Temporal changes and geographical differences in multiple sclerosis phenotypes in Japanese: Nationwide survey results over 30 years

M. Osoegawa, Jun Ichi Kira, T. Fukazawa, K. Fujihara, S. Kikuchi, M. Matsui, T. Kohriyama, G. Sobue, T. Yamamura, Y. Itoyama, T. Saida, K. Sakata, H. Ochi, T. Matsuoka, Yoshigoro Kuroiwa, Akihiro Igata, Hiroshi Nishitani, Susumu Chiba, Yoshitaka Fujii, Susumu FurukawaHideo Hara, Toshirou Hara, Kinya Hisanaga, Shu Ichi Ikeda, Shuji Izumo, Ryuji Kaji, Takashi Kanda, Shosei Koh, Susumu Kusunoki, Satoshi Kuwabara, Hidenori Matsuo, Hidehiro Mizusawa, Tatsufumi Nakamura, Kyoichi Nomura, Mieko Ogino, Yoshiro Ohara, Mitsuhiro Osame, Kohei Ota, Jun Shimizu, Akio Suzumura, Takeshi Tabira, Keiko Tanaka, Masami Tanaka, Makoto Yoneda, Hiroaki Yoshikawa, Nobuhiro Yuki

Research output: Contribution to journalArticlepeer-review

132 Citations (Scopus)


Background: There are two distinct phenotypes of multiple sclerosis (MS) in Asians, manifesting as optic-spinal (OSMS) and conventional (CMS) forms. In Japan, four nationwide surveys of MS have been conducted. The first three were in 1972, 1982, and 1989, and we performed the fourth in 2004. Results: The recent survey showed six main findings as follows: (1) a four-fold increase in the estimated number of clinically definite patients with MS in 2003 (9900; crude MS prevalence, 7.7/100,000) compared with 1972; (2) a shift in the peak age at onset from early 30s in 1989 to early 20s in 2003; (3) a successive proportional decrease in optic-spinal involvement in clinically definite patients with MS; (4) a significant north-south gradient for the CMS/OSMS ratio; (5) after subdivision of the mainland (30-45° North) into northern and southern parts at 37°N, northern-born northern residents (northern patients) showed a significantly higher CMS/OSMS ratio and higher frequency of brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) than southern-born southern residents (southern patients); (6) among northern patients, the absolute numbers of patients with CMS and those with Barkhof brain lesions rapidly increased with advancing birth year. Conclusions: These findings suggest that MS phenotypes are drastically altered by environmental factors, such as latitude and "Westernization".

Original languageEnglish
Pages (from-to)159-173
Number of pages15
JournalMultiple Sclerosis
Issue number2
Publication statusPublished - 2009

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology


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