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Phenotype and prognosis in African-Americans with multiple sclerosis: a retrospective chart review
R T Naismith1, K Trinkaus, A H Cross
1Department of Neurology, John L Trotter MS Center, Box 8111, Washington University, 660 South Euclid Avenue, Saint Louis, MO 63110, USA. naismithr@wustl.edu
Context:
There is an emerging body of literature regarding multiple sclerosis (MS) in African-Americans (AA) that suggests more rapid progression and a worse prognosis in this group. A phenotype of opticospinal MS has been proposed by some publications.
Objective:
To determine whether AA with MS have a different clinical phenotype, different distribution of clinical subtypes, and/or different levels of disability than Caucasians (CA) with MS. Specifically, is the disability attributable to severe cerebellar disease, which limits ambulation and function?
Design:
Retrospective chart analyses of a patient cohort from an academic MS center.
Patients:
A total of 86 AA were identified with MS, 79 were followed for > or = 5 years. The control group consisted of 80 randomly-selected CA with MS and similar follow-up.
Outcome Measures:
EDSS at diagnosis, five-year follow-up, and last follow-up; time to walking assistance device; disease subtype; involved functional systems.
Results:
AA MS patients displayed more cerebellar dysfunction, and worse EDSS scores at diagnosis, at four to six years follow-up from diagnosis, and at last follow-up compared to the CA MS patients with similar length of follow-up. AA MS patients had earlier and more frequent gait difficulty requiring use of a cane or wheelchair. AA MS patients had a higher prevalence of primary progressive (PP) MS (22 versus 9%) and a lower rate of relapsing-remitting (RR) MS (30 versus 52%) compared to CA.
Conclusions:
Compared to CA patients, MS in AA is characterized by a higher incidence of cerebellar dysfunction and a more rapid accumulation of disabilities. In this cohort, AA patients had a relatively higher rate of the PPMS subtype. These data suggest the presence of fundamental differences in the clinical phenotype and the natural history of MS in AA.
Insights
Multiple sclerosis (MS) in African Americans (AA) shows faster progression and greater disability, particularly cerebellar dysfunction, compared to Caucasians (CA). AA patients also exhibit a higher rate of primary progressive MS.
Area of Science:
- Neurology
- Immunology
- Genetics
Background:
- Emerging research suggests multiple sclerosis (MS) in African Americans (AA) presents with more aggressive disease progression and poorer prognosis.
- A distinct opticospinal MS phenotype has been proposed for AA patients.
Purpose of the Study:
- To investigate clinical phenotype differences in MS between African Americans (AA) and Caucasians (CA).
- To compare disease subtype distribution and disability levels, specifically focusing on cerebellar involvement impacting ambulation.
Main Methods:
- Retrospective analysis of a patient cohort from an academic MS center.
- Comparison of 86 AA MS patients (79 with >5 years follow-up) against 80 randomly selected CA MS patients with similar follow-up durations.
- Evaluation of Expanded Disability Status Scale (EDSS) scores, time to mobility aid use, disease subtype, and functional system involvement.
Main Results:
- AA MS patients exhibited significantly more cerebellar dysfunction and worse EDSS scores at diagnosis and throughout follow-up compared to CA MS patients.
- AA MS patients experienced earlier and more frequent gait impairment requiring assistive devices.
- AA MS patients presented with a higher prevalence of primary progressive MS (PPMS) and a lower rate of relapsing-remitting MS (RRMS) than CA MS patients.
Conclusions:
- MS in AA is characterized by increased cerebellar dysfunction and accelerated disability accumulation compared to CA.
- The AA MS cohort demonstrated a higher proportion of PPMS cases.
- These findings indicate significant differences in the clinical presentation and natural history of MS between AA and CA populations.
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