MS In Africans Abstracts

Aims
In the European Multiple Sclerosis (MS) database registered in Nice, about 8p.cent of the patients have a North African ethnic background.

Patients And Methods
We performed a descriptive retrospective study of a cohort of 76 MS patients with a North African ethnic background followed in the Neurology Department of Nice University Hospital.

This group was compared with a regional MS cohort (n=968) from our EDMUS database.

Statistical analysis enabled classification of patients into three subgroups which had been submitted to different environmental factors according to where they were born and their age at immigration.

There were prognostic aspects specific to each group.

Results
Regarding the entire cohort, poor prognostic factors included male gender, onset with sequellae, and substantial Brain lesions on initial T₂-weighted MRI.

For the subgroups, prognostic aspects specific to each group were:

1. Patients of North African origin born in France had:
   • An early age of onset
   • Delayed diagnosis
   • Remission between two long initial expressions of MS
   • Rapidly developed Cerebellar problems
     • With a Secondary/Progressive course
2. Patients having migrated after age 15 had:
   • A late age of onset
   • Delayed diagnosis
   • Remission between two short initial expressions of MS
   • An onset characterized by one symptom
     • Which was often a motor symptom
     • Involving the Spinal Cord or BrainStem
   • But late-developing Cerebellar problems and
     • Secondary/Progressive course are frequent
3. Patients having migrated before age 15 had:
   • An onset characterized by one symptom
   • Often a visual problem
     • With sequellae
   • Rapid development of Cerebellar problems

Conclusion
The present study was consistent with the more unfavorable course of MS in patients of North African ethnic background previously reported in the literature.

One should distinguish the subgroups to improve management of MS.

Early administration of treatment should be considered for these patients, including earlier and more frequent use of ImmunoSuppressive agents.

Multiple Sclerosis (MS) is a chronic inflammatory CNS disorder, resulting in Progressive Neurological Dysfunction.

The disease has a higher incidence in Caucasian Americans (CA) than African Americans (AA); however, the latter may have a more aggressive disease course.

We used cluster analysis to determine whether there is a difference in disease progression between the races and whether the APOE AND APOC1 genotypes influence the disease progression.

AA female patients were younger and had a higher progression index and MS severity score than CA female MS patients.

AA females who were APOE 4/4, 2/4, or 2/3 and APOC1 AA had a younger age-of-onset, had primarily a Relapsing/Remitting disease course, with a higher progression index and MS severity score, as assessed by cluster analysis.

Cluster analysis also indicated that CA female patients were of two groups. One group was younger, had the APOE 3/3 genotype with Relapsing/Remitting less severe disease.

The second CA group was older, had the APOE 3/4 or 2/3 genotypes with more of the Secondary/Progressive more severe disease phenotype.

Thus, the AA MS female patients who were APOE 4 carriers had an earlier age-of-onset and more severe disease course than CA MS female patients.

Objective
To compare the clinical disease progression in European (E) and North African (NA) patients with Multiple Sclerosis (MS) patients in France.

Methods
We compared the clinical features of MS in 211 NA patients and 2,945 E patients in a French population-based cohort with definite MS according to McDonald Criteria.

Results
Among the NA patients with MS, 66.4% were women vs 72.9% of the E patients (p = 0.04), 15.6% had a Primary/Progressive form of MS vs 11.7%, of the E patients (p = 0.08).

And, the mean age at onset was 29.9 +/- 9.8 years in the NA patients vs 32.9 +/- 10.6 years in the E patients (p < 0.0001).

In the NA patients, there was:
1. A higher proportion of patients with incomplete recovery from the first relapse (p < 0.0001)
2. A shorter time between the first two relapses (p = 0.02)
3. A higher number of relapses in the first 5 years (p = 0.03)

4. A shorter time to reach an Expanded Disability Status Scale score of 4.0 (p = 0.001) or 6.0 (p < 0.0001)

The only statistical difference in these factors between NA patients born in France and those born in North Africa was the mean age at onset of symptoms: it was earlier in NA patients born in France (p < 0.0001).

Conclusions
The course of Multiple Sclerosis is more aggressive in North African than in European patients.

Background
African Americans (AAs) experience greater disability from Multiple Sclerosis (MS) compared with Caucasian Americans (CAs).

InterEthnic Immunologic differences in MS and their relationship to disease-related disability have not been described.

Objective
To compare measures of CSF Humoral Immunity between AAs and CAs with MS.

Methods
Using a case-control design, all AA MS patients with CSF Immune studies at the Washington University MS center were compared with randomly selected CAs with MS.

Two CA controls were selected for every AA case. ImmunogGlobulin G (IgG) index and synthesis rates, OligoClonal Band positivity, white blood cell count, and CSF protein were compared between groups.

