Clinical and Demographic Characteristics of Immigrant and Local Multiple Sclerosis Patients in Turkey

Overview

Journal Noro Psikiyatr Ars

Date 2023 Jun 8

PMID 37287561

Authors

Belgin Petek Balci

Ezgi Bakircioglu Duman

Cansu Tunc

Birgul Bastan Tuzun

Ozlem Cokar

Affiliations

Soon will be listed here.

Abstract

Introduction: Increasing migration, due to wars, is one of the environmental factors in the etiology of multiple sclerosis. This study aims to compare demographic and clinical features of immigrant and local MS patients, as well as relapses during pregnancy and postpartum in female patients.

Method: Immigrant (Group 1) and local (Group 2) MS patients were evaluated between January 2019 - September 2020 retrospectively. Below-mentioned data of two groups were recorded and compared: i) demographic data, ii) cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings, iii) MS subtypes, iv) expanded disability status scores (EDSS), v) the time between first two relapses, vi) comorbidities, vii) treatment, viii) age of migration and country of origin, ix) pregnancy, x) relapse during pregnancy, xi) birth number, xii) breastfeeding, xiii) postpartum relapses.

Results: Both of the groups were composed of 34 MS patients (in total n=68). Gender distribution, mean age, MS subtypes, the time between first two relapses, disease duration, EDSS, CSF findings and comorbidities were similar between groups. Symptom of onset was predominantly sensory in both groups. Local patients had more cervical lesions and higher lesion load (p=0.003, p=0.006). 20.6% of migrant MS patients were untreated, all local patients were on treatment. Rates of injection and infusion therapies were similar, the rate of receiving oral therapy was higher in the second group. Clinical features and fertility status of female patients were similar.

Conclusion: According to the study no differences were preseentpresent between immigrant and local MS patients except for MRI lesion load and treatment parameters. The language barrier and irregular follow-ups were the major problems in treatment management.

References

Zeineddine M, Yamout B . Treatment of multiple sclerosis in special populations: The case of refugees. Mult Scler J Exp Transl Clin. 2020; 6(1):2055217319848466. PMC: 6956602. DOI: 10.1177/2055217319848466. View

Ascherio A, Munger K . Environmental risk factors for multiple sclerosis. Part II: Noninfectious factors. Ann Neurol. 2007; 61(6):504-13. DOI: 10.1002/ana.21141. View

Marrie R, Cohen J, Stuve O, Trojano M, Soelberg Sorensen P, Reingold S . A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015; 21(3):263-81. PMC: 4361468. DOI: 10.1177/1352458514564491. View

Magyari M, Soelberg Sorensen P . Comorbidity in Multiple Sclerosis. Front Neurol. 2020; 11:851. PMC: 7473304. DOI: 10.3389/fneur.2020.00851. View

Lublin F, Reingold S . 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):907-11. DOI: 10.1212/wnl.46.4.907. View

Siegert R, Abernethy D . Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005; 76(4):469-75. PMC: 1739575. DOI: 10.1136/jnnp.2004.054635. View

Marrie R, Patten S, Tremlett H, Wolfson C, Warren S, Svenson L . Sex differences in comorbidity at diagnosis of multiple sclerosis: A population-based study. Neurology. 2016; 86(14):1279-1286. PMC: 4826338. DOI: 10.1212/WNL.0000000000002481. View

Lo L, Taylor B, Winzenberg T, Palmer A, Blizzard L, van der Mei I . Change and onset-type differences in the prevalence of comorbidities in people with multiple sclerosis. J Neurol. 2020; 268(2):602-612. DOI: 10.1007/s00415-020-10194-x. View

Patten S, Beck C, Williams J, Barbui C, Metz L . Major depression in multiple sclerosis: a population-based perspective. Neurology. 2003; 61(11):1524-7. DOI: 10.1212/01.wnl.0000095964.34294.b4. View

10.

Cavalla P, Rovei V, Masera S, Vercellino M, Massobrio M, Mutani R . Fertility in patients with multiple sclerosis: current knowledge and future perspectives. Neurol Sci. 2006; 27(4):231-9. DOI: 10.1007/s10072-006-0676-x. View

11.

Senadim S, Uygun E, Erdogan M, Koksal A, Soysal A, Atakli D . Profile of Syrian Asylum-Seekers from Neurological Clinic in a Tertiary Center. Eur Neurol. 2019; 80(5-6):249-253. DOI: 10.1159/000496807. View

12.

Minden S, Feinstein A, Kalb R, Miller D, Mohr D, Patten S . Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013; 82(2):174-81. PMC: 3897434. DOI: 10.1212/WNL.0000000000000013. View

13.

Belbasis L, Bellou V, Evangelou E, Ioannidis J, Tzoulaki I . Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015; 14(3):263-73. DOI: 10.1016/S1474-4422(14)70267-4. View

14.

Jalkanen A, Alanen A, Airas L . Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler. 2010; 16(8):950-5. DOI: 10.1177/1352458510372629. View

15.

Vidal-Jordana A, Montalban X . Multiple Sclerosis: Epidemiologic, Clinical, and Therapeutic Aspects. Neuroimaging Clin N Am. 2017; 27(2):195-204. DOI: 10.1016/j.nic.2016.12.001. View

16.

Gale C, Martyn C . Migrant studies in multiple sclerosis. Prog Neurobiol. 1995; 47(4-5):425-48. View

17.

Oh J, Vidal-Jordana A, Montalban X . Multiple sclerosis: clinical aspects. Curr Opin Neurol. 2018; 31(6):752-759. DOI: 10.1097/WCO.0000000000000622. View

18.

Nguyen A, Kubala Havrdova E, Horakova D, Izquierdo G, Kalincik T, van der Walt A . Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study. Mult Scler Relat Disord. 2019; 28:235-243. DOI: 10.1016/j.msard.2019.01.003. View

19.

Riahi F, Zijdenbos A, Narayanan S, Arnold D, Francis G, Antel J . Improved correlation between scores on the expanded disability status scale and cerebral lesion load in relapsing-remitting multiple sclerosis. Results of the application of new imaging methods. Brain. 1998; 121 ( Pt 7):1305-12. DOI: 10.1093/brain/121.7.1305. View

20.

Silva A, Vilhena E, Lopes A, Santos E, Goncalves M, Pinto C . Depression and anxiety in a Portuguese MS population: associations with physical disability and severity of disease. J Neurol Sci. 2011; 306(1-2):66-70. DOI: 10.1016/j.jns.2011.03.042. View