Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-17T13:15:19.509Z Has data issue: false hasContentIssue false
  • English
  • Français

Disability and Survival of Multiple Sclerosis in Saskatoon, Saskatchewan

Published online by Cambridge University Press:  02 December 2014

Walter J. Hader
Walter J. Hader*
Affiliation:
Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon City Hospital, Saskatoon, Saskatchewan, Canada
*
University of Saskatchewan, Department of Physical Medicine and Rehabilitation, 701 Queen Street, Saskatoon City Hospital, Saskatoon, Saskatchewan, S7K 0M7, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

A population-based prevalent group of 150 clinical definite patients ascertained on 1 January 1977, in Saskatoon, Saskatchewan, was followed for 30 years.

Objectives:

To outline the clinical characteristics, determine the levels of disability at 15, 25, 35, 40, and 45 years after onset, to estimate the survival after onset and life expectancy.

Methods:

Clinical records were maintained, and the cohort reviewed each decade for 30 years. The disability levels according to the Kurtzke Extended Disability Status Scale were recorded and survival times were estimated. SPSS and Kaplan-Meier methods were used for analysis.

Results:

On prevalence day, 1 January 1977, there were 48(32%) men and 102(68%) women, with an average age of onset of 32.2±10 years and 28.4±8.6 years. The average duration of disease was 15.7 years. On 1 January 2007, 39(26%) patients were living, 105(70%) deceased, and 6(4%) were missing The disability levels recorded in 1977 and 2007, at 15 and 45 years after onset, were mild (EDSS≤2.5), 33.3% and 8.0%; moderate (EDSS3-5.5), 17.3% and 2.7%; severe (EDSS6-7.5), 6.6% and 4.7%; maximum (EDSS8-9.5), 22.7% and 10.7%. The median survival time after onset was 33 (95% CI: 27.3-38.6) years for men and 38 (95% CI: 34.1-41.9) years for women. The median duration of life was 68.9 years for men and 69.5 years for women, and a decreased life expectancy of 7.7 and 12.8 years.

Conclusions:

Multiple sclerosis is a progressive neurological disorder and long-term survival is associated with moderate to severe disability and decreased life expectancy.

Résumé:

RÉSUMÉ: Contexte:

Un groupe de 150 patients atteints de sclérose en plaques (SP) certaine, identifiés le premier janvier 1977 à Saskatoon en Saskatchewan, a été suivi pendant 30 ans.

Objectifs:

Le but de l'étude était de définir les caractéristiques cliniques, de déterminer les niveaux d'invalidité 15, 25, 35,40 et 45 ans après le début de la maladie, d'estimer la survie après le début de la maladie et l'espérance de vie.

Méthodes:

Les dossiers cliniques ont été mis à jour et la cohorte a été révisée à chaque décennie pendant 30 ans. Les niveaux d'invalidité selon la Kurtzke Extended Disability Status Scale (EDSS) ont été notés et le temps de survie a été estimé. Les données ont été analysées par SPSS et analyse de Kaplan-Meier.

Résultats:

Le premier janvier 1977, le jour où la prévalence a été déterminée, la cohorte était constituée de 48 hommes (32%) et de 102 femmes (68%) dont l'âge de début moyen était de 32,2 ± 10 ans et 28,4 ± 8,6 ans respectivement. La durée moyenne de la maladie était de 15,7 ans. Le premier janvier 2007, 39 patients (26%) étaient toujours vivants, 105 (70%) étaient décédés et 6 (4%) avaient été perdus de vue. Les niveaux d'invalidité notés en 1977 et en 2007, soit 15 et 45 ans après le début de la maladie, étaient légers (EDSS < 2,5) chez 33,3% et 8,0%; modérés (EDSS 3 à 5,5), chez 17,3% et 2,7%; sévères (EDSS 6 à 7,5) chez 6,6% et 4,7%; maximaux (EDSS 8 à 9,5) chez 22,7% et 10,7% respectivement. La survie médiane après le début de la maladie était de 33 ans (IC à 95% de 27,3 à 38,6) chez les hommes et de 38 ans (IC à 95% de 34,1 à 41,9) chez les femmes. La durée médiane de vie était de 68,9 ans chez les hommes et de 69,5 ans chez les femmes et l'espérance de vie était diminuée de 7,7 et 12,8 ans respectivement.

