Although fatigue is recognized as a symptom of MS, there have been insufficient methods for evaluating this symptom. We administered the Fatigue Impact Scale to 85 MS patients and 20 hypertensive patients. Neurologic impairment, mental health, and general health status were also assessed. MS patients reported significantly higher fatigue impact than hypertensive patients. Most MS patients reported fatigue as either their worst (14%), or one of their worst (55%) symptoms. Disease classification and neurologic impairment had little bearing on Fatigue Impact Scale scores in the MS sample. The best predictive models for mental health and general health status in the MS sample both included the Fatigue Impact Scale as a significant factor. This study demonstrates that: 1) fatigue is a very prevalent and severe problem in MS, 2) fatigue impact cannot be predicted by clinical measures of neurologic impairment, 3) fatigue has a significant effect on the mental health and general health status of MS patients.Resume: L'impact de la fatigue chez les patients atteints de sclerose en plaques. Bien qu'il soit reconnu que la fatigue est un des symptomes de la sclerose en plaques, il n'existe pas de methode satisfaisante pour evaluer ce symtome. 85 patients souffrant de la sclerose en plaques et a 20 patients souffrant d'hypertension ont et£ evalues au moyen de l'echelle de l'impact de la fatigue (Fatigue Impact Scale). Nous avons egalement evalue la deterioration neurologique, la same mentale et la sante en general. Les patients souffrant de la sclerose en plaques ont indique' que l'impact de la fatigue etait superieur de facon significative a celui decrit par les patients souffrant d'hypertension. La majorite des patients souffrant de la sclerose en plaques ont indique que la fatigue etait soit leur pire probleme (14%), soit l'un des plus severes (55%). La classification de la maladie ainsi que la severite de la deterioration neurologique etaient peu reliees a la fatigue, telle qu'evaluee par l'echelle de l'impact de la fatigue, chez les patients souffrant de la sclerose en plaques. Les resultats du l'echelle de l'impact de la fatigue constituaient un facteur significatif dans l'elaboration de modeles predisant le mieux la sante mentale et la sante en general. Cette 6tude demontre que: 1) la fatigue est un probleme frequent et grave dont souffrent ceux qui sont atteints de la sclerose en plaques, 2) l'impact de la fatigue ne peut etre pr6dit par les mesures de la deterioration neurologique, 3) la fatigue a un effet significatif sur la sante mentale et sur la sante en general des patients souffrant de la sclerose en plaques.Can. J. Neurol. Sci. 1994; 21: 9-14 Fatigue is recognized as a disabling symptom of Multiple Sclerosis (MS) but measurement of this symptom has proven difficult and ratings of fatigue are typically not included in the routine quantitative evaluation of neurologic impairment.

Objectives To determine if risk of multiple sclerosis (MS) is associated with month of birth in countries in the northern hemisphere and if factors related to month of birth interact with genetic risk. Design Population based study with population and family based controls and a retrospective cohort identified from death certificates. A post hoc pooled analysis was carried out for large northern datasets including Sweden and Denmark. Setting 19 MS clinics in major cities across Canada (Canadian collaborative project on the genetic susceptibility to multiple sclerosis); incident cases of MS from a population based study in the Lothian and Border regions of Scotland; and death records from the UK Registrar General. Populations 17 874 Canadian patients and 11 502 British patients with multiple sclerosis. Main outcome measure Diagnosis of multiple sclerosis. Results In Canada (n = 17 874) significantly fewer patients with MS were born in November compared with controls from the population census and unaffected siblings. These observations were confirmed in a dataset of British patients (n = 11 502), in which there was also an increase in the number of births in May. A pooled analysis of datasets from Canada, Great Britain, Denmark, and Sweden (n = 42 045) showed that significantly fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. For recent incident data, the effect of month of birth was most evident in Scotland, where MS prevalence is the highest. Conclusions Month of birth and risk of MS are associated, more so in familial cases, implying interactions between genes and environment that are related to climate. Such interactions may act during gestation or shortly after birth in individuals born in the northern countries studied.

