An epidemiological study of neuromyelitis optica in Cuba

Introduction Two population-based studies of neuromyelitis optica (NMO) in non-white populations provided prevalence rates of 0.32 and 3.1 per 100,000 population. Objective To estimate NMO prevalence in the multiethnic Cuban population by nation-wide case ascertainment. Methods The study was conducted from October 1, 2003 to November 30, 2004 . Ninety percent of general practitioners and all neurologists responded positively to the request for information on cases suspected of optic neuritis (ON), transverse myelitis (TM), multiple sclerosis, or NMO. Among the population of 11,177,743 there were 798 suspected cases, including 89 with possible NMO, relapsing ON (RON) and TM. Of the 89, 87 were examined by two of us (Cabrera JA, Lara R) who selected the NMO cases according to the 1999 Mayo Clinic criteria as well as those with relapsing TM and RON. Results 58 cases provided a prevalence rate of 0.52 per 100,000 (95 % CI 0.39–0.67). The 7 males and 51 females gave rates of 0.13 (CI 0.05–0.26) and 0.91 (CI 0.68–1.20). The estimated average annual incidence rate was 0.053 per 100,000 (CI 0.040–0.068). Prevalence rates did not differ significantly among the three ethnic groups. Black NMO cases were significantly older, with more relapses and motor deficit, as well as more abnormalities in brainstem evoked potentials and in brain MRI (not meeting MS criteria). The predominant clinical form was relapsing over monophasic. Conclusions: This Cuban multiethnic population had a prevalence of NMO of 0.52 per 100,000 and an estimated average annual incidence rate of 0.053 per 100,000 with no differences by ethnicity. Black patients were older, with more relapses and motor impairment.