The national and regional prevalence of multiple sclerosis (MS) in France was reported at the 2007 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting, showing the overall prevalence in France and its 22 regions using the same methodology for the first time.^[1] The computerized database of the National Health Insurance system (Caisse Nationale d'Assurance Maladie [CNAM]) assessed 80% of the French population or 54,974,101 people.

­      The national and regional prevalence was estimated on October 10, 2004.  

­      There were 49,626 cases of MS on the CNAM database on the prevalence date.  

­      The national prevalence was 90.3 per 100,000 (2.6 female-to-male ratio).  

­      The northern and eastern regions had a higher prevalence (101.1-122.2 per 100,000) compared with

­      the western and southern regions (78.5-84.3), with

­      the central region having an intermediate prevalence (84.3-101.1 per 100,000).  

The prevalence in Northeast France was 1.5 times that of Southwest France. These observations are consistent with the previously reported data of the heterogeneous distribution of MS in Europe between Northern and Southern European countries.

In Japan there is a geographic phenotype difference in MS. Two distinct subtypes of MS occur in Asians: optic-spinal multiple sclerosis (OCMS or neuromyelitis optica) and conventional multiple sclerosis (CMS). From 4 nationwide surveys in Japan taken in 1972, 1982, 1989, and 2004,

­      9900 patients with MS were seen with a prevalence of 7.7/100,000.^[2] OCMS was more common in southern Japan, whereas

­      CMS was more common in the north.

­      Peak age of onset in patients declined from their early 30s in 1972 to their early 20s in 2004.

­      The proportion of patients with OCMS decreased over the observation period from 1972 to 2004.

­      The frequency of CMS remained predominant in the northern regions.

In another epidemiologic presentation from Japan,^[3] an increasing incidence of MS in the Tokachi province of Hokkaido (the northernmost island of Japan) was noted over a 30-year period. Two epidemiologic surveys were conducted to assess the prevalence of MS in 2001 and 2006.

The Tokachi province had a population of

­      350,000 in 2001 and

­      360,000 in 2006.

­      In 2001 the prevalence of MS that satisfied the Poser criteria was 8.6/100,000 and

­      13.1/100,000 in 2006.

­      The mean age at the prevalence day was 41.0 years old and the mean age at onset was 28.4.

­      The mean duration of disease was 12.6 years.

­      The rate of primary progressive MS was 4%;

­      relapsing-remitting MS was 70%; and

­      secondary progressive MS was 26%.

­      The prevalence of OCMS was 1.7/100,000 in both 2001 and 2006 showing no change compared with CMS.

From prior data, it was known that the mean annual incidence increase of MS was 0.15 from 1975 to 1989 but 0.68 from 1990 to 2004. It appears that the increased prevalence of MS in northern Japan may be due to the increased incidence since 1990.

Since disease-modifying therapies (DMTs) have been available, considerable healthcare resources are used by MS patients.  A healthcare utilization survey was carried out from a Health Insurance Portability and Accountability Act (HIPAA)-compliant commercial administrative claims database.  The database contained integrated inpatient, outpatient, and pharmacy records on over 12 million persons from all major US regions, with the diagnostic International Classification of Diseases, Ninth Revision (ICD-9) code for MS (340.xx) as the first or second diagnosis.^[4]

The time span analyzed ranged from June 2005 to June 2006.  The results found 12,216 identified MS patients, 77% of whom were women, and 84% aged 30-59 years (mean, 47 years). Fifty-six percent used at least 1 DMT. Interferon (IFN) beta-1a (intramuscular) was most common (19.8%), followed by glatiramer acetate (19.4%), INF IFN beta-1a subcutaneous (10.2%), IFN beta-1b (9.2%), and mitoxantrone (0.9%). Six percent received 2 or more DMTs. Those who used DMT were more likely to use symptomatic treatments: Forty-three percent used medications for depression, 31% for spasticity, 25% for bladder symptoms, 19% for fatigue, and 28% for pain or dysesthesiae (Impairment of any of the senses, esp. of touch.)

Twelve percent of patients were admitted to a hospital (56% condition-related); 11% had emergency department visits (13% condition-related); 2.4% had intensive care unit stays (44% condition-related); and 1.8% had skilled nursing facility stays (58% condition-related). Even though DMTs are available to the majority of MS patients, only 56% of the MS patients in this particular survey chose to take DMTs, but a significant amount of healthcare resources was still used by this group creating costs beyond the cost of the DMTs.  This could be interpreted to suggest that improved treatments are needed to reduce the current healthcare as well as personal burden of MS.