Phenotype and prognosis in African-Americans with multiple sclerosis: a retrospective chart review.
BACKGROUND
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?


METHODS
Retrospective chart analyses of a patient cohort from an academic MS center.


METHODS
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.


METHODS
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.
Naismith
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Department of Neurology, John L Trotter MS Center, Box 8111, Washington University, 660 South Euclid Avenue, Saint Louis, MO 63110, USA. naismithr@wustl.edu
Trinkaus
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Cross
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D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002183:Canes / Q000706:statistics & numerical data; D002531:Cerebellum / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009103:Multiple Sclerosis / Q000208:ethnology* / Q000503:physiopathology*; D010641:Phenotype; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014910:Wheelchairs / Q000706:statistics & numerical data