Neurology Department, Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia.
Neuroscience Department, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
Neurol Sci. 2018 May;39(5):879-884. doi: 10.1007/s10072-018-3295-4. Epub 2018 Feb 23.
Data regarding multiple sclerosis (MS) course in North Africans are scarce and mainly retrospective. To prospectively assess disability progression of multiple sclerosis in Tunisia. Analysis was performed in 600 patients from the MS database of the Mongi Ben Hmida National Institute of Neurology (Tunis, Tunisia), prospectively recorded over a 10-year period. Two MS phases were defined: phase 1, from MS clinical onset to Disability Status Scale (DSS) 3; and phase 2, from DSS 3 to DSS 6. Median durations of both phases and median ages at DSS 3 and DSS 6 were estimated using the Kaplan-Meier method. Median ages at DSS scores 3 and 6 were 48 years (95% confidence interval (CI), 45-50) and 53 years (95% CI, 52-55), respectively. Median time from onset to DSS 3 (phase 1 duration) was 9 years (95% CI, 7-11) and median time to DSS 6 was 12 years (95% CI, 10-15). Median phase 2 duration was 3 years (95% CI, 2.4-3.6). Males and progressive-onset patients had faster disability worsening during the first phase of the disease. Conversely, disability progression during the second phase was independent of gender and MS phenotype at onset. Our study showed that disability progression followed a two-stage process in Tunisian MS patients with however a more aggressive course compared to that in Westerners.
有关北非多发性硬化症（MS）病程的数据稀缺，且主要为回顾性研究。本研究旨在前瞻性评估突尼斯多发性硬化症的残疾进展情况。对来自突尼斯蒙吉本哈米达国家神经病学研究所（Tunis，突尼斯）多发性硬化症数据库的 600 例患者进行了分析，该数据库在 10 年内进行了前瞻性记录。定义了两个 MS 阶段：阶段 1，从 MS 临床发病到残疾状况量表（DSS）3 分；阶段 2，从 DSS 3 分至 DSS 6 分。使用 Kaplan-Meier 方法估计两个阶段的中位持续时间以及 DSS 3 分和 DSS 6 分的中位年龄。DSS 评分 3 分和 6 分的中位年龄分别为 48 岁（95%置信区间（CI），45-50）和 53 岁（95%CI，52-55）。从发病到 DSS 3 分（阶段 1 持续时间）的中位时间为 9 年（95%CI，7-11），到 DSS 6 分的中位时间为 12 年（95%CI，10-15）。中位阶段 2 持续时间为 3 年（95%CI，2.4-3.6）。男性和进行性发病患者在疾病的第一阶段残疾恶化更快。相反，在第二阶段，残疾进展与性别和发病时的 MS 表型无关。我们的研究表明，突尼斯多发性硬化症患者的残疾进展遵循两阶段过程，但与西方人相比，进展更为迅速。
