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Etemadifar Masoud, Sedaghat Nahad, Sbeity Hussien, Kaveyee Hasan
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Оригинал публикации
Prevalence of Stroke in People with Multiple Sclerosis.
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https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Multiple sclerosis (MS) is a chronic condition affecting the central nervous system (CNS). MS is associated with various comorbidities, including cardiovascular diseases, neurological disturbances, stroke, hypertension, and metabolic disorders.[ 1 ] stroke characterized by malperfusion of CNS tissue, is among the significant comorbidities observed in MS patients.[ 2 3 ] We undertook a study aimed at determining the prevalence of stroke among pwMS in Isfahan, Iran.
The study presented herein (approved by the Isfahan University of Medical Sciences [IR.MUI.MED.REC.1401.256]) was an observational, cross-sectional study on the pwMS seen regularly at the Isfahan MS clinic from 2018 to 2022. Inclusion was based on the following criteria:
Being diagnosed based on McDonald’s criteria a year before interview; and Residence within the Isfahan province.
Being diagnosed based on McDonald’s criteria a year before interview; and
Residence within the Isfahan province.
Participants were interviewed by their MS neurologist either in person or via telephone calls, and the MS neurologist documented results in electronic forms. Data items included sociodemographics (current age, sex, and ethnicity), and MS-related characteristics (age at MS onset, MS subtype, expanded disability status scale score [EDSS], and disease modifying therapy (DMT)). WHO International Classification of Diseases (ICD)-10 codes I61 (intracerebral hemorrhage [ICH]), I62 (other nontraumatic intracranial hemorrhage), and I63 (cerebral infarction) were used as definitions of stroke. An incident stroke was identified through comprehensive history taking neurological examination and confirmed through neuroimaging.
Interviews with 2465 pwMS (1965 females, 500 males/RRMS = 2251, SPMS = 214) revealed 10 (0.4%) cases of incident stroke (six ICH and four cerebral infarctions). Table 1 summarizes their features. The crude stroke prevalence was 41 (95% CI 19, 74) per 10,000 pwMS. Stroke patients were 70% female (7 persons, 35.6 per 10000 female patients, 95% CI = 9.3, 61.9) and 30% male (3 individuals, 60 per 10,000 male patients, 95% CI = 12, 108) with a P value of 0.438. The mean (SD) age of MS patients with stroke and disease onset was 51.8 (9.28) and 38.8 (10.23) years. The mean (SD) time between MS diagnosis and stroke was 6.5 (2.91) years. The mean (SD) EDSS score was 2.05(±0.3).
Table 1 Demographic information of MS patients that had stroke attack Patient Number Sex Age (years) Age at MS Start (years) Duration between MS and Stroke (years) First MS sign MS type MS medication Last EDSS Past medical history Stroke type (ischemic– hemorrhagic) Bleeding site 1 Male 57 29 8 Quadriplegia + Paresthesia SPMS Natalizuamb 3 - Ischemic Left Occiput 2 Female 63 47 10 Upper limbs paresthesia RRMS Interferon beta 1-a 1.5 Ulcerative colitis Hemorrhagic Right Parietal Lobe 3 Female 45 33 5 Right facial paresthesia + diplopia RRMS Interferon beta1-a 1.5 - Hemorrhagic Parietal Lobe 4 Female 58 48 8 Upper limbs paresthesia RRMS Dimethyl fumarate 1 Hypertension + Diabetes type 1 Ischemic Lacunar in internal capsule 5 Female 50 40 3 Vertigo, ataxia SPMS Rituximab 4 Asthma Hemorrhagic Left temporal and parietal 6 Male 58 49 6 Left lower limb Weakness RRMS Interferon beta 1-a 1.5 Hypertension Ischemic Medulla 7 Female 49 21 10 Lower limbs paresthesia + diplopia RRMS Dimethyl fumarate 1 - Ischemic Left middle cerebral artery branch 8 Female 55 45 9 Upper limbs paresthesia RRMS Teriflunomide 1.5 - Hemorrhagic Pons 9 Male 30 28 2 Diplopia RRMS Dimethyl fumarate 1 Hypertension Hemorrhagic Left Parietal 10 Female 53 48 4 Lower limbs weakness SPMS Dimethyl fumarate 3 - Hemorrhagic Thalamus
Demographic information of MS patients that had stroke attack
Regarding the clinical subtypes of MS at the time of stroke, 70% of the ones with stroke had RRMS (31 per 10000 of RRMS patients, 95% CI = 8.2, 54), whereas the remaining 30% had SPMS (140 per 10,000 of SPMS patients, 95% CI = 0, 298) with a P value of 0.013.
Our study on pwMS from Isfahan revealed a stroke prevalence of 41 (95% CI 19, 74) per 10,000 persons, underscoring the relevance of this comorbidity in clinical practice.[ 2 4 ] Diet, smoking, and nonsteroidal anti-inflammatory drug (NSAID) use affect MS comorbidities and stroke risk, showing the complex relationship between environmental and biological factors.[ 3 ] Moreover, MS patients often have cardiovascular comorbidities such hypertension and hyperlipidemia, which increase their stroke risk.[ 5 ] One of the most common risk factors for stroke in our stroke affected MS patients was hypertension ( n = 3, 30%). Thus, cardiovascular prevention for MS patients may prevent strokes.
In conclusion, the co-occurrence of MS and stroke poses a significant challenge in clinics, as they share clinical attributes, and contribute to substantial disability for affected individuals.
Ethical considerations and code of ethics
Ethical approval was obtained from the Isfahan University of Medical Sciences with the code of [IR.MUI.MED.REC.1401.256]; ensuring that the study met all necessary standards and regulations.
Conflicts of interest
There are no conflicts of interest.