Epidemiological data for multiple sclerosis in Greece.
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Biomedical subjects
Publications and source records attributed to M Elian.
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Previous studies on the prevalence of multiple sclerosis in Italy have grossly underestimated the prevalence of the disease. The prevalence in the Republic of San Marino (near Rimini), in Sicily, and no doubt in the rest of Italy, is of the same order of magnitude as in Europe--that is, 40-60/100 000. The contrast of this with the very low prevalence in Malta (only 60 miles (96 km) away from Sicily) of 4/100 000 should provide a clue to the genetic and environmental factors responsible for multiple sclerosis.
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200 disabled multiple sclerosis patients living at home in England were interviewed to discover to what extent they were receiving the social and health benefits to which they were entitled. Many patients were ignorant of their entitlements, and there were major deficiencies in their receipt of cash benefits, job retraining, rehousing and home alterations, help in the home, and telephones, cars, and radio and television receivers. Social-worker visits were infrequent and ineffective. No single person is responsible for informing patients about benefits and helping to secure them. A multiple sclerosis register is recommended, together with automatic referral of those listed to social workers. The only major criticism of medical care was that the diagnosis should be revealed to the patient earlier and more information on the disorder should be provided. More frequent contact with multiple sclerosis patients by ancillary health workers (physiotherapists and health visitors) is needed.
Fifty-two patients over 30 years of age with EEG abnormality during IPS are described. In many, the disturbance was of "intermediate" type, that is limited in distribution and of lower voltage than the typical photo-convulsive response. Although over half the patients had epilepsy, this was often mild, complicating a variety of other conditions. The presence of these responses to IPS probably indicates a lowered seizure threshold.
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After an intensive survey only 14 patients have been found with a diagnosis of probable multiple sclerosis (MS) in the islands of Malta. This is a low prevalence of 4.2 per 100 000. The low prevalence of MS is confirmed by the small number of deaths certified as due to MS--six in 11 years--and by the absence of Maltese MS patients resident in England among the MS patients admitted to hospital in Greater London and the West Midlands (1960-72). The low prevalence of MS found in Malta can be contrasted with the high prevalence found in Enna city in central Sicily. The genetic and environmental reasons for this difference in MS prevalence between the neighbouring islands of Sicily and Malta require further study.
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303 patients underwent brain biopsy; 20 patients were available for a follow-up EEG examination, up to 16 years after the biopsy. 4 patients (20%) had focal fits starting within 6 months after the intervention. In the EEG of 15 patients (75%) 2 varieties of focal abnormalities appeared: "trepanation activity" which, for reasons discussed below should be regarded as an abnormality; and other focal features, including spikes, more often seen in patients with epilepsy. It is concluded that irritative brain lesions appear in a considerable number of patients after brain biopsy. The decision of performing this diagnostic procedure should be made after taking in consideration that: by enhancing the possibility of a correct diagnosis we may induce focal seizures in every fifth patient and irritative phenomena in three fourths of their EEG'S.
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Electroencephalograms (73) of 11 patients with confirmed herpes simplex encephalitis were recorded. Based on serial recordings it was seen that the repetitive complexes could be recorded at any time of the illness; they were associated with a fatal outcome. The repetitive complexes were absent in all patients who survived. Long-term follow-up of the surviving patients shows spike discharges, which were transitory and not associated with clinical signs in three of them, with a return to normal rhythmic activity. It is proposed that the EEG may be used as a prognostic sign in herpes simplex encephalitis.
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