Epidemiology of multiple sclerosis in western Herzegovina

Objectives To determine epidemiological rates of multiple sclerosis (MS) in western Herzegovina. Patients and methods We analysed data from 81 MS patients (49 females, 32 males) on the prevalence day, 31 December 2003. Patient information was obtained from a search of all available medical records from the period 1994–2003 in the investigated area. Results Crude prevalence of MS was 27/100,000 (95% confidence interval (CI) 20–34). Prevalence was highest in the mountainous municipality of Posušje (56/100,000) and lowest in the coastal municipality of Neum (0 incidence). The annual incidence of MS was 1.6/100,000 (95% CI 0–3.3). The female/male ratio of MS was 1.5. The mean age of the patients on prevalence day was 40.0 ± 11.6 years, and the mean age at disease onset was 31.0 ± 7.1 years. Eight (10%) of the patients had a first-degree relative with MS. The primary progressive (PP) disease course was observed only in females. Visual symptoms were the initial symptom of MS in 6 (7%) of the patients. Conclusions Western Herzegovina is an area of moderate risk for MS, and the distribution of MS in western Herzegovina is heterogeneous. PP-MS occurred only in females, and involvement of the visual pathways as the initial symptom of MS was low.