Survival analysis was conducted to compare times to ambulatory assistance.

Results
Sixty-six AA cases and 132 CA controls were identified. Measures of CSF Humoral activity were all higher in the AA group.

The mean IgG index of AAs was 1.35 (SD 0.62), and that of CAs was 1.05 (SD 0.55), for a mean difference of 0.30 (p = 0.001).

The median IgG synthesis rate was also higher among AAs (13.55 vs 8.20 mg/day), for a median difference of 5.35 mg/day (p = 0.010).

Survival analysis confirmed previous reports of earlier ambulatory assistance requirement among AAs.

Despite differences in both Humoral Immune Response and times to ambulatory assistance, Cox proportional hazards modeling did not show IgG index as predictive of earlier ambulatory assistance.

Conclusions
The CSF Humoral Immune Response is more active among African Americans (AAs) than among Caucasian Americans (CAs) with Multiple Sclerosis.

AAs also progress to ambulatory assistance earlier than CAs, but high ImmunoGlobulin G index does not predict earlier progression to the disability endpoint.

Context
There is an emerging body of literature regarding Multiple Sclerosis (MS) in African-Americans (AA) that suggests more rapid progression and a worse prognosis in this group.

A phenotype of OpticoSpinal MS has been proposed by some publications.

Objective
To determine whether AA with MS have a different clinical phenotype, different distribution of clinical subtypes, and/or different levels of disability than Caucasians (CA) with MS.

Specifically, is the disability attributable to severe Cerebellar disease, which limits ambulation and function?

Design & Patients
Retrospective chart analyses of a patient cohort from an academic MS center.

A total of 86 AA were identified with MS, 79 were followed for > or = 5 years. The control group consisted of 80 randomly-selected CA with MS and similar follow-up.

Outcome Measures
EDSS at diagnosis, five-year follow-up, and last follow-up; time to walking assistance device; disease subtype; involved functional systems.

Results
AA MS patients displayed more Cerebellar dysfunction, and worse EDSS scores at diagnosis, at four to six years follow-up from diagnosis, and at last follow-up compared to the CA MS patients with similar length of follow-up.

AA MS patients had earlier and more frequent gait difficulty requiring use of a cane or wheelchair.

AA MS patients had a higher prevalence of Primary/Progressive (PP) MS (22 versus 9%) and a lower rate of Relapsing/Remitting (RR) MS (30 versus 52%) compared to CA.

Conclusions
Compared to CA patients, MS in AA is characterized by a higher incidence of Cerebellar dysfunction and a more rapid accumulation of disabilities.

In this cohort, AA patients had a relatively higher rate of the PPMS subtype. These data suggest the presence of fundamental differences in the clinical phenotype and the natural history of MS in AA.

Background
African Americans (AAs) with Multiple Sclerosis (MS) seem to have a more severe disease course than white Americans (WAs).

To our knowledge, it is not known to what extent treatment with Interferon-ß-1a will effect the MS disease course within the AA population.

Objective& Design
To compare the response to treatment with Interferon-ß-1a between AA and WA MS patients.

This is an exploratory post hoc analysis of the Evidence of Interferon Dose-Response: European North American Comparative Efficacy (EVIDENCE) study.

Setting
The EVIDENCE study is a randomized controlled trial that compared the efficacy of once weekly, intramuscular, 30-microg Interferon-ß-1a treatment with thrice weekly, subcutaneous, 44-microg Interferon-ß-1a therapy in treatment-naive MS subjects.

Participants
Thirty-six AA subjects were compared with 616 WA subjects.

Main Outcome Measures
The number of MS exacerbations, the proportion of exacerbation-free subjects.

And, the number of new MS lesions present on Brain Magnetic Resonance Imaging were compared between AA and WA subjects at 24 and 48 weeks after initiating treatment with Interferon-ß-1a.

Results
The AA subjects experienced more exacerbations and were less likely to remain exacerbation free (statistical trends).

The AA subjects developed more new MS lesions on T₂-weighted Brain Magnetic Resonance Imaging at 48 weeks (P = .04).

Conclusions
Despite the small sample size, AA subjects appeared less responsive to treatment than WA subjects on outcome measures, reaching significance only for T₂-weighted lesion count at 48 weeks.

However, it is difficult to base these differences solely on response to treatment given the potential differing in MS disease course in AA patients.

This research profiles African American residents with Multiple Sclerosis (MS) at admission to the nursing facility and compares them to profiles of white residents with MS using the Minimum Data Set (MDS).

We analysed MDS admission assessments for 1367 African Americans with MS and 9294 whites with MS.

