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Vol. 37, No. 3-4, 2011
Issue release date: December 2011
Neuroepidemiology 2011;37:231–235

Prevalence of Multiple Sclerosis: Door-to-Door Survey in Three Rural Areas of Coastal Black Sea Regions of Turkey

Türk Börü Ü. · Taşdemir M. · Güler N. · Dilaver Ayık E. · Kumaş A. · Yıldırım S. · Duman A. · Sur H. · Kurtzke J.F.
aNeurology Clinic, Dr. Lütfi Kindar Kartal Training and Research Hospital, bDepartment of Public Health, Marmara University Faculty of Medicine, and cDepartment of Health Management, Marmara University Faculty of Health Sciences, Istanbul, Turkey; dDepartment of Neurology, Georgetown University, Washington, D.C., USA

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Background: Little information exists on multiple sclerosis (MS) in Turkey. With a door-to-door survey in an urban part of Istanbul, we recently reported a prevalence rate of 101/100,000 population. We therefore investigated three rural areas of Turkey at the same latitude. Methods: The same survey methods were used for total populations of two rural areas (Kandıra and Geyve) near Istanbul, and for half the population of Erbaa, all near 40° north latitude on the Black Sea coast. Results: In Kandıra, 5 of 8 suspects were diagnosed as having MS among 8,171 screened, resulting in a prevalence rate of 61/100,000. Geyve with 7 MS cases in 17,016 screened had a prevalence of 41/100,000, and Erbaa with 15 MS cases in 28,177 screened one of 53/100,000. Together they showed a prevalence of 51/100,000. Of the 27 patients, 20 were women; 25 had definite and 2 possible MS, the former all with abnormal laboratory findings. Average ages were 30.5 years at onset and 39.1 years at diagnosis. Clinical features and course were typical of European MS. Conclusion: These findings indicate that Turkey is a high-risk MS area, similar to most regions of Mediterranean Europe, where all recent increases are likely due to (undefined) environmental factors.

