Multiple sclerosis in Isfahan, Iran: Past, Present and Future.

Abstract

Isfahan province of Iran is now globally well known for its high prevalence of Multiple Sclerosis (MS).[1–3] Fifteen years ago, this fact was in spite of primary north–south based expectations (MS gradient hypothesis) in which Isfahan, as a part of Iran, could only be a low-risk area with prevalence of less than 5/100,000.[4–6] During the last decade, serial population-based studies by Isfahan MS society (IMSS) reformed our knowledge about MS epidemiology in our province. The first IMSS study was performed between 2004 and 2005, reporting a period prevalence of 35.5/100,000. This report put Isfahan as a medium- to high-risk area.[1] The following year, a more comprehensive study was performed reporting a period prevalence of 43.8/100,000 between April 2003 and July 2006. This study also reported an incidence rate of 3.64/100,000 for the year 2005.[2] IMSS final study was performed in 2010, reporting a period prevalence of 73.3/100,000 between April 2003 and July 2010 and an incidence rate of 9.1/100,000 in 2009. These values were dramatically higher than previous reports, and of course, harbinger of a disaster. According to the latter report, Isfahan was addressed as one of the most high-risk regions for MS in Asia and Oceania.[3] During the period from July 2010 to date (end of July 2011), IMSS has identified 443 new cases (unpublished data), providing an incidence figure of ~ 9.22/100,000.