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The aim of this study was to estimate survival rates of multiple sclerosis (MS) patients in the Belgrade population, Yugoslavia, and furthermore, to determine the prognostic value of some demographic and clinical variables for survival. The cumulative survival probability was calculated by the Kaplan-Meier method. The prognostic value of different variables was assessed by univariate and multivariate analyses using the Cox regression model. In the Belgrade population, the cumulative 25-year survival probability of MS patients and the mean survival time from MS onset were 73.2% and 38 years, respectively. The univariate analysis showed that survival was significantly related to sex, age at onset, course of disease and monoregional initial symptoms. A multivariate model demonstrated that a relapsing-remitting course of MS and monoregional onset were predictors of a better prognosis. The presence of motor symptoms at the onset was found to be an independent predictor of a poorer outcome of MS.

OBJECTIVES To estimate the distribution of multiple sclerosis in the Belgrade population. METHODS All persons who were affected and/or died from multiple sclerosis (Poser's criteria), with residence in the Belgrade region had been collected from January 1, 1985 to December 31, 1996. Prevalence was adjusted by direct method, using world population. RESULTS From 1985 to 1996, 823 patients were suffering from multiple sclerosis. Sex ratio was 1:1.9. The mean age at onset was 32.2 +/- 9.8 years. A relapsing-remitting course of multiple sclerosis was reported in 50.7% patients, secondary progressive in 36.4%, patients, and primary progressive in 12.9% patients. On December 31, 1996, age-adjusted prevalence of multiple sclerosis in Belgrade was 41.5/100,000, 28.2/100,000 for males, and 54.1/100,000 for females. During the period studied, statistically highly significant increasing trend of multiple sclerosis prevalence was observed (P = 0.0001). CONCLUSIONS According to findings presented in this study, Belgrade is an area with high prevalence of multiple sclerosis.

In a hospital-based study of 119 patients with definite multiple sclerosis, demographic and clinical factors were analysed with respect to their validity in assessing the long-term prognosis. Over a mean follow-up of 21.7 years, the following factors negatively influenced the prognosis by the univariate analysis: male sex, age at onset over 25, pyramidal involvement or spasticity at onset, 53 functional systems affected at onset or after 5 years, incomplete first remission, length of the first remission 41 year, 45 attacks in the first 10 years, secondary or primary-progressive disease, time to reach secondary progression over 5 years and time to reach EDSS 6 over 7 years. The multivariate model showed that in patients with relapsing-remitting disease, 5 years after onset, pyramidal involvement at onset and shorter time to reach EDSS 6 predicted poor outcome, while after 10 years, higher age at onset and incomplete first remission indicated poor prognosis. Ten years after onset, the predictors of poor outcome in the secondary-progressive group were shorter time to reach EDSS 6 or secondary progression and higher EDSS, while in the primary-progressive group those variables were spasticity or higher number of functional systems affected at onset, and higher EDSS after 5 and 10 years.

The aim of our study was to analyse clinical and paraclinical characteristics of patients with multiple sclerosis (MS) with previous diagnosis of primary-progressive (PP) MS according to the Poser's criteria and further investigate if they fulfil the McDonald's diagnostic criteria for this disorder. A total of 561 MS patients were registered in the database at the Institute of Neurology, Belgrade, from 1 January 1997 to 31 December 2000 and 63 of them (11.2%) with previous diagnosis of PPMS were analysed retrospectively. Male/female ratio was 1.3:1 and mean age at onset 33.2 years. Most frequent at onset were pyramidal (in 73% of patients) and sensory symptoms (in 41% of patients); 74.6% of patients had greater than or equal to nine brain magnetic resonance imaging (MRI) lesions. Intrathecal oligoclonal immunoglobulin G (IgG) was detected in 96.7% and prolonged visual evoked potentials (VEP) P100 latency in 82.4% of patients. Of the total study group of 561 patients, 10.2% fulfilled the recently recommended McDonald's diagnostic criteria for the diagnosis of PPMS. Our findings further support the significance of the brain/spinal cord MRI, cerebrospinal fluid and VEP findings for precise diagnostic assessment in patients with suspected PP form of MS.

The levels of uric acid (UA), a natural peroxynitrite scavenger, were measured in sera from 240 patients with multiple sclerosis (MS) and 104 sex- and age-matched control patients with other neurological diseases (OND). The mean serum UA concentration was lower in the MS than in the OND group, but the difference did not reach the level of statistical significance (P = 0.068). However, the mean serum UA level from patients with active MS (202.6 + 67.1 mumol/l) was significantly lower than that in inactive MS patients (226.5 + 78.6 mumol/l; P = 0.046) and OND controls (P = 0.007). We found a significant inverse correlation of serum UA concentration with female gender (P = 0.0001), disease activity (P = 0.012) and duration (P = 0.017), and a trend towards an inverse correlation with disability as assessed by EDSS score, which did not reach statistical significance (P = 0.067). Finally, multivariate linear regression analyses showed that UA concentration was independently correlated with gender (P = 0.0001), disease activity (P = 0.014) and duration of the disease (P = 0.043) in MS patients. These findings suggest that serum UA might serve as a possible marker of disease activity in MS. They also provide support to the potential beneficial therapeutic effect of radical-scavenging substances in MS.

The antiphospholipid antibody syndrome is a disorder characterised by the production of autoantibodies directed against negatively charged cell membrane phosholipids. Antiphospholipid antibodies have been described in various neurological disorders. It has been generally accepted that viral, bacterial, and parasitic infections can serve as a trigger factor for autoimmune reactions. Despite the growing knowledge that has accumulated, the relation between parasites and autoimmunity has not been clarified. Enterobius vermicularis (pinworm) is a nematode rarely found outside the gastrointestinal tract, but allergic reaction due to enterobiasis has been reported.1 We describe the case of transverse myelopathy preceded by intestinal pinworm infestation in the primary antiphospholipid antibody syndrome. To our knowledge, such an association has not been reported previously. Pinworm therapy was complicated by the Jarisch-Herxheimer reaction manifested by temporary exacerbation of pre-existing neurological symptoms. In March 1998, a 40 year old woman who complained of perianal itching noticed the presence of worms migrating from the anus. Three days later itching and numbness involved both legs, and the patient had weakness in the legs. These symptoms progressed over the next 3 days to severe paraparesis and urinary urgence. Her medical history was relevant for three unexplained miscarriages …