Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2002 Sep;73(3):256–260. doi: 10.1136/jnnp.73.3.256

Multiple sclerosis in Malta in 1999: an update

G Dean 1, M Elian 1, A G de Bono 1, R Asciak 1, N Vella 1, V Mifsud 1, J Aquilina 1
PMCID: PMC1738011  PMID: 12185155

Abstract

Objectives: To ascertain the prevalence of multiple sclerosis (MS) in the islands of Malta and compare it with a previous study undertaken 21 years earlier, when a remarkably low prevalence was found.

Method: Deaths with MS on the death certificate since the last study were reviewed. Sources of information about new patients were the Hospital Activity Analysis scheme, the MS Society of Malta, the records of the state hospitals, long stay private hospitals and nursing homes, lists provided by the state pharmacies, and magnetic resonance imaging, cerebrospinal fluid, and evoked response studies. Prevalence day was 1 January 1999. The Poser classification was used.

Results: Since 1978, 17 patients had died with a verified diagnosis of MS on the death certificate. They included all 10 deaths with MS from the original study and two immigrants. Fifty patients had clinically definite MS (CDMS) and 13 clinically probable MS (CPMS). The prevalence of CDMS was 13.2/100 000 (male 11.2, female 15.2). The prevalence of CDMS and CPMS combined was 16.7/100 000 (male 13.3, female 19.9). The annual incidence was 0.7/100 000. Twelve patients were found with CDMS among the 7213 immigrants resident in Malta (166/100 000). The expected rate was 1/100 000, determined at Maltese born rates. There were major changes in the population distribution during the 21 years between the two studies, with a big increase in the age groups with a high risk of MS. There is a longer expectation of life and the diagnosis in now made earlier.

Conclusion: Malta still has a low MS prevalence. In comparison with Sicily and other Mediterranean countries of Europe it offers an opportunity to ascertain the genetic and environmental factors responsible for the disease.