Conclusions:

La SP est une maladie neurologique progressive et la survie à long terme est associée à une invalidité de modérée à sévère et à une espérance de vie réduite.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 1 , January 2010 , pp. 28 - 35
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Wallin, MT, Page, WF, Kurtzke, JF. Epidemiology of multiple sclerosis in US Veterans. VIII. Long-term survival after onset of multiple sclerosis. Brain. 2000;123:1677–87.CrossRefGoogle ScholarPubMed
2. Poser, S, Kurtzke, JF, Poser, W, Schlaf, G. Survival in multiple sclerosis. J Clin Epidemiol. 1989;42:159–68.CrossRefGoogle ScholarPubMed
3. Miller, DH, Hornabrook, CW, Purdie, G. The natural history of multiple sclerosis: a regional study with longitudinal data. J Neurol Neurosurg Psychiatry. 1992;55:341–6.CrossRefGoogle ScholarPubMed
4. Hader, WJ, Hader, MB, Ebers, GC. Survival of multiple sclerosis in London-Middlesex County, Ontario. Can J Neurol Sci. 1996;23 (1):S45.Google Scholar
5. Weinshenker, BG, Bass, B, Rice, OA, Noseworthy, J, Carriere, W, Baskerville, J, et al. The natural history of multiple sclerosis: a geographically based study. 1. Clinical course and disability. Brain. 1989;112:133–46.Google Scholar
6. Hader, WJ. The prognosis of multiple sclerosis in Saskatoon, Saskatchewan. A twenty year follow-up study. Can J Neurol Sci. 1997;24(1):S43.Google Scholar
7. Bronnum-Hansen, H, Koch-Henriksen, N, Stenager, E. Trends in survival and cause of death in Danish patients with multiple sclerosis. Brain. 2004;127:844–50.CrossRefGoogle ScholarPubMed
8. Benedikz, J Stephansson, M, Guomundsson, J, Jonasdottir, A, Fossdal, R, Gulcher, J, et al. The natural history of untreated multiple sclerosis in Iceland. A total population-based 50 year prospective study. Clin Neurol Neurosurg. 2002;104:208–10.Google Scholar
9. Ebers, G. Natural history of multiple sclerosis. In:Compston, A, Ebers, G, editors. McAlpine’s multiple sclerosis. 3rd ed. London: Churchill Livingstone; 1998. p. 191–221.Google Scholar
10. Wynn, DR, Rodriquez, M, O’Fallon, Wm, Kurland, LT. A reappraisal of the epidemiology of multiple sclerosis in Olmstead Country, Minnesota. Neurology. 1990;40:780–6.Google Scholar
11. Kurtzke, JF, Beebe, GW, Nagler, B, Nefzger, MD, Auth, TL, Kurland, LT. Studies on the natural history of multiple sclerosis. V. Long term survival in young men. Arch Neurol. 1970;22:215–25.CrossRefGoogle ScholarPubMed
12. Riise, T, Bronning, JA, Aarli, JA, Nyland, H, Larsen, JP, Edland, A. Prognostic factors for life expectancy in multiple sclerosis analysed by Cox Methods. J Clinical Epidemiology. 1988;41: 1031–6.CrossRefGoogle Scholar
13. Bronnum-Hansen, H, Koch-Henriksen, N, Hyllested, K. Survival of patients with multiple sclerosis in Denmark: a nationwide, long term epidemiologic survey. Neurology. 1994;44:1901–7.Google Scholar
14. Sumelahti, ML, Tienari, PJ, Wikstrom, J, Salminem, TM, Hakama, M. Survival of multiple sclerosis in Finland between 1964 and 1993. Multiple Sclerosis. 2002;8:350–5.CrossRefGoogle ScholarPubMed
15. Confavreux, C, Aenard, D, Devic, M. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain. 1980;103:281–300.Google Scholar
16. Hader, W, Hader, M, Atkinson, B. Disability and survival outcomes of multiple sclerosis in Saskatoon, Saskatchewan. A twenty-five year natural history study. J Neuro Sci. 2005;238(1):S68.Google Scholar
