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Multiple sclerosis in Japan appears to be a milder disease compared to the UK

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Multiple sclerosis (MS) is relatively common in the West, but rare in Japan. In the literature, there are few comparative data regarding disease severity throughout the world. The objective of this study was to compare disability in patients from a UK and a Japanese MS cohort. We retrospectively analysed the clinical features of patients with MS from a UK and Japanese MS centre. The Multiple Sclerosis Severity Score (MSSS), which adjusts the Expanded Disability Status Scale score according to disease duration, was used as a marker of disease severity. One thousand one hundred forty-eight UK patients and 104 Japanese patient were identified representing the relative national prevalence. Demographics and disease duration did not differ between the groups. Median MSSS was significantly different between the two groups (Japan 3.34 vs. UK 5.87, p < 0.001). Primary progressive MS was more common in the UK (12.9 %) than in the Japanese cohort (3 %, p = 0.044). The majority of Japanese patients (83.7 % vs. UK 17 %) had been exposed to disease modifying treatments (DMTs). Exposure to DMTs did not show a significant effect on disability. In conclusion, this study suggests that MS in Japan may be associated with less disability than in UK. More Japanese patients were treated with DMTs. Differences in treatments do not seem to explain the disparity in disability severity. This suggests either genetic or environmental influences on disease severity.

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  1. Ascherio A, Munger K (2008) Epidemiology of multiple sclerosis: from risk factors to prevention. Semin Neurol 28(1):17–28

    Article  PubMed  Google Scholar 

  2. Wang H, Munger KL, Reindl M et al (2008) Myelin oligodendrocyte glycoprotein antibodies and multiple sclerosis in healthy young adults. Neurology 71(15):1142–1146

    Article  CAS  PubMed  Google Scholar 

  3. Faridar A, Eskandari G, Sahraian MA et al (2012) Vitamin D and multiple sclerosis: a critical review and recommendations on treatment. Acta Neurol Belg 112(4):327–333

    Article  PubMed  Google Scholar 

  4. Levin LI, Munger KL, O’Reilly EJ et al (2010) Primary infection with the Epstein–Barr virus and risk of multiple sclerosis. Ann Neurol 67(6):824–830

    PubMed Central  PubMed  Google Scholar 

  5. Alonso A, Hernán MA (2008) Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology 71(2):129–135

    Article  PubMed Central  PubMed  Google Scholar 

  6. Koutsouraki E, Costa V, Baloyannis S (2010) Epidemiology of multiple sclerosis in Europe: a review. Int Rev Psychiatry 22(1):2–13

    Article  PubMed  Google Scholar 

  7. Kira J (2003) Multiple sclerosis in the Japanese population. Lancet Neurol 2(2):117–127

    Article  PubMed  Google Scholar 

  8. Wasay M, Khatri IA, Khealani B, Sheerani M (2006) MS in Asian countries. Int MS J 13(2):58–65

    CAS  PubMed  Google Scholar 

  9. Houzen H, Niino M, Kikuchi S et al (2003) The prevalence and clinical characteristics of MS in northern Japan. J Neurol Sci 211(1–2):49–53

    Article  PubMed  Google Scholar 

  10. Detels R, Visscher BR, Malmgren RM et al (1977) Evidence for lower susceptibility to multiple sclerosis in Japanese-Americans. Am J Epidemiol 105(4):303–310

    CAS  PubMed  Google Scholar 

  11. Nakashima I, Fujihara K, Okita N et al (1999) Clinical and MRI study of brain stem and cerebellar involvement in Japanese patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 67(2):153–157

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Osoegawa M, Kira J, Fukazawa T et al (2009) Temporal changes and geographical differences in multiple sclerosis phenotypes in Japanese: nationwide survey results over 30 years. Mult Scler 15(2):159–173

    Article  CAS  PubMed  Google Scholar 

  13. Houzen H, Niino M, Hirotani M et al (2012) Increased prevalence, incidence, and female predominance of multiple sclerosis in northern Japan. J Neurol Sci 323(1–2):117–122

    Article  PubMed  Google Scholar 

  14. Chong HT, Tan CT (2008) A review of multiple sclerosis with Asian perspective. Med J Malaysia 63(5):356–361

    CAS  PubMed  Google Scholar 

  15. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13(3):227–231

    Article  CAS  PubMed  Google Scholar 

  16. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452

    Article  CAS  PubMed  Google Scholar 

  17. Table of MSSS scores derived from EDSS.

  18. Multiple Sclerosis Severity Score (2007).

  19. Strange RC, Ramachandran S, Zeegers MP et al (2010) The Multiple Sclerosis Severity Score: associations with MC1R single nucleotide polymorphisms and host response to ultraviolet radiation. Mult Scler 16(9):1109–1116

    Article  CAS  PubMed  Google Scholar 

  20. Pachner AR, Steiner I (2009) The multiple sclerosis severity score (MSSS) predicts disease severity over time. J Neurol Sci 278(1–2):66–70

    Article  PubMed  Google Scholar 

  21. Tanaka K, Kujuro Y, Suzuki S et al (2005) Clinical and laboratory features of in-patients with multiple sclerosis in a University Hospital in Tokyo from 1988–2002. Intern Med 44(6):560–566

    Article  PubMed  Google Scholar 

  22. Chan KH, Tsang KL, Ho PW et al (2011) Clinical outcome of relapsing remitting multiple sclerosis among Hong Kong Chinese. Clin Neurol Neurosurg 113(8):617–622

    Article  CAS  PubMed  Google Scholar 

  23. Lau KK, Wong WW, Sheng B et al (2008) The clinical course of multiple sclerosis patients in Hong Kong. J Neurol Sci 268(1–2):78–82

