Frontiers in Epidemiology (Jun 2024)

Multiple sclerosis in Central America and Caribbean countries: frequency and clinical characterization of an emergent disease

  • Fernando Gracia,
  • Fernando Gracia,
  • Deyanira A. Ramírez Navarro,
  • Nicia E. Ramírez Sánchez,
  • Roberto Weiser,
  • Alexander Parajeles-Vindas,
  • Ligia I. Portillo Rivera,
  • Ericka López Torres,
  • Luis A. García Valle,
  • Alfredo Sanabria-Castro,
  • César Abdón López,
  • Pahola Araujo,
  • Maria J. Ayerdis Zamora,
  • Andrea Balmaceda-Meza,
  • Aron Benzadon Cohen,
  • Awilda Candelario Cueto,
  • Diego Castillo,
  • Romy Castro-Escobar,
  • Karla Z. Corea Urbina,
  • Anyeri de Peña Rivas,
  • Octavio Duarte Sotelo,
  • Temís Enamorado Claros,
  • José L. Giroud Benítez,
  • Karla Gracia,
  • Mario Larreategui,
  • Jorge A. Martínez Cerrato,
  • Josmarlin P. Medina Báez,
  • Carlos E. Menjivar Samayoa,
  • Gustavo Miranda-Loria,
  • Priscilla Monterrey-Alvarez,
  • Lilliam A. Morales Arguello,
  • Michelle Ortiz,
  • Carlos D. Pérez Baldioceda,
  • Lizeth Pinilla Aguilar,
  • Luis C. Rodríguez Salinas,
  • Virginia Rodríguez-Moreno,
  • Sebastián Rojas-Chaves,
  • Norbel Román-Garita,
  • Biany Santos Pujols,
  • Carlos Valderrama,
  • Ivonne Van Sijtveld,
  • Indhira Zabala Angeles,
  • Victor M. Rivera,
  • Blas Armien,
  • Blas Armien

DOI
https://doi.org/10.3389/fepid.2024.1368675
Journal volume & issue
Vol. 4

Abstract

Read online

BackgroundMultiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population.Methods and resultsData from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3–3.5 × 100,000 inhabitants, and the lowest, 0.07–0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies.ConclusionThis is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged.

Keywords