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. 2003 Jan;74(1):25–28. doi: 10.1136/jnnp.74.1.25

Multiple sclerosis in Finland: incidence trends and differences in relapsing remitting and primary progressive disease courses

M Sumelahti 1, P Tienari 1, M Hakama 1, J Wikstrom 1
PMCID: PMC1738192  PMID: 12486261

Abstract

Objective: To compare the secular trends and geographical differences in the incidence of relapsing-remitting (RRMS) and primary progressive multiple sclerosis (PPMS) in Finland, and to draw inferences about aetiological differences between the two forms of the disease.

Methods: New multiple sclerosis cases in southern Uusimaa and the western districts Vaasa and Seinäjoki of Finland in 1979–1993 were verified from hospital records and classified into RRMS and PPMS. Patients met the Poser criteria for definite multiple sclerosis or otherwise satisfied the criteria for PPMS. Disease course was categorised by the same neurologist. Crude and age adjusted incidence in 1979–1993 was estimated.

Results: During 1979–1993 the age adjusted incidence was 5.1 per 100 000 person-years in Uusimaa, 5.2 in Vaasa, and 11.6 in Seinäjoki. The rates in Uusimaa remained stable, while a decrease occurred in Vaasa and an increase in Seinäjoki. Between 1979–86 and 1987–93 the incidence of PPMS increased in Seinäjoki from 2.6 to 3.7 per 105 and decreased in Vaasa from 1.9 to 0.2 per 105; the trends were similar for RRMS.

Conclusions: There are significant differences in secular trends for multiple sclerosis incidence in Finland by geographical area, but these are similar for PPMS and RRMS. The recent changes point to locally acting environmental factors. The parallel incidence trends for RRMS and PPMS suggest similar environmental triggers for the two clinical presentations of multiple sclerosis.

