ABSTRACT
Introducción. La esclerosis múltiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central con patogenia inmunomediada. Recientes estudios indican un aumento de su prevalencia, y numerosos trabajos relacionan el virus de Epstein-Barr (VEB) con su etiología. Objetivo. Análisis de prevalencia de la EM en la Región de Murcia, incluyendo la descripción de las características clínicas en el momento del inicio de la enfermedad, y del estado serológico del VEB de los pacientes con EM. Pacientes y métodos. Estudio epidemiológico retrospectivo, tomando como muestra la población residente en el área sanitaria centro-oeste de la Región de Murcia (257.865 habitantes). Se analizan datos clínicos y serológicos extraídos de diferentes fuentes. Resultados. Prevalencia de la EM en la población estudiada: 88 casos/100.000 habitantes. Prevalencia de la EM junto con el síndrome desmielinizante aislado: 98,4 casos/100.000 habitantes. Incidencia media de la EM: 5,8 casos/100.000 habitantes/año. En el inicio de la EM, el 67,8% eran mujeres, el 81,9% presentaba un curso recurrente-remitente, la edad media era de 31,4 años, el sistema funcional más frecuentemente afectado era el sensitivo (45,1%), el inicio fue monofocal en el 55,4% y el grado de discapacidad en la Expanded Disability Status Scale era de 2,1 puntos. La seroprevalencia del VEB fue del 99,3%. La reactivación de la infección por VEB se relacionó con actividad clínica de EM en 10 pacientes (45,4%). Conclusiones. Actualmente, la prevalencia de la EM en la Región de Murcia es similar a la estimada en otras comunidades autónomas españolas. El estudio confirma la tendencia de incremento de prevalencia observada en las últimas décadas (AU)
Introduction. Multiple sclerosis (MS) is a demyelinating inflammatory disease of the central nervous system with immunemediated pathogenesis. Recent research points to an increase in its prevalence, and a number of studies relate EpsteinBarr virus (EBV) with its aetiology. Aims. This study seeks to analyse the prevalence of MS in the Region of Murcia, and includes a description of the clinical characteristics at the time of onset of the disease, and of the EBV serological status of patients with MS. Patients and methods. We conducted a retrospective epidemiological study based on a sample consisting of the population living within the central-west healthcare area of the Region of Murcia (257,865 inhabitants). Clinical and serological data extracted from different sources were analysed. Results. Prevalence of MS in the population under study: 88 cases/100,000 inhabitants. Prevalence of MS together with isolated demyelinating syndrome: 98.4 cases/100,000 inhabitants. Mean incidence of MS: 5.8 cases/100,000 inhabitants/ year. At the onset of MS, 67.8% were females, 81.9% presented a relapsing-remitting course, the mean age was 31.4 years, the sensory system was the most frequently compromised (45.1%), onset was monofocal in 55.4% and the degree of disability on the Expanded Disability Status Scale was 2.1 points. The seroprevalence of EBV was 99.3%. The reactivation of EBV infection was related to the clinical activity of MS in 10 patients (45.4%). Conclusions. Currently, the prevalence of MS in the Region of Murcia is similar to that estimated in other Spanish autonomous regions. The study confirms the trend of increased prevalence observed over the last few decades (AU)
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Multiple Sclerosis/epidemiology , Multiple Sclerosis/etiology , Multiple Sclerosis/pathology , Incidence , Prevalence , Herpesvirus 4, Human/metabolism , Herpesvirus 4, Human/physiology , Herpesvirus 4, Human/pathogenicity , Health Profile , Serologic Tests/instrumentation , Serologic Tests/methods , Serologic Tests , Demyelinating Diseases/epidemiology , Demyelinating Diseases/pathology , Demyelinating Diseases/prevention & control , Nervous System Diseases/diagnosis , Nervous System Diseases/pathology , Nervous System Diseases/prevention & control , Retrospective Studies , Epidemiology, Descriptive , Spain/epidemiologyABSTRACT
OBJECTIVE: The aim of this study was to determine the possible relationship between the Sp1 polymorphism of gene COL1A1 and bone metabolism disorder in individuals with epilepsy. METHODS: To this end, we carried out an observational cross-sectional study on 64 patients in monotherapy with an antiepileptic drug. The patients were classified on the basis of the presence of the 's' allele of the COL1A1 Sp1 polymorphism. RESULTS: In the patients with SS, the standardized bone mineral density (sBMD) in the left femoral neck was 1024.9±206.1 mg/cm, whereas in the patients with Ss or ss, the density was significantly lower, 917±141.4 mg/cm (P=0.027), as was the femoral t-score (0.72±1.67 vs. -0.29±1.15, P=0.01). The values in the lumbar spine were equally greater in those with SS: 1219.1±236.3 versus 1090.5±142.7 mg/cm for the sBMD (P=0.018) and 0.67±1.98 versus -0.34±1.16 for the lumbar t-score (P=0.023). The bone biomarkers showed no significant differences nor did the 25-OH vitamin D and parathormone values. In the patient group treated with valproic acid (VPA), the densitometric values were significantly lower in the Ss or ss patients compared with SS homozygotes: 887.1±142.6 versus 1120.6±198.2 mg/cm for femoral sBMD (P=0.02), 990±98.1 versus 1417±251.2 mg/cm for lumbar sBMD (P=0.001). Of the patients who were carriers of the 's' allele and who were treated with VPA, 86% achieved osteopenia values. CONCLUSION: In our study, the presence of the 's' allele of the COL1A1 Sp1 polymorphism in individuals with epilepsy was related to lower bone BMD (lumbar and femoral). This relationship seemed to be further apparent in the patients undergoing treatment with VPA.
