title: Is it time for a new global classification of multiple sclerosis?
abstract: BACKGROUND
  The geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates.
  
  
  OBJECTIVE
  The aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys.
  
  
  METHODS
  We conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012.
  
  
  RESULTS
  MS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6-36.2).
  
  
  CONCLUSIONS
  In the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.
authors: Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina. Electronic address: finep@infovia.com.ar.
authors: Mario O
authors: MO
authors: Melcon
authors: Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina.
authors: Jorge
authors: J
authors: Correale
authors: Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina.
authors: Carlos M
authors: CM
authors: Melcon
mesh_terms: D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D009103:Multiple Sclerosis / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies
keywords: Epidemiology worldwide; Incidence; Multiple sclerosis; Prevalence