Abstract
Background
Epidemiological studies on the distribution of multiple sclerosis (MS) conducted in the Mediterranean area in the last two decades have disclosed a significant increase in frequency of the disease, indicating caution when a latitude-related model of MS is accepted. Previous descriptive surveys in the province of Ferrara, northern Italy, carried out by our own epidemiological research group, have established that this area is at high risk for MS.
Objective
To confirm the above assumption and to update MS frequency estimates in this area.
Design and setting
We conducted a community-based intensive prevalence and incidence study, by adopting a complete enumeration approach.
Results
On December 31, 2004, 423 patients (300 women and 123 men) suffering from definite or probable MS (Poser's criteria) living in the province of Ferrara, yielded a crude prevalence rate of 120.93 (95 % CI, 110.05–134.23) per 100,000, 164.26 for women and 73.59 for men. The average incidence from 1990 to 2003 was 4.35 per 100,000 (95 % CI, 3.77–4.99), 5.91 for women and 2.63 for men. The incidence rate,which was relatively stable during the previous 25 years (1965–1989) with a mean rate of 2.3 per 100,000, increased to a value of 3.39 per 100,000 in the period 1990–1994, 4.09 per 100,000 in the period 1995–1999 and 3.84 per 100,000 in the period 2000–2003.
Conclusions
These results confirm that in Ferrara MS occurs more frequently than suggested by the geographic- related distribution model and, based on other recent national surveys, support the view that northern Italy is a high-risk area for the disease. The marked increase in MS prevalence rate, in comparison with previous investigations, is in part due to the increasing survival of patients as a result of improved supportive care and the accumulation of new incidence cases owing to the reduction in diagnostic latency for better quality of neurological diagnostic procedures. The incidence in the province of Ferrara was found to slowly change with an incremental trend,which cannot only be attributed to improvements in diagnostic ability. Environmental risk factors in genetically predisposed people over time could be considered.
Similar content being viewed by others
References
Granieri E, Casetta I, Tola MR (1995) Epidemiology of multiple sclerosis in Italy and southern Europe. Acta Neurol Scand 161 (Suppl):60–70
Compston DAS (1998) Distribution of multiple sclerosis. In: Compston DAS, Ebers G, Lassman H, McDonald I, Matthews B, Wekerle H (eds) McAlpine multiple sclerosis. 3rd ed. London: Churchill Livingston, pp 63–100
Kurtzke JF (2000) Epidemiology of multiple sclerosis. Does this really point toward an etiology? Lectio doctoralis. Neurol Sci 21:383–403
Marrie RA (2004) Environmental risk factors in multiple sclerosis aetiology. Lancet Neurol 3:709–718
Poser CM (1994) The epidemiology of multiple sclerosis: a general overview. Ann Neurol 36 (Suppl 2):S180–S193
Ebers GC, Sadovnick AD (1997) Epidemiology. In: Paty DW, Ebers GC (eds) Multiple sclerosis. Philadelphia: FA Davis, pp 5–28
Kurtzke JF (2005) Epidemiology and etiology of multiple sclerosis. Phys Med Rehabil Clin N Am 16:327–349
Weinshenker BG, Rodriguez M (1994) Epidemiology of multiple sclerosis. In: Gorelic PB, Alter M (eds) Handbook of Neuroepidemiology. New York:Marcel Dekker; pp 533–567
Rosati G, Granieri E, Carreras M, et al. (1981) Multiple sclerosis in northern Italy: Prevalence in the province of Ferrara in 1978. Ital J Neurol Sci 2:17–23
Granieri E, Tola MR, Paolino E, Carreras M, Rosati G, Monetti VCl (1985) The frequency of multiple sclerosis in Italy: a descriptive study in Ferrara. Ann Neurol 17:80–84
