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Temporal changes and geographical differences in multiple sclerosis phenotypes in Japanese: nationwide survey results over 30 years

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

J Kira

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan kira{at}neuro.med.kyushu-u.ac.jp

T Fukazawa

Department of Neurology, Nishimaruyama Hospital, Sapporo, Japan

K Fujihara

Department of Neurology, Tohoku University School of Medicine, Sendai, Japan

S Kikuchi

Department of Neurology, Sapporo-Minami National Hospital, Sapporo, Japan

M Matsui

Department of Neurology, Kanazawa Medical University, Kanazawa, Japan

T Kohriyama

Department of Clinical Neuroscience and Therapeutics, Division of Integrated Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

G Sobue

Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan

T Yamamura

Department of Immunology, National Institute of Neuroscience, NCNP, Tokyo, Japan

Y Itoyama

Department of Neurology, Tohoku University School of Medicine, Sendai, Japan

T Saida

Department of Neurology, Center for Neurological Diseases, Utano National Hospital, Kyoto, Japan

K Sakata

Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Morioka, Japan

H Ochi

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

T Matsuoka

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

and The Research Committee of Neuroimmunological Diseases

Background

There are two distinct phenotypes of multiple sclerosis (MS) in Asians, manifesting as optic-spinal (OSMS) and conventional (CMS) forms. In Japan, four nationwide surveys of MS have been conducted. The first three were in 1972, 1982, and 1989, and we performed the fourth in 2004.

Results

The recent survey showed six main findings as follows: (1) a four-fold increase in the estimated number of clinically definite patients with MS in 2003 (9900; crude MS prevalence, 7.7/100,000) compared with 1972; (2) a shift in the peak age at onset from early 30s in 1989 to early 20s in 2003; (3) a successive proportional decrease in optic-spinal involvement in clinically definite patients with MS; (4) a significant north–south gradient for the CMS/OSMS ratio; (5) after subdivision of the mainland (30–45° North) into northern and southern parts at 37°N, northern-born northern residents (northern patients) showed a significantly higher CMS/OSMS ratio and higher frequency of brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) than southern-born southern residents (southern patients); (6) among northern patients, the absolute numbers of patients with CMS and those with Barkhof brain lesions rapidly increased with advancing birth year.

Conclusions

These findings suggest that MS phenotypes are drastically altered by environmental factors, such as latitude and "Westernization."

Key Words: epidemiology • Japanese • latitude • magnetic resonance imaging • multiple sclerosis • optic-spinal

This version was published on February 1, 2009

Multiple Sclerosis, Vol. 15, No. 2, 159-173 (2009)
DOI: 10.1177/1352458508098372


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