A large sample of Canadian adults was surveyed by telephone to determine the prevalence and characterization of headache, and the effects of headache on life-style, consulting behaviours and medication use. We reported prevalence and characterization in a previous issue; here, we detail the effects of headaches on sufferers. Sixteen and one-half percent of adult Canadians experience migraine and 29% tension-type headaches. In over 70% of headache sufferers interpersonal relationships are impaired. Regular activities are limited in 78% of migraine attacks and 38% of tension-type headaches. Despite this, only 64% of migraine and 45% of tension-type headache sufferers had ever sought medical attention, and of these only 32% returned for ongoing care. Fourteen percent of migraine and 8% of tension-type headache sufferers had used emergency departments. Most headache sufferers take medication, primarily over-the-counter varieties. Measures to reach the headache population are needed, as are safe effective treatment options that will encourage them to participate in their medical care. RESUME: Impact de la migraine et de la cephalee de tension sur le mode de vie, les habitudes de consultation et I'utilisation de medicaments: une etude canadienne de population. Nous avons effectue une enquete tel6-phonique aupres d'un echantillon important d'adultes canadiens pour determiner la prevalence et le type de cephalee, ainsi que les effets de ces cephalees sur le mode de vie, les habitudes de consultation et la medication utilisee. Nous avons rapporte la premiere partie de cette etude dans une publication anterieure; nous rapportons ici les effets des cephalees chez ceux qui en souffrent. Seize et demi pourcent des adultes canadiens souffrent de migraine et 29% de cephalee de tension. Chez plus de 70% des individus qui souffrent de cephalee, les relations interpersonnelles en sont affectees. Les activites courantes sont limitees lors de 78% des acces de migraine et de 38% des acces de cephal6e de tension. Malgre cela, seulement 64% des individus qui souffrent de migraine et 45% de ceux qui souffrent de cephalee de tension ont deja consulte un medecin a ce sujet et parmi ceux-ci, seulement 32% ont maintenu le suivi. Quatorze pourcent de ceux qui souffrent de migraine et 8% de ceux qui souffrent de cephalee de tension ont consulte un departement d'urgence. La plupart de ceux qui souffrent de cephalee utilisent une medication, surtout une medication sans ordonnance. II est necessaire de mettre en place des mesures visant a informer la population qui souffre de c6pha!6e et de lui fournir des options therapeutiques securitaires pour l'encourager a participer a ses propres soins medicaux.

The aetiology of multiple sclerosis (MS) is uncertain. There is strong circumstantial evidence to indicate it is an autoimmune complex trait. Risks for first degree relatives are increased some 20 fold over the general population. Twin studies have shown monozygotic concordance rates of 25-30% compared to 4% for dizygotic twins and siblings. Studies of adoptees and half sibs show that familial risk is determined by genes, but environmental factors strongly influence observed geographic differences. Studies of candidate genes have been largely unrewarding. We report a genome search using 257 microsatellite markers with average spacing of 15.2 cM in 100 sibling pairs (Table 1, data set 1 - DS1). A locus of lambda>3 was excluded from 88% of the genome. Five loci with maximum lod scores (MLS) of >1 were identified on chromosomes 2, 3, 5, 11 and X. Two additional data sets containing 44 (Table 1, DS2) and 78 sib pairs (Table 1, DS3) respectively, were used to further evaluate the HLA region on 6p21 and a locus on chromosome 5 with an MLS of 4.24. Markers within 6p21 gave MLS of 0.65 (non-significant, NS). However, D6S461, just outside the HLA region, showed significant evidence for linkage disequilibrium by the transmission disequilibrium test (TDT), in all three data sets (for DS1 chi2 = 10.8, adjusted P < 0.01)(DS2 and DS3 chi2 = 10.9, P < 0.0005), suggesting a modest susceptibility locus in this region. On chromosome 5p results from all three data sets (222 sib pairs) yielded a multipoint MLS of 1.6. The results support genetic epidemiological evidence that several genes interact epistatically to determine heritable susceptibility.

ABSTRACT:Trained telephone interviewers contacted 1,573 adults across Canada about the nature and frequency of headaches suffered by them or by others in their households. Using a table of pain symptoms and other characteristics abstracted from the International Headache Society (IHS) classification, the headaches were assigned to migraine headache, tension-type headache or other diagnostic groups. Of the households sampled, 59% had at least one headache sufferer in residence. The proportion of headache sufferers with migraine was 14%; with tension-type, 36%; and with both, 14%. Migraine headache caused more disability than tension-type headache, with nearly 20% of migraine sufferers taking time off work and disability lasting for a mean of 1 day. It is concluded that the current prevalences of migraine and tension-type headache in Canada fall around the mean of previous studies, that the IHS criteria can form a basis for diagnostic classification and that the functional impact of migraine has been seriously underestimated in the past.

Previous studies have reported variable prevalence of pain in multiple sclerosis (MS) and have not documented the impact of pain on daily living. In this consecutive series, we report on data collected from structured interviews with 85 patients seen within a 16-month period at a regional referral clinic. The prevalence of pain for the month preceding assessment was 53%. There were no significant differences between patients who did and those who did not report pain on the basis of patient demographics (age, gender) and disease characteristics (disease subtype, duration and neurologic symptom severity). Disease duration and neurologic symptom severity were significantly correlated with the number of hours of pain per week but were not correlated with pain severity, the number of pain sites or pain-related distress. There was wide variability in the number of pain hours/week reported with 17.6% of the sample reporting continuous pain for the month preceding assessment. Sixty-five percent of patients with pain reported taking medications for pain and 90% of these patients evaluated their medication(s) as 50% effective or better. Nevertheless, patients with pain reported poorer mental health and more social-role handicap. Discussion focuses on the need for routine assessment of pain and the comprehensive evaluation of the effectiveness of pain interventions in the therapeutic management of patients with MS.

To estimate the patterns and prevalence of cannabis use among patients with multiple sclerosis (MS), 220 patients were surveyed in Halifax, Nova Scotia. Seventy-two subjects (36%) reported ever having used cannabis for any purpose; 29 respondents (14%) reported continuing use of cannabis for symptom treatment. Medical cannabis use was associated with male gender, tobacco use, and recreational cannabis use. The symptoms reported by medical cannabis users to be most effectively relieved were stress, sleep, mood, stiffness/spasm, and pain.

No abstract