Granieri E, Malagù S, Casetta I, et al. (1996) Multiple sclerosis in Italy. A reappraisal of incidence and prevalence in Ferrara. Arch Neurol 53:793–798
Bodmer WF (1972) Population genetics of the HLA system: retrospect and prospect. In: Dausset J, Colombani J (eds) Histocompatibility testing. Copenhagen, Denmark:Munksgaard International Publisher Ltd; pp 611–677
Poser CM, Paty DW, Sheinberg L, et al. (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231
Kurtzke JF (2000) Natural history and clinical outcome measures for multiple sclerosis studies. Why at the present time does EDSS scale remain a preferred outcome measure to evaluate disease evolution? Neurol Sci 21:339–341
Schoenberg BS (1983) Calculating confidence intervals for rates and ratios: simplified method utilizing tabular values based in the Poisson distribution. Neuroepidemiology 2:257–265
Waterhause J, Muir C, Shanmungarataham K, Powell J (1982) Cancer incidence in five continents. IARC Sci Publ 4:673
Armitage P (1955) Tests for linear trends in proportions and frequencies. Biometrics 11:375–386
Kahn HA, Sempos CT (1980) Statistical methods in epidemiology. Oxford: the University Press
Rosati G (2001) The prevalence of multiple sclerosis in the world: an update. Neurol Sci 22:117–139
Granieri E, Monaldini C, De Gennaro R, et al. (2007) Multiple sclerosis in the Republic of San Marino: a prevalence and incidence study. Mult Scler (in press)
Ranzato F, Perini P, Tzintzeva E, et al. (2003) Increasing frequency of multiple sclerosis in Padova, Italy: a 30 year epidemiological survey. Mult Scler 9:387–392
Sironi L, Mamoli A, D’Alessandro G, Camerlingo M, Bottacchi E (1991) Frequency of multiple sclerosis in Valle d’Aosta, 1971–1985. Neuroepidemiology 10:66–69
Rosati G, Aiello I, Pirastru MI, et al. (1996) Epidemiology of multiple sclerosis in Northwestern Sardinia: further evidence for higher frequency in Sardinians compared to other Italians. Neuroepidemiology 15:10–19
Granieri E, Casetta I, Govoni V, et al. (2000) The increasing incidence and prevalence of MS in a Sardinian province. Neurology 55:842–848
Nicoletti A, Lo Bartolo ML, Lo Fermo S, et al. (2001) Prevalence and incidence of multiple sclerosis in Catania, Sicily. Neurology 56:62–66
Savettieri G, Salemi G, Ragonese P, Aridon P, Scola G, Randisi G (1998) Prevalence and incidence of multiple sclerosis in the city of Monreale, Italy. J Neurol 245:40–43
Guidetti D, Cavalletti S, Morelli E, et al. (1995) Epidemiological survey of multiple sclerosis in the provinces of Reggio Emilia and Modena, Italy. Neuroepidemiology 14:7–13
Ragonese P, Salemi G, D’Amelio M, Gammino M, Aridon P, Savettieri G (2004) Multiple sclerosis in southern Europe:Monreale City, Italy. A twentyyear follow-up incidence and prevalence study. Neuroepidemiology 23:306–309
Solaro C, Allemani C, Messmer Uccelli M, et al. (2005) The prevalence of multiple sclerosis in the north-west Italian province of Genoa. J Neurol 252:436–440
Granieri E, Casetta I, Tola MR, Rosati G (2001) Epidemiologia della sclerosi multipla. In: Canal N, Ghezzi A, Zaffaroni M, Zibetti A (eds) Sclerosi Multipla. Attualità e prospettive. Milano Parigi Barcellona:Masson, pp 2–39
Rothwell PM, Charlton D (1998) High incidence and prevalence of multiple sclerosis in south east Scotland: evidence of a genetic predisposition. J Neurol Neurosurg Psychiatry 64:730–735
Forbes RB, Wilson SV, Swingler RJ (1999) The prevalence of multiple sclerosis in Tayside, Scotland: do latitudinal gradients really exist? J Neurol 246:1033–1040
McDonnell GV, Hawkins SA (1998) An epidemiologic study of multiple sclerosis in Northern Ireland. Neurology 50:423–428
