carstensen

. Age-period-cohort models for the Lexis diagram. Stat Med 2007; 26(15): 3018–3045.

18.

Sasieni

. Age-period-cohort models in Stata. Stata J 2012; 12(1): 45–60.

19.

Pittock

Mayr

McClelland

. Disability profile of MS did not change over 10 years in a population-based prevalence cohort. Neurology 2004; 62(4): 601–606.

20.

Sumelahti

M-L

Tienari

Hakama

. Multiple sclerosis in Finland: Incidence trends and differences in relapsing remitting and primary progressive disease courses. J Neurol Neurosurg Psychiatry 2003; 74(1): 25–28.

21.

Celius

Vandvik

. Multiple sclerosis in Oslo, Norway: Prevalence on 1 January 1995 and incidence over a 25-year period. Eur J Neurol 2001; 8(5): 463–469.

22.

Ramagopalan

Byrnes

Orton

S-M

. Sex ratio of multiple sclerosis and clinical phenotype. Eur J Neurol 2010; 17(4): 634–637.

23.

Trojano

Lucchese

Graziano

. Geographical variations in sex ratio trends over time in multiple sclerosis. PLoS ONE 2012; 7(10): e48078.

24.

Schumacher

Beebe

Kibler

. 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 N Y Acad Sci 1965; 122: 552–568.

25.

Poser

Paty

Scheinberg

. New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 1983; 13(3): 227–231.

26.

McDonald

Compston

Edan

. Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50(1): 121–127.

27.

Polman

Reingold

Edan

. Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘McDonald Criteria’. Ann Neurol 2005; 58(6): 840–846.

28.

Polman

Reingold

Banwell

. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69(2): 292–302.

29.

Lublin

Reingold

. Defining the clinical course of multiple sclerosis: Results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46(4): 907–911.

30.

Folkhälsoinstitutet. Tobaksvanor, tidsserier och regionala resultat. Available from: http://www.folkhalsomyndigheten.se/amnesomraden/statistik-och-undersokningar/enkater-och-undersokningar/nationella-folkhalsoenkaten/levnadsvanor/tobaksvanor/ (2014, accessed 01 April 2015).

31.

Healy

Ali

Guttmann

CRG

. Smoking and disease progression in multiple sclerosis. Arch Neurol 2009; 66(7): 858–864.

32.

Kappos

Calabresi

. Ocrelizumab in relapsing-remitting multiple sclerosis: A phase 2, randomised, placebo-controlled, multicentre trial. Lancet 2011; 378(9805): 1779–1787.

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A significant decrease in diagnosis of primary progressive multiple sclerosis: A cohort study

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material