    Article  PubMed  Google Scholar 

  24. Chang KH, Lyu RK, Chen CM et al (2006) Clinical characteristics of multiple sclerosis in Taiwan: a cross-sectional study. Mult Scler 12(4):501–506

    Article  CAS  PubMed  Google Scholar 

  25. Matsuoka T, Matsushita T, Kawano Y et al (2007) Heterogeneity of aquaporin-4 autoimmunity and spinal cord lesions in multiple sclerosis in Japanese. Brain 130(Pt 5):1206–1223

    Article  PubMed  Google Scholar 

  26. Gale CR, Martyn CN (1995) Migrant studies in multiple sclerosis. Prog Neurobiol 47(4–5):425–448

    Article  CAS  PubMed  Google Scholar 

  27. Roxburgh RH, Seaman SR, Masterman T, Hensiek AE, Sawcer SJ, Vukusic S, Achiti I, Confavreux C, Coustans M, le Page E, Edan G, McDonnell GV, Hawkins S, Trojano M, Liguori M, Cocco E, Marrosu MG, Tesser F, Leone MA, Weber A, Zipp F, Miterski B, Epplen JT, Oturai A, Sørensen PS, Celius EG, Lara NT, Montalban X, Villoslada P, Silva AM, Marta M, Leite I, Dubois B, Rubio J, Butzkueven H, Kilpatrick T, Mycko MP, Selmaj KW, Rio ME, Sá M, Salemi G, Savettieri G, Hillert J, Compston DA (2005) Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity. Neurology 64(7):1144–1151

    Article  CAS  PubMed  Google Scholar 

  28. Kitley J, Leite MI, Nakashima I, Waters P, McNeillis B, Brown R, Takai Y, Takahashi T, Misu T, Elsone L, Woodhall M, George J, Boggild M, Vincent A, Jacob A, Fujihara K, Palace J (2012) Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan. Brain. 135(Pt 6):1834–1849

    Article  PubMed  Google Scholar 

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The authors thank Dr. Yoko Kanamori for her assistance in collecting data.

Conflicts of interest

Dr. Piccolo reports no disclosures. Dr. Kumar reports no disclosures. Dr. Ichiro Nakashima has served on the scientific advisory boards for Biogen Idec Japan and Novartis Pharma, has received funding for a trip and speaks from Biogen Idec Japan, Tanabe Mitsubishi, and Novartis Pharma, has received grant support from LSI Medience Corporation. Dr. Misu has received speaker honoraria from Bayer Schering Pharma, Biogen Idec Japan, Mitsubishi Tanabe Pharma Corporation, Asahi Kasei Medical Co., and Astellas Pharma Inc. and has received research support from Bayer Schering Pharma, Biogen Idec Japan, Asahi Kasei Kuraray Medical Co., The Chemo-Sero-Therapeutic Research Institute, Mitsubishi Tanabe Pharma Corporation, Teijin Pharma, and Grants-in-Aid for Scientific Research from the Ministry of Education, Science and Technology, and the Ministry of Health, Labor and Welfare of Japan. Dr. Kong reports no disclosures. Dr. Wakerley has been sponsored by Novartis in the past. Dr. Ryan reports no disclosures. Ana Cavey is the Coloplast Neurogenic Nurse Advisory Board March 2014. Dr. Fujihara serves on scientific advisory boards for Bayer Schering Pharma, Biogen Idec, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Chugai Pharmaceutical, Ono Pharmaceutical, Nihon Pharmaceutical, Merck Serono, Alexion Pharmaceuticals, Medimmune and Medical Review; has received funding for travel and speaker honoraria from Bayer Schering Pharma, Biogen Idec, Eisai Inc., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Astellas Pharma Inc., Takeda Pharmaceutical Company Limited, Asahi Kasei Medical Co., Daiichi Sankyo, and Nihon Pharmaceutical; serves as an editorial board member of Clinical and Experimental Neuroimmunology (2009–present) and a advisory board member of Sri Lanka journal of Neurology; has received research support from Bayer Schering Pharma, Biogen Idec Japan, Asahi Kasei Medical, The Chemo-Sero-Therapeutic Research Institute, Teva Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, Chugai Pharmaceutical, Ono Pharmaceutical, Nihon Pharmaceutical, and Genzyme Japan; is funded as the primary investigator (#26293205, 2014–2016) and the secondary investigator (#22229008, 2010–2015) by the Grants-in-Aid for Scientific Research from the Ministry of Education, Science and Technology of Japan and as the secondary investigator by the Grants-in-Aid for Scientific Research from the Ministry of Health, Welfare and Labor of Japan (2010–present). Dr. Palace is partly funded by highly specialised services to run a National congenital myasthenia service and a neuromyelitis service. She has received support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Chugai Pharma and Bayer Schering, and unrestricted grants from Merck Serono, Novartis, Biogen Idec and Bayer Schering. Her hospital trust receives funds for her role as clinical lead for the RSS, and she has received grants from the MS society and Guthie Jackson Foundation for unrelated research studies. She is a board member for the charitable European MS foundation ‘The Charcot Foundation’ and on the steering committee for a European collaborative MS imaging group ‘MAGNIMS’.

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This study fulfilled the local ethical requirements.

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Correspondence to Jacqueline Palace.

Additional information

L. Piccolo, G. Kumar and I. Nakashima contributed equally.

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Piccolo, L., Kumar, G., Nakashima, I. et al. Multiple sclerosis in Japan appears to be a milder disease compared to the UK. J Neurol 262, 831–836 (2015).

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