Govoni V, Vasetta I, Granieri E, et al. (1993) Mortality study on multiple sclerosis in the province of Ferrara, northern Italy, 1968 through 1989. Acta Neurol (Napoli) 15:161–176
Poser S (1994) The epidemiology of multiple sclerosis in southern lower Saxony. In: Firnhaber W, Lauer K (eds) Multiple sclerosis in Europe: An Epidemiological Update. Alsbach/ Bergstrasse, Germany: Leuchtturm Verlag, pp 130–133
Compston DAS (1994) The epidemiology of multiple sclerosis: principles, achievements, and recommendations. Ann Neurol 36 (Suppl 2):S211–S217
Mindrhoud JM, Zwanikken CP (1994) Increasing prevalence and incidence of multiple sclerosis: an epidemiological study in the province of Groningen, the Netherlands. In: Firnhaber W, Lauer K (eds) Multiple sclerosis in Europe: An Epidemiological Update. Alsbach/Bergstrasse, Germany: Leuchtturm Verlag, pp 113–121
Benedikz J, Magnusson H, Gudmundsson G (1994) Multiple sclerosis in Iceland, with observations on the alleged epidemic in the Faroe Islands. Ann Neurol 36 (Suppl 2):S175–S179
Larsen JP, Aarli JA, Nyland H, Riise T (1984) Western Norway, a high-risk area for multiple sclerosis: a prevalence/ incidence study in the county of Hordaland. Neurology 34:1202–1207
Grønning M, Riise T, Kvale G, Nyland H, Larsen JP, Aarli JA (1991) Incidence of multiple sclerosis in Hordaland, western Norway: a fluctuating pattern. Neuroepidemiology 10:53–61
Midgard R, Riise T, Svanes C, Kvale G, Nyland H (1996) Incidence of multiple sclerosis in More and Romsdal, Norway from 1950 to 1991. An age-periodcohort analysis. Brain 119:203–211
Sumelahti ML, Tienari PJ, Hakama M, Wikstrom J (2003) Multiple sclerosis in Finland: incidence trends and differences in relapsing remitting and primary progressive disease courses. J Neurol Neurosurg Psychiatry 74:25–28
Celius EG, Vandvik B (2001) Multiple sclerosis in Oslo, Norway: prevalence on 1 January 1995 and incidence over a 25-year period. Eur J Neurol 8:463–469
Grimaldi LME, Salemi G, Grimaldi G, et al. (2001) High incidence and increasing prevalence of MS in Enna (Sicily), southern Italy. Neurology 57:1891–1893
Pryse-Phillips WE (1986) The incidence and prevalence of multiple sclerosis in Newfoundland and Labrador, 1960–1984. Ann Neurol 20:323–328
Wynn DR, Rodriguez M, O’Fallon WM, Kurland LT (1990) A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota. Neurology 40:780–786
Sloka JS, Pryse-Phillips WE, Stefanelli M (2005) Incidence and prevalence of multiple sclerosis in Newfoundland and Labrador. Can J Neurol Sci 32:37–42
Hammond SR, English D, de Wytt C, et al. (1988) The clinical profile of MS in Australia: a comparison between medium- and high-frequency prevalence zones. Neurology 38:980–986
Hammond SR, English DR, McLeod JG (2000) The age-range of risk of developing multiple sclerosis: evidence from a migrant population in Australia. Brain 123:968–974
Skegg DCG, Corwin PA, Craven RS, Malloch JA, Pollock M (1987) Occurrence of multiple sclerosis in the north and south of New Zealand. J Neurol Neurosurg Psychiatry 50:134–139
Granieri E (2000) Exogenous factors in the aetiology of multiple sclerosis. J Neurovirol 6 (Suppl 2):S67–S75
Cocco E, Sardu C, Lai M, Spinicci G, Contu P, Marrosu MG (2004) Anticipation of age at onset in multiple sclerosis: a Sardinian cohort study. Neurology 25(62):1794–1798
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Granieri, E., Economou, NT., De Gennaro, R. et al. Multiple sclerosis in the province of Ferrara. J Neurol 254, 1642–1648 (2007). https://doi.org/10.1007/s00415-007-0560-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-007-0560-5