Phenotypical aspects and clinical course of multiple sclerosis in 76 patients with a North African ethnic background followed at the Nice University Hospital

Aims. In the European multiple sclerosis (MS) database registered in Nice, about 8p.cent of the patients have a North African ethnic background. Patients and methods. We performed a descriptive retrospective study of a cohort of 76 MS patients with a North African ethnic background followed in the Neurology Department of Nice University Hospital. This group was compared with a regional MS cohort (n=968) from our EDMUS database. Statistical analysis enabled classification of patients into three subgroups which had been submitted to different environmental factors according to where they were born and their age at immigration. There were prognostic aspects specific to each group. Results. Regarding the entire cohort, poor prognostic factors included male gender, onset with sequellae, and substantial brain lesions on initial T2-weighted MRI. For the subgroups; prognostic aspects specific to each group were: 1) patients of North African origin born in France had an early age of onset, delayed diagnosis, remission between two long initial expressions of MS, and rapidly developed cerebellar problems with a secondary progressive course: 2) patients having migrated after age 15 had a late age of onset, delayed diagnosis, remission between two short initial expressions of MS, an onset characterized by one symptom, which was often a motor symptom involving the spinal cord or brain stem, but late-developing cerebellar problems and secondary progressive course are frequent; 3) patients having migrated before age 15 had an onset characterized by one symptom, often a visual problem, with sequellae and rapid development of cerebellar problems. Conclusion. The present study was consistent with the more unfavorable course of MS in patients of North African ethnic background previously reported in the literature. One should distinguish the subgroups to improve management of MS. Early administration of treatment should be considered for these patients, including earlier and more frequent use of immunosuppressive agents.