Full Text

The Full Text of this article is available as a PDF (136.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bufill E., Blesa R., Galan I., Dean G. Prevalence of multiple sclerosis in the region of Osona, Catalonia, northern Spain. J Neurol Neurosurg Psychiatry. 1995 May;58(5):577–581. doi: 10.1136/jnnp.58.5.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Dean G., Aksoy H., Akalin T., Middleton L., Kyriallis K. Multiple sclerosis in the Turkish- and Greek-speaking communities of Cyprus. A United Nations (UNHCR) Bicommunal Project. J Neurol Sci. 1997 Feb 12;145(2):163–168. doi: 10.1016/s0022-510x(96)00255-9. [DOI] [PubMed] [Google Scholar]
  3. Dean G., Brady R., McLoughlin H. Motor neurone disease and multiple sclerosis among immigrants to Britain. Br J Prev Soc Med. 1977 Sep;31(3):141–147. doi: 10.1136/jech.31.3.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dean G., Elian M. Epidemiological data for multiple sclerosis in Greece. Neuroepidemiology. 1985;4(1):59–60. doi: 10.1159/000110214. [DOI] [PubMed] [Google Scholar]
  5. Dean G., Elian M. Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales. J Neurol Neurosurg Psychiatry. 1993 Jun;56(6):633–637. doi: 10.1136/jnnp.56.6.633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dean G., Goodall J., Downie A. The prevalence of multiple sclerosis in the Outer Hebrides compared with north-east Scotland and the Orkney and Shetland Islands. J Epidemiol Community Health. 1981 Jun;35(2):110–113. doi: 10.1136/jech.35.2.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dean G., Grimaldi G., Kelly R., Karhausen L. Multiple sclerosis in southern Europe. I: Prevalence in Sicily in 1975. J Epidemiol Community Health. 1979 Jun;33(2):107–110. doi: 10.1136/jech.33.2.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dean G., McLoughlin H., Brady R., Adelstein A. M., Tallett-Williams J. Multiple sclerosis among immigrants in Greater London. Br Med J. 1976 Apr 10;1(6014):861–864. doi: 10.1136/bmj.1.6014.861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dean G., Savettieri G., Giordano D., Butera C., Taibi G., Morreale S., Karhausen L. The prevalence of multiple sclerosis in Sicily. II: Agrigento city. J Epidemiol Community Health. 1981 Jun;35(2):118–122. doi: 10.1136/jech.35.2.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Elian M., Alonso A., Awad J., Dean G., Okoye R., Sachs J., Savettieri G., Vassallo L., Festenstein H. HLA associations with multiple sclerosis in Sicily and Malta. Dis Markers. 1987 Jun;5(2):89–99. [PubMed] [Google Scholar]
  11. Elian M., Dean G. Multiple sclerosis among the United Kingdom-born children of immigrants from the West Indies. J Neurol Neurosurg Psychiatry. 1987 Mar;50(3):327–332. doi: 10.1136/jnnp.50.3.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Elian M., Nightingale S., Dean G. Multiple sclerosis among United Kingdom-born children of immigrants from the Indian subcontinent, Africa and the West Indies. J Neurol Neurosurg Psychiatry. 1990 Oct;53(10):906–911. doi: 10.1136/jnnp.53.10.906. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Fernández O., Luque G., San Román C., Bravo M., Dean G. The prevalence of multiple sclerosis in the Sanitary District of Vélez-Málaga, southern Spain. Neurology. 1994 Mar;44(3 Pt 1):425–429. doi: 10.1212/wnl.44.3_part_1.425. [DOI] [PubMed] [Google Scholar]
  14. Granieri E., Casetta I., Govoni V., Tola M. R., Marchi D., Murgia S. B., Ticca A., Pugliatti M., Murgia B., Rosati G. The increasing incidence and prevalence of MS in a Sardinian province. Neurology. 2000 Sep 26;55(6):842–848. doi: 10.1212/wnl.55.6.842. [DOI] [PubMed] [Google Scholar]
  15. Granieri E., Casetta I., Tola M. R. Epidemiology of multiple sclerosis in Italy and in southern Europe. Acta Neurol Scand Suppl. 1995;161:60–70. doi: 10.1111/j.1600-0404.1995.tb05859.x. [DOI] [PubMed] [Google Scholar]
  16. Granieri E., Tola R., Paolino E., Rosati G., Carreras M., Monetti V. C. The frequency of multiple sclerosis in Italy: a descriptive study in Ferrara. Ann Neurol. 1985 Jan;17(1):80–84. doi: 10.1002/ana.410170117. [DOI] [PubMed] [Google Scholar]
  17. Grimaldi L. M., Salemi G., Grimaldi G., Rizzo A., Marziolo R., Lo Presti C., Maimone D., Savettieri G. High incidence and increasing prevalence of MS in Enna (Sicily), southern Italy. Neurology. 2001 Nov 27;57(10):1891–1893. doi: 10.1212/wnl.57.10.1891. [DOI] [PubMed] [Google Scholar]
  18. Middleton L. T., Dean G. Multiple sclerosis in Cyprus. J Neurol Sci. 1991 May;103(1):29–36. doi: 10.1016/0022-510x(91)90279-g. [DOI] [PubMed] [Google Scholar]
  19. Morganti G., Naccarato S., Elian M., Ferrari P., Kelly R., Karhausen L., Dean G. Multiple sclerosis in the Republic of San Marino. J Epidemiol Community Health. 1984 Mar;38(1):23–28. doi: 10.1136/jech.38.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Poser C. M., Paty D. W., Scheinberg L., McDonald W. I., Davis F. A., Ebers G. C., Johnson K. P., Sibley W. A., Silberberg D. H., Tourtellotte W. W. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983 Mar;13(3):227–231. doi: 10.1002/ana.410130302. [DOI] [PubMed] [Google Scholar]
  21. Rosati G., Aiello I., Pirastru M. I., Mannu L., Demontis G., Becciu S., Sau G., Zoccheddu A. Sardinia, a high-risk area for multiple sclerosis: a prevalence and incidence study in the district of Alghero. Ann Neurol. 1987 Feb;21(2):190–194. doi: 10.1002/ana.410210212. [DOI] [PubMed] [Google Scholar]
  22. Savettieri G., Daricello B., Giordano D., Karhausen L., Dean G. The prevalence of multiple sclerosis in Sicily. I: Monreale city. J Epidemiol Community Health. 1981 Jun;35(2):114–117. doi: 10.1136/jech.35.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Savettieri G., Elian M., Giordano D., Grimaldi G., Ventura A., Dean G. A further study on the prevalence of multiple sclerosis in Sicily: Caltanissetta city. Acta Neurol Scand. 1986 Jan;73(1):71–75. doi: 10.1111/j.1600-0404.1986.tb03243.x. [DOI] [PubMed] [Google Scholar]
  24. Savettieri G., Salemi G., Ragonese P., Aridon P., Scola G., Randisi G. Prevalence and incidence of multiple sclerosis in the city of Monreale, Italy. J Neurol. 1998 Jan;245(1):40–43. doi: 10.1007/s004150050172. [DOI] [PubMed] [Google Scholar]
  25. Sironi L., Mamoli A., D'Alessandro G., Camerlingo M., Bottacchi E. Frequency of multiple sclerosis in Valle d'Aosta, 1971-1985. Neuroepidemiology. 1991;10(2):66–69. doi: 10.1159/000110249. [DOI] [PubMed] [Google Scholar]
  26. Uria D. F., Abad P., Calatayud M. T., Virgala P., Diaz A., Chamizo C., Dean G. Multiple sclerosis in Gijon health district, Asturias, northern Spain. Acta Neurol Scand. 1997 Dec;96(6):375–379. doi: 10.1111/j.1600-0404.1997.tb00301.x. [DOI] [PubMed] [Google Scholar]
  27. Vassallo L., Elian M., Dean G. Multiple sclerosis in southern Europe. II: Prevalence in Malta in 1978. J Epidemiol Community Health. 1979 Jun;33(2):111–113. doi: 10.1136/jech.33.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES