MULTIPLE SCLEROSIS IN BIHOR COUNTY - ROMANIA

Abstract

AIMS

The objective of our study done during 2005 aims to show the prevalence and incidence of multiple sclerosis (MS) in the Bihor County, which is an endemic zone regarding the incidence of MS across Romania.

METHODS

At the MS Day Centre of Oradea we invited at periodic controls the 359 patients with MS from our county, who were clinically investigated as well as MRI, exam of the CSF and evoked potentials.

RESULTS

The prevalence of MS in the Bihor County is of 63 at 100.000 citizens. The incidence of MS in the Bihor County is of 3.7 at 100.000 citizens. It is interesting to mention about the prevalence and incidence of MS on the two crests of the Bihor Mountains, where the prevalence has reached 100 at 100.000 citizens and the incidence 6 at 100.000 citizens. One explanation is that the basements of these mountains contain Aluminum, which if as an extra amount dis-inhibits the gene that generates the synthesis of the basic protein of myelin responsible with inducing the MS.

CONCLUSIONS

Our studies show a higher frequency of MS at the northern part of the 45 degrees parallel, where the Bihor County is situated. The prevalence of 100 at 100.000 citizens and an incidence of 6 at 100.000 citizens which are found into an area in the county show that there we have two zones of MS, which we find to be in connection wi 727f59h th the larger amounts of Aluminum into the soil of that area.

BACKGROUND/AIMS

According to POZZILLI C. et al. (2002)[1], multiple sclerosis (MS) affects at least 350000 Europeans, and we would consider even a bigger number.

Some descriptive studies, based on accurate methods have shown that the distribution of MS across Europe is connected to latitude (GRANIERI E., 1997)[2].

Up to 1980, the European countries situated between 36º and 46º northern latitude, where also Romania is laid, were considered as having a smaller rate of the MS prevalence, about 5-25 patients at 100000 citizens, in comparison to the central and northern European countries . This perspective was based mainly on the former studies which were made in Italy during 1959-1975. More recent studies, which have been made in Italy and other southern European countries show that both prevalence and incidence of MS are much higher than previously expected. (ROSATI G. 1994)[3]. therefore, the distribution of MS among Europe seems to be more complex than previously expected, with large variations not only in the countries situated on the same latitude, but also within the countries. There are very significant deviations from homogeneity, and the zones with high incidence and prevalence have the tendency of being continuous, constituting areas. Across Europe MS is frequent in the southern Scandinavia, but not into the northern part: into the Orkney and Shetland Islands, but not into the Faroe Islands, into Sardinia, but not among Greece or Spain, into Sicily, but not among Malta.

The Scandinavian distribution has been studied during the years by KURTZKE J.K. The northern zones of high incidence seem to describe a "Fennoscandinavian focus", even into the southern regions across Sweden.

Sardinia represents a homogenate population, distinguished even since the Caucasian group had been separated, although it is not certainly known its pre-historical areal. The most recent study, which has been done across the northern Sardinia,( Sassari), shows a prevalence of 144.4 patients at 100000 citizens and a notable increase of the incidence across time (PUGLIATI M. et al., 2001)[4]. These findings prove the hypothesis according to which the distribution of this disease does not clarify the gradient-factor latitude, warning only about the presumption that the MS frequency across Sardinia is one of the highest all over the world, indicating the presence of a "Scandinavian focus" in MS also among more southern countries.

Romania is laid into the south-eastern part of Central Europe, on the lowest part of the Danube flowing, with access to the Black Sea, between 43º37'07"-48º15'06" northern latitude and 20º15'44"-29 º 41'24" eastern longitudes. In Romania, the first epidemiological studies concerning MS were made by Kreindler, studies in which are noted the presence of 3 Romanian areas where the incidence of MS is increased: the north-western Transylvania, where also the Bihor County is laid, northern Moldavia and northern Oltenia. Stamatoiu during 1982, (quoted by BAJENARU O, 2004) [5], show that in Romania MS has a prevalence of about 35-40 patients at 100000 citizens. An epidemiological study made by Petrescu A. and Verdes F. during 1987, all across the country, shows that the prevalence of MS across Romania is about 25 patients at 100000 citizens. The authors of the study find the highest prevalence into the north-western Transylvania, where also the Bihor County is laid, somewhere between 25-62.6 patients at 100000 citizens.

Our study done during 2005-2006 aims to show the prevalence and incidence of MS in the Bihor County, which is an endemic zone regarding the incidence of MS across Romania, and also to detect whether there is any "Scandinavian focus" in MS and which are its causes.

METHODS

The method consisted in the studying of the patients' files diagnosed with MS during the last 30 years at the Clinical Hospital of Neurology and Psychiatry of Oradea.

At the MS Day Centre of Oradea we invited at periodic controls the 389 patients diagnosed with MS from our county, who were hospitalized. To those patients who were not investigated during the hospitalization, the MRI, exam of the CSF and evoked potentials were done, during a new in-coming, and also a detailed clinical neurological examination was done in the meanwhile. Out of the 389 hospitalized patients, 359 of them fulfilled the McDonald's criteria which confirm the presence of MS.