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Selected References

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  1. Bashir K., Whitaker J. N. Clinical and laboratory features of primary progressive and secondary progressive MS. Neurology. 1999 Sep 11;53(4):765–771. doi: 10.1212/wnl.53.4.765. [DOI] [PubMed] [Google Scholar]
  2. Challoner P. B., Smith K. T., Parker J. D., MacLeod D. L., Coulter S. N., Rose T. M., Schultz E. R., Bennett J. L., Garber R. L., Chang M. Plaque-associated expression of human herpesvirus 6 in multiple sclerosis. Proc Natl Acad Sci U S A. 1995 Aug 1;92(16):7440–7444. doi: 10.1073/pnas.92.16.7440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Confavreux C., Aimard G., Devic M. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain. 1980 Jun;103(2):281–300. doi: 10.1093/brain/103.2.281. [DOI] [PubMed] [Google Scholar]
  4. Grønning M., Riise T., Kvåle G., Nyland H., Larsen J. P., Aarli J. A. Incidence of multiple sclerosis in Hordaland, western Norway: a fluctuating pattern. Neuroepidemiology. 1991;10(2):53–61. doi: 10.1159/000110247. [DOI] [PubMed] [Google Scholar]
  5. Kinnunen E., Koskimies S., Lagerstedt A., Wikström J. Histocompatibility antigens in familial multiple sclerosis in a high-risk area of the disease. J Neurol Sci. 1984 Aug;65(2):147–155. doi: 10.1016/0022-510x(84)90079-0. [DOI] [PubMed] [Google Scholar]
  6. Kinnunen E., Wikström J., Porras J., Palo J. The epidemiology of multiple sclerosis in Finland: increase of prevalence and stability of foci in high-risk areas. Acta Neurol Scand. 1983 May;67(5):255–262. doi: 10.1111/j.1600-0404.1983.tb04574.x. [DOI] [PubMed] [Google Scholar]
  7. Kremenchutzky M., Cottrell D., Rice G., Hader W., Baskerville J., Koopman W., Ebers G. C. The natural history of multiple sclerosis: a geographically based study. 7. Progressive-relapsing and relapsing-progressive multiple sclerosis: a re-evaluation. Brain. 1999 Oct;122(Pt 10):1941–1950. doi: 10.1093/brain/122.10.1941. [DOI] [PubMed] [Google Scholar]
  8. Kurtzke J. F. Geography in multiple sclerosis. J Neurol. 1977 Apr 28;215(1):1–26. doi: 10.1007/BF00312546. [DOI] [PubMed] [Google Scholar]
  9. Larsen J. P., Aarli J. A., Nyland H., Riise T. Western Norway, a high-risk area for multiple sclerosis: a prevalence/incidence study in the county of Hordaland. Neurology. 1984 Sep;34(9):1202–1207. doi: 10.1212/wnl.34.9.1202. [DOI] [PubMed] [Google Scholar]
  10. Larsen J. P., Kvaale G., Riise T., Nyland H., Aarli J. A. Multiple sclerosis--more than one disease? Acta Neurol Scand. 1985 Aug;72(2):145–150. doi: 10.1111/j.1600-0404.1985.tb00856.x. [DOI] [PubMed] [Google Scholar]
  11. Lublin F. D., Reingold S. C. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996 Apr;46(4):907–911. doi: 10.1212/wnl.46.4.907. [DOI] [PubMed] [Google Scholar]
  12. Masterman T., Ligers A., Olsson T., Andersson M., Olerup O., Hillert J. HLA-DR15 is associated with lower age at onset in multiple sclerosis. Ann Neurol. 2000 Aug;48(2):211–219. [PubMed] [Google Scholar]
  13. McDonnell G. V., Hawkins S. A. Clinical study of primary progressive multiple sclerosis in Northern Ireland, UK. J Neurol Neurosurg Psychiatry. 1998 Apr;64(4):451–454. doi: 10.1136/jnnp.64.4.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Minderhoud J. M., van der Hoeven J. H., Prange A. J. Course and prognosis of chronic progressive multiple sclerosis. Results of an epidemiological study. Acta Neurol Scand. 1988 Jul;78(1):10–15. doi: 10.1111/j.1600-0404.1988.tb03611.x. [DOI] [PubMed] [Google Scholar]
  15. Nevanlinna H. R. Genetic markers in Finland. Haematologia (Budap) 1980;13(1-4):65–74. [PubMed] [Google Scholar]
  16. Noseworthy J., Paty D., Wonnacott T., Feasby T., Ebers G. Multiple sclerosis after age 50. Neurology. 1983 Dec;33(12):1537–1544. doi: 10.1212/wnl.33.12.1537. [DOI] [PubMed] [Google Scholar]
