Jeannin S, Bourg V, Berthier F, Lebrun C
Service de Neurologie, CHRU NICE, Hôpital PASTEUR, 30 Voie Romaine, Nice.
Rev Neurol (Paris). 2007 Apr;163(4):440-7. doi: 10.1016/s0035-3787(07)90419-1.
In the European multiple sclerosis (MS) database registered in Nice, about 8p.cent of the patients have a North African ethnic background.
We performed a descriptive retrospective study of a cohort of 76 MS patients with a North African ethnic background followed in the Neurology Department of Nice University Hospital. This group was compared with a regional MS cohort (n=968) from our EDMUS database. Statistical analysis enabled classification of patients into three subgroups which had been submitted to different environmental factors according to where they were born and their age at immigration. There were prognostic aspects specific to each group.
Regarding the entire cohort, poor prognostic factors included male gender, onset with sequellae, and substantial brain lesions on initial T2-weighted MRI. For the subgroups, prognostic aspects specific to each group were: 1) patients of North African origin born in France had an early age of onset, delayed diagnosis, remission between two long initial expressions of MS, and rapidly developed cerebellar problems with a secondary progressive course: 2) patients having migrated after age 15 had a late age of onset, delayed diagnosis, remission between two short initial expressions of MS, an onset characterized by one symptom, which was often a motor symptom involving the spinal cord or brain stem, but late-developing cerebellar problems and secondary progressive course are frequent; 3) patients having migrated before age 15 had an onset characterized by one symptom, often a visual problem, with sequellae and rapid development of cerebellar problems.
The present study was consistent with the more unfavorable course of MS in patients of North African ethnic background previously reported in the literature. One should distinguish the subgroups to improve management of MS. Early administration of treatment should be considered for these patients, including earlier and more frequent use of immunosuppressive agents.
在尼斯注册的欧洲多发性硬化症（MS）数据库中，约8%的患者有北非种族背景。
我们对尼斯大学医院神经科随访的76例有北非种族背景的MS患者进行了描述性回顾性研究。将该组患者与我们EDMUS数据库中的一个地区性MS队列（n = 968）进行比较。统计分析能够将患者分为三个亚组，根据他们的出生地和移民时的年龄，这些亚组受到不同的环境因素影响。每个组都有特定的预后方面。
就整个队列而言，不良预后因素包括男性、伴有后遗症起病以及初始T2加权MRI上有大量脑病变。对于亚组，每个组特定的预后方面如下：1）出生在法国的北非裔患者起病年龄早、诊断延迟、在MS的两次长期初始发作之间缓解，并且小脑问题迅速发展，病程呈继发进展型；2）15岁以后移民的患者起病年龄晚、诊断延迟、在MS的两次短期初始发作之间缓解，起病以一种症状为特征，通常是涉及脊髓或脑干的运动症状，但小脑问题后期出现且继发进展型病程常见；3）15岁以前移民的患者起病以一种症状为特征，通常是视觉问题，伴有后遗症且小脑问题迅速发展。
本研究与文献中先前报道的北非种族背景患者中MS病程更不利的情况一致。应该区分亚组以改善MS的管理。对于这些患者应考虑早期给予治疗，包括更早和更频繁地使用免疫抑制剂。
