R T Naismith1, K Trinkaus, A H Cross. 1. Department of Neurology, John L Trotter MS Center, Box 8111, Washington University, 660 South Euclid Avenue, Saint Louis, MO 63110, USA. naismithr@wustl.edu
Abstract
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: Retrospective chart analyses of a patient cohort from an academic MS center. PATIENTS: 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.
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: Retrospective chart analyses of a patient cohort from an academic MS center. PATIENTS: 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.
Authors: Natalia Gonzalez Caldito; Shiv Saidha; Elias S Sotirchos; Blake E Dewey; Norah J Cowley; Jeffrey Glaister; Kathryn C Fitzgerald; Omar Al-Louzi; James Nguyen; Alissa Rothman; Esther Ogbuokiri; Nicholas Fioravante; Sydney Feldman; Ohemaa Kwakyi; Hunter Risher; Dorlan Kimbrough; Teresa C Frohman; Elliot Frohman; Laura Balcer; Ciprian Crainiceanu; Peter C M Van Zijl; Ellen M Mowry; Daniel S Reich; Jiwon Oh; Dzung L Pham; Jerry Prince; Peter A Calabresi Journal: Brain Date: 2018-11-01 Impact factor: 13.501
Authors: Dorlan J Kimbrough; Elias S Sotirchos; James A Wilson; Omar Al-Louzi; Amy Conger; Darrel Conger; Teresa C Frohman; Shiv Saidha; Ari J Green; Elliot M Frohman; Laura J Balcer; Peter A Calabresi Journal: Ann Neurol Date: 2015-01-13 Impact factor: 10.422
Authors: Bruce A C Cree; David E Reich; Omar Khan; Philip L De Jager; Ichiro Nakashima; Toshiyuki Takahashi; Amit Bar-Or; Christine Tong; Stephen L Hauser; Jorge R Oksenberg Journal: Arch Neurol Date: 2009-02
Authors: B A Johnson; J Wang; E M Taylor; S J Caillier; J Herbert; O A Khan; A H Cross; P L De Jager; P-A F Gourraud; B C A Cree; S L Hauser; J R Oksenberg Journal: Genes Immun Date: 2009-10-29 Impact factor: 2.676