African American residents with MS were significantly younger at admission than white residents with MS, with almost one half of these African Americans 50 years or younger compared to only one quarter of these whites.

African American residents with MS were significantly more physically disabled and Cognitively Impaired at admission than white residents with MS.

Although there were significant racial differences in disability, there were no significant racial differences among these MS residents in the use of various therapies provided by qualified therapists.

These observed racial differences among MS residents in disease manifestations, severity, progression and disability are due to multiple variables and point out the need for more research.

By combining discoveries from Genetics, Immunology, Epidemiology and Virology we can gain a better understanding of the complex pathophysiology of MS and develop more effective treatments and preventive measures.

Our findings also indicate potential racial disparities in the use of MS-related care, illustrating that a greater outreach effort may be needed to evaluate and treat African Americans with MS.

Background
African American (AA) individuals are thought to develop Multiple Sclerosis (MS) less frequently than Caucasian American (CA) individuals.

Objective & Methods
To compare the clinical characteristics of AA and CA patients with MS, the clinical features of MS were compared in a large retrospective cohort of AA (n = 375) and CA (n = 427) subjects.

Results
The proportion of women to men was similar in AA and CA subjects (81% [AA] vs 77% [CA]; p = 0.122).

There were no differences in the proportions of subjects with Relapsing/Remitting, Secondary/Progressive, Primary/Progressive, and Progressive/Relapsing MS.

The median time to diagnosis was 1 year after symptom onset in AA subjects and 2 years after symptom onset in CA subjects (p = 0.0013).

The age at onset was approximately 2.5 years later in AA than CA subjects (33.7 vs 31.1 years; p = 0.0001).

AA subjects presented with multisite signs and symptoms at disease onset more often than CA subjects (p = 0.018).

Clinical involvement restricted to the Optic Nerves and Spinal Cord (OpticoSpinal MS) occurred in 16.8% of AA patients compared with 7.9% of CA patients (p < 0.001).

Transverse Myelitis also occurred more frequently in AA subjects (28 vs 18%; p = 0.001).

Survival analysis revealed that AA subjects were at higher risk for development of ambulatory disability than CA subjects.

After adjusting for baseline variations and differences in therapeutic interventions, AAs were at 1.67-fold greater risk for requiring a cane to ambulate than CA patients (p < 0.001).

There was a trend suggesting that AAs were also at greater risk for development of wheelchair dependency (p = 0.099).

Adjusted Cox proportional hazard models showed that this effect was in part attributable to the older age at onset in AAs (p < 0.001).

Conclusions
Compared with Multiple Sclerosis (MS) in Caucasian Americans, African American patients with MS have a greater likelihood of developing OpticoSpinal MS and Transverse Myelitis and have a more aggressive disease course.

Objective
Although epidemiology indicates that Multiple Sclerosis is more common among whites than African Americans, the course of disease may be more aggressive among African Americans.

This study examines disease course in a large Multiple Sclerosis clinic population.

Design
A case-controlled, retrospective record review compared the severity of Multiple Sclerosis for African Americans and for whites.

Because the baseline demographics of the two groups differed, we performed analyses of multiple subgroups in an attempt to control for various characteristics.

Results
Consistent evidence of more disability in African Americans compared with whites was found, although subgroups were often too small to establish statistical significance.

African Americans had a higher mean Expanded Disability Status Scale score than whites in a subgroup selected to minimize differences in access to care and disease perceptions.

African Americans reported limb weakness as a presenting symptom of Multiple Sclerosis more frequently than did whites. When patients were followed at our Multiple Sclerosis center, rates of disease progression were nearly identical.

Conclusions
More African Americans than whites experience Pyramidal System involvement early in Multiple Sclerosis, leading to greater disability as measured by the ambulation-sensitive Expanded Disability Status Scale.

Once patients have moderate difficulty walking, the rate of progression is the same for both groups, albeit occurring at a later age for whites than for African Americans.

The objective of this study was to determine the clinical characteristics of Multiple Sclerosis (MS) in African American (AA) patients in the New York State Multiple Sclerosis Consortium (NYSMSC) patient registry.

The NYSMSC is a group of 18 MS centers throughout New York State organized to prospectively assess clinical characteristics of MS patients.

AAs comprise 6% (329) of the total NYSMSC registrants (5602). Demographics, disease course, therapy, and SocioEconomic Status were compared in AA registrants versus NonAfrican Americans (NAA).

There was an increased female preponderance and a significantly younger age at diagnosis in the AA group. AA patients were more likely to have greater disability with increased disease duration.

No differences were seen in types of MS and use of Disease Modifying Therapies. Our findings suggest a racial influence in MS.

Further genetic studies that consider race differences are warranted to elucidate mechanisms of disease susceptibility.