17. Hader, WJ. Prevalence of multiple sclerosis in Saskatoon. CMAJ. 1982;27:295–7.Google Scholar
18. Hader, WJ, Yee, IML. Incidence and prevalence of multiple sclerosis in Saskatoon, Saskatchewan. Neurology. 2007;69:1224–9.CrossRefGoogle ScholarPubMed
19. Allison, RS, Millar, JDH. Prevalence and familial incidence of disseminated multiple sclerosis. Ulster Med J. 1954;23(2)5–49.Google Scholar
20. Schumacher, GA, Beebe, G, Kibler, RF, Kurland, LT, Kurtzke, LF, McDowell, F, et al. Problems of experimental trials of therapy in multiple sclerosis: report by the Panel on Evaluation of Experimental Trials of Therapy in Multiple Sclerosis. Ann NY Acad Sci. 1965;122:552–68.CrossRefGoogle Scholar
21. Kurtzke, JF. On the evaluation of disability in multiple sclerosis. Neurology. 1961;11:686–94.Google Scholar
22. Kurtzke, JF. Rating neurologic improvement in multiple sclerosis: an expanded disability status scale. (EDSS) Neurology. 1983;33:1444–52.Google Scholar
23. Kaplan, EL, Meier, P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.Google Scholar
24. Weisstein, EW. Life Expectancy. Available from: http://mathworld.wolfram.com/LifeExpectancy.html Google Scholar
25. Statistics, Canada. Methodology. Life Tables Catalogue 84-532, 1984.Google Scholar
26. Statistics, Canada. Periodic Life Tables 2002. Available from: http://www12.statcan.ca Google Scholar
27. Weinshenker, BG, Ebers, GC. The natural history of multiple sclerosis. Can J Neurol Sci. 1987;14:255–61.Google Scholar
28. Kantarci, OH, Siva, A, Eraksoy, MR, Sutlas, N, Karabudak, R, Agaoglu, J, et al. Survival and predictors of disability in Turkish MS patients. Neurology. 1998;51:765–72.Google Scholar
29. Lublin, FD, Reingold, SC. Defining the clinical course of multiple sclerosis: results of an international survey. National MS Society (USA). Advisory committee on clinical trials of new agents in multiple sclerosis. Neurology. 1996;46:907–11.CrossRefGoogle ScholarPubMed
30. Matthews, WB. Course and prognosis. In: Matthews, WB, Acheson, ED, Batchelor, JR, Weller, RO, editors. McAlpine’s multiple sclerosis. London: Churchill-Livingston; 1985. p. 49–72.Google Scholar
31. Pittock, SJ. Does benign multiple sclerosis today imply benign multiple sclerosis tomorrow? Implications for treatment. Editorial. Neurology. 2007;68:480–1.Google Scholar
32. Sayao, AL, Devonshire, V, Tremlett, H. Longitudinal follow-up of “benign” multiple sclerosis at 20 years. Neurology. 2007;68: 496–500.Google Scholar
33. Skog, B, Runmarker, B, Anderson, O. A 37-50 years follow-up of the Gothenburg multiple sclerosis cohort. Mult Scler. 2004;10 Suppl:S156.Google Scholar
34. Weinshenker, BG. The natural history of multiple sclerosis. In: Antel, JP, editor. Neurologic Clinics. 1995;13(1): p. 119–46.CrossRefGoogle ScholarPubMed
35. Confavreux, C, Compston, C. The natural history of multiple sclerosis. In: Compston, A, editor. McAlpine’s multiple sclerosis. 4th ed. London. Churchill Livingstone; 2005: p. 183–269.Google Scholar
36. Confavreux, C, Vukusic, S, Moreau, T, Adeleine, P. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000;343(20):1430–8.Google Scholar
37. Sadovnick, AD, Ebers, GC, Wilson, RW, Paty, DW. Life expectancy in patients attending multiple sclerosis clinics. Neurology. 1992;42:991–4.Google Scholar