RESULTS

The prevalence of MS in the Bihor County is of 53 at 100.000 citizens, while in the capital of the county, Oradea City is of 63 at 100.000 citizens.

The incidence of MS in the Bihor County is of 3.1 at 100.000 citizens, while in Oradea is of 3.7 at 100.000 citizens.

Regarding the origin environment origin, it is noted a mildly increased frequency into the urban, in comparison to the rural, 58.91% urban vs. 41.08% rural. The gender repartition found a 56.43% at female patients and 43.57% at men. Regarding the patients' occupational status, we could underline that there were found some professions with an excess of cases, and starting with this hypothesis, researches were made to find the repartition of the disease on professions. The following professions were found and their percentages: intellectuals 3.46%, clerks 3.96%, pupils, students, teachers 1.49%, medical staff 4.95%, workers 26.23%, housewives 7.42%, retired 42.57%( most of them disease retired), farmers 5.94%, employees in public services 2.49%, unemployed 1.49%.

Regarding the age of the debut of the disease, there is a debut up to 20 years at 8%, between 20-33 years 41.66%, between 34-40 36.8%, between 41-50 9.68% and over 50 years 3.86%. The age of the last hospitalization was assessed as follows: less than 20 years old 1.48%, between 21-30 16.34%, between 31-40 36.14%, between 41-50 33.66%, between 51-60 11.38%, over 60 years 1%.

The patients' marital status in the batch was the following: 86.3% married, 2.97% divorced and quite a high percentage of 10.73% unmarried, which could prove the certain social implications of this disease.

Regarding the number of children patients have, it can be observed that the disease does not influence the birthrate and fertility, the patients without children having mostly the origin out of the unmarried ones.28.22% of the patients have one child, 28.21% two children, 10.89% three, 2.97% four, 0.5% five, while 29.21% of the patients have no children.

Studying the prevalence of MS among different areas of the Bihor County, we have found large variations between them.It is interesting to mention about the prevalence and incidence of MS on the two crests of the Bihor Mountains, where the prevalence has reached 100 at 100.000 citizens and the incidence 6 at 100.000 citizens. Into this area of the Bihor County the prevalence has almost a double range than the county average. One explanation is that the basements of these mountains contain Aluminum, which if as an extra amount dis-inhibits the gene that generates the synthesis of the basic protein of myelin, which is responsible with inducing the MS. The myelin which is excessively generated does not have the structure of the normal myelin, which has as a consequence the trigger action of the T lymphocytes upon that myelin, therefore inducing the appearance of MS.

Oltenia is a geographic region situated in the south-western part of Romania, with a Mediterranean influenced climate, and it is considered by Stamatoiu I. an area with a bigger prevalence and incidence than the country average. Into this area there is a factory which prepares the Aluminum. This fact is also an argument in sustaining our theory which supposes the Aluminum implication in the appearance of MS.

CONCLUSIONS

Although Romania is laid in the south-eastern part of Europe, there is a rather high incidence in comparison to the countries in the neighborhood such as Greece and Turkey, and we may consider Romania as a "Scandinavian focus "into this European region. Inside Romania there are also counties in which the prevalence and incidence are almost double than the country average. Therefore, Bihor County is one of them. During 1982, Stamatoiu shows that in Romania the incidence of MS is about 35-40 patients at 100000 citizens.

In the Bihor County we have a prevalence of 53 at 100.000 citizens, which is much more increased than the prevalence across Romania, fact that entitles us to say that the Bihor County is a "Scandinavian focus ".We have found interesting the prevalence of MS on the two crests of the Bihor Mountains, where the prevalence has reached 100 patients diagnosed with MS at 100000 citizens, and an incidence of 6 at 100000 citizens, almost double than both the prevalence and incidence rate across the Bihor County, which proves that there we have a so-called "Scandinavian focus" of MS across our county. The explanation relies to be in connection wi 727f59h th the larger amounts of bauxite into the soil of that area, which is extracted and out of which Aluminum is prepared. This affirmation is in concordance with the theory according to which the basements of these mountains containing Aluminum in excess, is an element which dis-inhibits the gene that generates the synthesis of the basic protein of myelin, which is responsible with inducing the MS. The myelin which is excessively generated does not have the structure of the normal myelin, which has as a consequence the trigger action of the T lymphocytes upon that myelin, therefore inducing the appearance of MS.

Oltenia is a geographic region situated in the south-western part of Romania, with a Mediterranean influenced climate, and it is considered by Stamatoiu I. an area with a bigger prevalence and incidence than the country average. Into this area there is a factory which prepares the Aluminum. This fact is also an argument in sustaining our theory which supposes the Aluminum implication in the appearance of MS.

From our study we can draw some other conclusions: in the Bihor County the frequency of MS is bigger in the urban; more men than women are involved; MS is more frequent at those professions which involve physical effort; the debut age of the disease is situated between 20-40 years, yet having also 3.86% of patients whose age debut is over 50; the majority of our patients are married (86.3%); regarding the number of children our MS patients have, we may say that the disease does not influence the birthrate nor the fertility among the patients with MS, 70.79% of the patients having children. The other 29.21% of patients who have no children generally belong to the group of the singles or widowers.

Bibliography

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