Phenotype and prognosis in African-Americans with multiple sclerosis: a retrospective chart review

• Published in: Multiple sclerosis Vol. 12; no. 6; pp. 775 - 781
• Main Authors: Naismith, R T, Trinkaus, K, Cross, A H
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA SAGE Publications 01.12.2006; Arnold; Sage Publications Ltd
• Subjects: Adult; African Americans - statistics & numerical data; Biological and medical sciences; Canes - statistics & numerical data; Cerebellum - physiopathology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disability Evaluation; Female; Humans; Immunomodulators; Incidence; Male; Medical sciences; Multiple Sclerosis - ethnology; Multiple Sclerosis - physiopathology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Pharmacology. Drug treatments; Phenotype; Prognosis; Retrospective Studies; Severity of Illness Index; Wheelchairs - statistics & numerical data; ethnicity; African-American; prognosis; multiple sclerosis; cerebellar; Multiple sclerosis; Prognosis; Prevalence; Inflammatory disease; Incidence; Disability; Cerebellar disease; Degenerative disease; Diagnosis; Human; Nervous system diseases; Retrospective; Cerebral disorder; Locomotion; Walking; Phenotype; Follow up study; Dysfunction; Central nervous system disease; Subtype; Comparative study; African American
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458506070923

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 ≥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.