  17. Olerup O., Hillert J., Fredrikson S., Olsson T., Kam-Hansen S., Möller E., Carlsson B., Wallin J. Primarily chronic progressive and relapsing/remitting multiple sclerosis: two immunogenetically distinct disease entities. Proc Natl Acad Sci U S A. 1989 Sep;86(18):7113–7117. doi: 10.1073/pnas.86.18.7113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Phadke J. G. Clinical aspects of multiple sclerosis in north-east Scotland with particular reference to its course and prognosis. Brain. 1990 Dec;113(Pt 6):1597–1628. doi: 10.1093/brain/113.6.1597. [DOI] [PubMed] [Google Scholar]
  19. 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]
  20. Revesz T., Kidd D., Thompson A. J., Barnard R. O., McDonald W. I. A comparison of the pathology of primary and secondary progressive multiple sclerosis. Brain. 1994 Aug;117(Pt 4):759–765. doi: 10.1093/brain/117.4.759. [DOI] [PubMed] [Google Scholar]
  21. Rinne U. K., Panelius M., Kivalo E., Hokkanen E., Palo J. Distribution of multiple sclerosis in Finland, with special reference to some geological factors. Acta Neurol Scand. 1966;42(4):385–399. doi: 10.1111/j.1600-0404.1966.tb01191.x. [DOI] [PubMed] [Google Scholar]
  22. Robertson N., Compston A. Surveying multiple sclerosis in the United Kingdom. J Neurol Neurosurg Psychiatry. 1995 Jan;58(1):2–6. doi: 10.1136/jnnp.58.1.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Sirén M. K., Sareneva H., Lokki M. L., Koskimies S. Unique HLA antigen frequencies in the Finnish population. Tissue Antigens. 1996 Dec;48(6):703–707. doi: 10.1111/j.1399-0039.1996.tb02695.x. [DOI] [PubMed] [Google Scholar]
  24. Sumelahti M. L., Tienari P. J., Wikström J., Palo J., Hakama M. Regional and temporal variation in the incidence of multiple sclerosis in Finland 1979-1993. Neuroepidemiology. 2000 Mar-Apr;19(2):67–75. doi: 10.1159/000026241. [DOI] [PubMed] [Google Scholar]
  25. Thompson A. J., Kermode A. G., MacManus D. G., Kendall B. E., Kingsley D. P., Moseley I. F., McDonald W. I. Patterns of disease activity in multiple sclerosis: clinical and magnetic resonance imaging study. BMJ. 1990 Mar 10;300(6725):631–634. doi: 10.1136/bmj.300.6725.631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Thompson A. J., Polman C. H., Miller D. H., McDonald W. I., Brochet B., Filippi M Montalban X., De Sá J. Primary progressive multiple sclerosis. Brain. 1997 Jun;120(Pt 6):1085–1096. doi: 10.1093/brain/120.6.1085. [DOI] [PubMed] [Google Scholar]
  27. Tienari P. J., Wikström J., Sajantila A., Palo J., Peltonen L. Genetic susceptibility to multiple sclerosis linked to myelin basic protein gene. Lancet. 1992 Oct 24;340(8826):987–991. doi: 10.1016/0140-6736(92)93007-a. [DOI] [PubMed] [Google Scholar]
  28. Warren S., Warren K. G. Prevalence, incidence, and characteristics of multiple sclerosis in Westlock County, Alberta, Canada. Neurology. 1993 Sep;43(9):1760–1763. doi: 10.1212/wnl.43.9.1760. [DOI] [PubMed] [Google Scholar]
  29. Weatherby S. J., Thomson W., Pepper L., Donn R., Worthington J., Mann C. L., Davies M. B., Fryer A. A., Boggild M. D., Young C. A. HLA-DRB1 and disease outcome in multiple sclerosis. J Neurol. 2001 Apr;248(4):304–310. doi: 10.1007/s004150170205. [DOI] [PubMed] [Google Scholar]
  30. Weinshenker B. G., Bass B., Rice G. P., Noseworthy J., Carriere W., Baskerville J., Ebers G. C. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989 Feb;112(Pt 1):133–146. doi: 10.1093/brain/112.1.133. [DOI] [PubMed] [Google Scholar]
  31. Wikström J., Palo J. Studies on the clustering of multiple sclerosis in Finland I: Comparison between the domiciles and places of birth in selected subpopulations. Acta Neurol Scand. 1975 Feb;51(2):85–98. doi: 10.1111/j.1600-0404.1975.tb01362.x. [DOI] [PubMed] [Google Scholar]
  32. Wikström J. Studies on the clustering of multiple sclerosis in Finland II: microepidemiology in one high-risk county with special reference to familial cases. Acta Neurol Scand. 1975 Mar;51(3):173–183. doi: 10.1111/j.1600-0404.1975.tb07598.x. [DOI] [PubMed] [Google Scholar]
  33. de la Chapelle A. Disease gene mapping in isolated human populations: the example of Finland. J Med Genet. 1993 Oct;30(10):857–865. doi: 10.1136/jmg.30.10.857. [DOI] [PMC free article] [PubMed] [Google Scholar]

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