Is it time for a new global classification of multiple sclerosis?

J Neurol Sci. 2014 Sep 15;344(1-2):171-81. doi: 10.1016/j.jns.2014.06.051. Epub 2014 Jun 29.

Abstract

Background: The geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates.

Objective: The aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys.

Methods: We conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012.

Results: MS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6-36.2).

Conclusion: In the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.

Keywords: Epidemiology worldwide; Incidence; Multiple sclerosis; Prevalence.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Female
  • Global Health*
  • Humans
  • Incidence
  • Male
  • Multiple Sclerosis / classification*
  • Multiple Sclerosis / diagnosis
  • Multiple Sclerosis / epidemiology
  • Prevalence
  • Retrospective Studies