The article reviewed here is a review article – ‘The Accuracy of Prevalence Rates of Multiple Sclerosis:A Critical Review’ by Poser and Brinar. There may be psychiatric comorbidity with Multiple Sclerosis including depression and cognitive dysfunction. Epidemiology plays an important role in the management of illnesses identifying trends, clarifying associations and establishing the illness burden at a population level which can be used in resource allocation. In this paper, the authors set out to critically review the literature on prevalence rates in Multiple Sclerosis (MS). One of the authors was involved in the establishment of one set of diagnostic criteria. In the introduction, the authors write that
‘Hundreds of epidemiologic studies measuring MS prevalence rates (PR) have been published all over the world‘
The authors state that is their intention to demonstrate uncertainties over the established prevalence rate of Multiple Sclerosis. There is no stated methodology for the review and it is possible that by setting out to demonstrate this point that there is a risk of selection bias in the cited studies. Indeed for this reason, a meta-analysis with clearly stated inclusion and exclusion criterion for papers could be justified when attempting to answer questions about the prevalence rates. A number of review articles do not necessarily follow a systematic approach and instead focus on established experts in the field identifying relevant papers and trends. In this paper, the authors argue that there are a number of factors which confound the establishment of prevalence rates for Multiple Sclerosis. The confounders are illnesses which share features with Multiple Sclerosis. Thus a significant proportion of the review is concerned with the distinction between Multiple Sclerosis and Disseminated Encephalomyelitis (DEM) (including the recurrent form). This discussion is quite involved and includes evidence from neuroimaging as well as a comparison of the clinical course of both illnesses. The authors argue that in a number of studies, DEM has been included under the label of MS. The authors also consider the overlap with Neuromyelitis Optica and MS as well as the occurrence of silent MS.
The paper shows some of the considerations that are taken when establishing prevalence rates. They would also be relevant to diagnostic construction. The questions here could be further tested using a meta-analysis.
Charles Poser and Vesna Brinar. The Accuracy of Prevalence Rates of Multiple Sclerosis:A Critical Review’. Neuroepidemiology. 2007. 29. 150-155.
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