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  1. Rosati G: The prevalence of multiple sclerosis in the world: an update. Neurol Sci 2001;22:117–139.
  2. Granieri E, Casetta I: Common childhood and multiple adolescent infections and multiple sclerosis. Neurology 1997;47(suppl): S42–S54.
  3. Ebers GC, Sadovnic AD: The geographic distribution of multiple sclerosis: a review. Neuroepidemiology 1993;12:1–5.
  4. Houzen H, Niino M, Hata D, Nakano F, Kikuchi S, Fukazawa T, Sasaki H: Increasing prevalence and incidence of multiple sclerosis in northern Japan. Mult Scler 2008;14:887–892.
  5. Kim NH, Kim HJ, Kim BJ, Lee KH, Kim EH, Kim EA, Kim S, Park MS, Yoon WT: Prevalence of multiple sclerosis in Korea. Neurology 2010;75:1432–1438.
  6. Mayr WT, Pittock SJ, McClelland RL, Jorgensen NW, Noseworthy JH, Rodriguez M: Incidence and prevalence of multiple sclerosis in Olmsted County, Minnesota, 1985–2000. Neurology 2003;61:1373–1377.
  7. Pugliatti M, Rosatti G, Carton H, Riise T, Drulovic J, Vecsei L, Milanov I: Epidemiology of multiple sclerosis in Europe. Eur J Neurol 2006;13:700–722.
  8. Grytten N, Glad SB, Aarseth JH, Nyland H, Midgard R, Myhr KM: A 50-year follow-up of the incidence of multiple sclerosis in Hordaland County, Norway. Neurology 2006;66:182–186.
  9. Limburg CC: The geographic distribution of multiple sclerosis. Proc Assoc Res Nerv Ment Dis 1950;28:15–24.
  10. Papathanasopoulus P, Gourzoulidou E, Messinis L, Georgiou V, Leotsinidis M: Prevalence and incidence of multiple sclerosis in western Greece: a 23-year survey. Neuroepidemiology 2008;30:167–173.
  11. Etemadifar M, Janghorbani M, Shaygannejad V, Ashtari F: Prevalance of multiple sclerosis in Isfahan, Iran. Neuroepidemiology 2006;27:39–44.
  12. Al-Hashel J, Besterman AD, Wolfson C: The prevalance of multiple sclerosis in the Middle East. Neuroepidemiology 2008;31:129–137.
  13. Pugliatti M, Sotgiu S, Solinas P, Castiglia P, Rosatti G: Multiple sclerosis prevalence amongst Sardinians: further evidence against latitude gradient theory. Neurol Sci 2001;22:163–165.
  14. luliano G, Napoletano R: Prevalence and incidence of multiple sclerosis in Salerno (southern Italy) and its province. Eur J Neurol 2008;15:73–76.
  15. Koch-Henriksen N, Sorensen PS: The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010;9:520–532.
  16. Türk Börü Ü, Alp R, Sur H, Gül L: Prevalence of multiple sclerosis: door to door survey in Maltepe, Istanbul, Turkey. Neuroepidemology 2006;27:17–21.
  20. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Toutyellotte WW: New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983;13:227–231.
  21. Kurtzke JF: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444–1452.
  22. Dean G, Aksoy H, Akalin T, Middleton L, Kyriallis K: Multiple sclerosis in Turkish- and Greek-speaking communities of Cyprus. A United Nations (UNHCR) Bicommunal Project. J Neurol Sci 1997;145:163–168.
  23. Pugliatti M, Rosatti G, Carton H, Riise T, Drulovic J, Vecsei L, Milanov I: The epidemiology of multiple sclerosis in Europe. Eur J Neurol 2006;13:700–722.
  24. Vukussic S, Van Bocksteal V, Gosselin S, Confavreux C: Regional variations in the prevalence of multiple sclerosis in French farmers. J Neurol Neurosurg Psychiatry 2007;78:707–709.
  25. Grimaldi LME, Palmeri B, Salemi G, Gigla G, D’Amelio M, Grimaldi R, Vitello G, Ragonese P, Savetteri G: High prevalence and fast rising incidence of multiple sclerosis in Caltanissetta, Sicily, southern Italy. Neuroepidemiology 2007;28:28–32.
  26. Rothwell PM, Charlton D: High incidence and prevalence of multiple sclerosis in east south Scotland: evidence of a genetic predisposition. J Neurol Neurosurg Psychiatry 1998;64:730–715.
  27. Forbes RB, Wilson SW, Swingler RJ: The prevalence of multiple sclerosis in Tayside, Scotland: do latitudinal gradients really exist? J Neurol 1999;246:170–174.
  28. Sumelahti MI, Tienari PJ, Wikstrom J, Palo J, Hakama M: Increasing prevalence of multiple sclerosis in Finland. Acta Neurol Scand 2001;103:153–158.
  29. Larsen JP, Aarli JA, Nyland H, Riise T: Western Norway, a high-risk area for multiple sclerosis: a prevalence/incidence study in county Hordaland. Neurology 1984;34;1202–1207.
  30. Midgard R, Riise T, Nyland H: Epidemiologic trends in multiple sclerosis in Møre and Romsdal, Norway: a prevalence/incidence study in a stable population. Neurology 1991;41:887–892.
  31. Sarasoja T, Wikstrom J, Paltalama J, Hakama M, Sumelathi ML: Occurrence of multiple sclerosis in central Finland: a regional and temporal comparison during 30 years. Acta Neurol Scand 2004;110:331–336.
  32. Grønlie SA, Myrvoll E, Hansen G, Gronning M, Mellgren SI: Multiple sclerosis in North Norway, and first appearance in an indigenous population. J Neurol 2000;247:129–133.
  33. Benito-León J: Are the prevalence and incidence of multiple sclerosis changing? Neuroepidemiology 2011;36:148–149.
  34. Fasbender P, Kolmel HW: Incidence of multiple sclerosis in the urban area of Erfurt, Thuringia, Germany. Neuroepidemiology 2008;30:147–151.
  35. Orton SM, Herrera BM, Yee IM, et al: Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006;5:932–936.
  36. Debouverie M, Pittion-Vouyovitch S, Louis S, Roederer T, Guillemin F: Increasing incidence of multiple sclerosis among women in Lorraine, Eastern France. Mult Scler 2007;13:962–967.

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