Japanese MSers accumulate less disability

Piccolo L, Kumar G, Nakashima I, Misu T, Kong Y, Wakerley B, Ryan S, Cavey A, Fujihara K, Palace J. Multiple sclerosis in Japan appears to be a milder disease compared to the UK. J Neurol. 2015 Jan 22. [Epub ahead of print]

Multiple sclerosis (MS) is relatively common in the West, but rare in Japan. In the literature, there are few comparative data regarding disease severity throughout the world. The objective of this study was to compare disability in patients from a UK and a Japanese MS cohort. We retrospectively analysed the clinical features of patients with MS from a UK and Japanese MS centre. The Multiple Sclerosis Severity Score (MSSS), which adjusts the Expanded Disability Status Scale score according to disease duration, was used as a marker of disease severity. One thousand one hundred forty-eight UK patients and 104 Japanese patients were identified representing the relative national prevalence. Demographics and disease duration did not differ between the groups. Median MSSS was significantly different between the two groups (Japan 3.34 vs. UK 5.87, p < 0.001). Primary progressive MS was more common in the UK (12.9 %) than in the Japanese cohort (3 %, p = 0.044). The majority of Japanese patients (83.7 % vs. UK 17 %) had been exposed to disease modifying treatments (DMTs). Exposure to DMTs did not show a significant effect on disability. In conclusion, this study suggests that MS in Japan may be associated with less disability than in UK. More Japanese patients were treated with DMTs. Differences in treatments do not seem to explain the disparity in disability severity. This suggests either genetic or environmental influences on disease severity.

Is it genes,environment of therapeutic lag

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    • I think it could be that there is something in the Japanese genetic makeup that may mean they handle neurological insults better.
      A genome study could be informative.

    • Japan isn't burdened with obesity. Childhood obesity has increased in Japan but the increase is one of the slowest in the developed world. I have MS but I am borderline underweight, but I think obesity has been looked at as an added risk for MS.

  • Only 17% of UK patients treated with DMT?
    At first glance this seems to be the biggest difference between UK and Japan……

  • Or is it just a statistical "phenomena".
    If I am right in Japan and China, NMO is more common than MS.

    So if they diagnose their patients on a better quality level (AQAP4 AB-tests are not a standard test), they sure have less MSers.

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