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The Gulf War era multiple sclerosis cohort: 3. Early clinical features.
Acta Neurol Scand 2018; 137(1):76-84AN

Abstract

OBJECTIVES

To present clinical features at diagnosis for a large nationwide incident cohort of multiple sclerosis (MS) among those serving in the US military during the Gulf War era (GWE).

MATERIALS & METHODS

Medical records and databases from the Department of Veterans Affairs (VA) for cases of MS with onset in or after 1990, active duty between 1990 and 2007 and service connection by the VA, were reviewed for diagnosis and demographic variables. Neurological involvement was summarized by the Kurtzke Disability Status Scale (DSS) and the Multiple Sclerosis Severity Score (MSSS).

RESULTS

Among 1919 cases of clinically definite MS, 94% had a relapsing-remitting course and 6% were primary progressive at diagnosis. More males of all races and blacks of both sexes were progressive. At diagnosis, functional system involvement was pyramidal 69%, cerebellar 58%, sensory 55%, brainstem 45%, bowel/bladder 23%, cerebral 23%, visual 18%, and other 5%. Mean DSS scores were: white males, females 2.9, 2.7; black males, females 3.3, 2.8; and other-race males, females 3.2, 2.6. Mean and median MSSS were marginally greater in black males and other males compared to the other sex-race groups.

CONCLUSIONS

In this incident cohort, males and blacks had significantly higher proportions of primary progressive MS. DSS at diagnosis was significantly more severe in blacks and significantly less so in whites and in women vs men, but MSSS was only marginally greater in black males and other-race males. This morbidity assessment early in the course of MS provides population-based data for diagnosis, management, and prognosis.

Authors+Show Affiliations

Department of Veterans Affairs Multiple Sclerosis Center of Excellence - East, Washington, DC, USA. Department of Neurology, Georgetown University Medical School, Washington, DC, USA. Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.Department of Veterans Affairs Multiple Sclerosis Center of Excellence - East, Washington, DC, USA. Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.Department of Veterans Affairs Multiple Sclerosis Center of Excellence - East, Washington, DC, USA.Department of Veterans Affairs Multiple Sclerosis Center of Excellence - East, Washington, DC, USA. Department of Neurology, Georgetown University Medical School, Washington, DC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28832890

Citation

Wallin, M T., et al. "The Gulf War Era Multiple Sclerosis Cohort: 3. Early Clinical Features." Acta Neurologica Scandinavica, vol. 137, no. 1, 2018, pp. 76-84.
Wallin MT, Culpepper WJ, Maloni H, et al. The Gulf War era multiple sclerosis cohort: 3. Early clinical features. Acta Neurol Scand. 2018;137(1):76-84.
Wallin, M. T., Culpepper, W. J., Maloni, H., & Kurtzke, J. F. (2018). The Gulf War era multiple sclerosis cohort: 3. Early clinical features. Acta Neurologica Scandinavica, 137(1), pp. 76-84. doi:10.1111/ane.12810.
Wallin MT, et al. The Gulf War Era Multiple Sclerosis Cohort: 3. Early Clinical Features. Acta Neurol Scand. 2018;137(1):76-84. PubMed PMID: 28832890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Gulf War era multiple sclerosis cohort: 3. Early clinical features. AU - Wallin,M T, AU - Culpepper,W J, AU - Maloni,H, AU - Kurtzke,J F, Y1 - 2017/08/22/ PY - 2017/07/27/accepted PY - 2017/8/24/pubmed PY - 2018/6/21/medline PY - 2017/8/24/entrez KW - cohort KW - disability KW - epidemiology KW - multiple sclerosis KW - symptoms SP - 76 EP - 84 JF - Acta neurologica Scandinavica JO - Acta Neurol. Scand. VL - 137 IS - 1 N2 - OBJECTIVES: To present clinical features at diagnosis for a large nationwide incident cohort of multiple sclerosis (MS) among those serving in the US military during the Gulf War era (GWE). MATERIALS & METHODS: Medical records and databases from the Department of Veterans Affairs (VA) for cases of MS with onset in or after 1990, active duty between 1990 and 2007 and service connection by the VA, were reviewed for diagnosis and demographic variables. Neurological involvement was summarized by the Kurtzke Disability Status Scale (DSS) and the Multiple Sclerosis Severity Score (MSSS). RESULTS: Among 1919 cases of clinically definite MS, 94% had a relapsing-remitting course and 6% were primary progressive at diagnosis. More males of all races and blacks of both sexes were progressive. At diagnosis, functional system involvement was pyramidal 69%, cerebellar 58%, sensory 55%, brainstem 45%, bowel/bladder 23%, cerebral 23%, visual 18%, and other 5%. Mean DSS scores were: white males, females 2.9, 2.7; black males, females 3.3, 2.8; and other-race males, females 3.2, 2.6. Mean and median MSSS were marginally greater in black males and other males compared to the other sex-race groups. CONCLUSIONS: In this incident cohort, males and blacks had significantly higher proportions of primary progressive MS. DSS at diagnosis was significantly more severe in blacks and significantly less so in whites and in women vs men, but MSSS was only marginally greater in black males and other-race males. This morbidity assessment early in the course of MS provides population-based data for diagnosis, management, and prognosis. SN - 1600-0404 UR - https://www.unboundmedicine.com/medline/citation/28832890/The_Gulf_War_era_multiple_sclerosis_cohort:_3__Early_clinical_features_ L2 - https://doi.org/10.1111/ane.12810 DB - PRIME DP - Unbound Medicine ER -