Part,  Chapter, Paragraph

  1   II,     4.  1    |        individual EU Member States (MS) and the EU as a whole.
  2   II,     4.  1    |             EUROSTAT algorithm, and MS death counts and population
  3   II,     4.  1    |             2005 for the 27 current MS were also computed with
  4   II,     4.  1    |       values estimated each year at MS level within EU27.~ ~Table
  5   II,     4.  1    |          longevity gaps between the MS since 1995.~ ~Table 4.1.
  6   II,     4.  1    |           Member States in 2005. At MS level, values of life expectancy
  7   II,     4.  1    |             the same throughout all MS.~ ~Detailed values of life
  8   II,     4.  1    |            level (EU25) and for all MS has disclosed striking gaps
  9   II,     4.  1    |           2005 the gaps between the MS with the highest and lowest
 10   II,     4.  1    |          women. Gaps in HLY between MS are even wider: over 20
 11   II,     4.  1    |           be uniform throughout all MS. Equivalent gaps are evident
 12   II,     4.  1    |           made by EHEMU showed that MS experienced a marked convergence
 13   II,     4.  1    |            to improve health of all MS equally.~ ~Moreover, improving
 14   II,     4.  1    |           working together with the MS to improve the reliability
 15   II,     4.  1    | socio-economic status (SES) between MS. This is a necessary step
 16   II,     5.  5.  3|  Introduction~ ~Multiple sclerosis (MS) is a chronic progressive
 17   II,     5.  5.  3|       Sadovnick and Ebers, 1993).~ ~MS is an acquired inflammatory
 18   II,     5.  5.  3|   degeneration (Trapp et al, 1998). MS etiology is unknown. The
 19   II,     5.  5.  3|         Lucchinetti et al, 1996).~ ~MS clinically manifests itself
 20   II,     5.  5.  3|       sources~ ~The distribution of MS incidence and prevalence
 21   II,     5.  5.  3|          and disability,and that of MS mortality was reviewed for
 22   II,     5.  5.  3|             on the clinical course, MS is typified as Primary Progressive (
 23   II,     5.  5.  3|        RR-MS, PR-SP-MS and PP-MS.~ ~MS case registers in ”Europe”~
 24   II,     5.  5.  3|  information on the epidemiology of MS; some examples follow. The
 25   II,     5.  5.  3|       Registry (DMSR) has collected MS cases since 1948 (www ),
 26   II,     5.  5.  3|            recording information on MS cases from multiple sources,
 27   II,     5.  5.  3|    diagnostic validity for definite MS of 94%. It links with Denmark’
 28   II,     5.  5.  3|             multiple assessments of MS epidemiological indices
 29   II,     5.  5.  3|      obligatory information serving MS population-based studies
 30   II,     5.  5.  3|      history and physiopathology of MS (Confavreux et al, 2000;
 31   II,     5.  5.  3|        information of all prevalent MS patients in Norway (Myhr
 32   II,     5.  5.  3|           serum) from all available MS patients was implemented.~ ~
 33   II,     5.  5.  3|          nationwide epidemiological MS register was initiated under
 34   II,     5.  5.  3|          the auspices of the German MS Society (Flachenecker et
 35   II,     5.  5.  3|             number of patients with MS, course of the disease,
 36   II,     5.  5.  3|  standardised data sets of ca. 5800 MS patients were recorded from
 37   II,     5.  5.  3|               Nearly 200 surveys on MS epidemiology published in
 38   II,     5.  5.  3|         epidemiological patterns of MS distribution in time and
 39   II,     5.  5.  3|          and increased awareness of MS; and the subsequent tendency
 40   II,     5.  5.  3|             latitudinal gradient of MS prevalence across the UK
 41   II,     5.  5.  3|            the Scottish border. The MS prevalence in Northern Ireland
 42   II,     5.  5.  3|          Ireland, the prevalence of MS is similar to that in the
 43   II,     5.  5.  3|           comparable latitudes.~The MS prevalence in the Nordic
 44   II,     5.  5.  3|          higher prevalence rates of MS reported in some regions
 45   II,     5.  5.  3|          the Fennoscandian focus of MS. This extended from western
 46   II,     5.  5.  3|             regional differences in MS prevalence and incidence
 47   II,     5.  5.  3|             epidemiological data on MS in Denmark that appear to
 48   II,     5.  5.  3|    background for susceptibility to MS.~Iceland provides a 50-year
 49   II,     5.  5.  3|           The threefold increase of MS prevalence up to 119 in
 50   II,     5.  5.  3|           assessment over time. The MS risk in Iceland is similar
 51   II,     5.  5.  3|         Scandinavian countries.~The MS prevalence in Germany has
 52   II,     5.  5.  3|        geographical distribution of MS prevalence was heterogeneous
 53   II,     5.  5.  3|  northeast-to-southwest gradient of MS distribution in France was
 54   II,     5.  5.  3|             a focal distribution of MS in ethnic groups with different
 55   II,     5.  5.  3|       Several prevalence surveys on MS have been conducted in Italy
 56   II,     5.  5.  3|             an area at low risk for MS, is believed to account
 57   II,     5.  5.  3|        account for the low absolute MS risk in the Maltese.~Prevalence
 58   II,     5.  5.  3|        susceptibility in increasing MS frequency cannot be ruled
 59   II,     5.  5.  3|           64.~The total annual mean MS incidence in Europe is estimated
 60   II,     5.  5.  3|        Italy.~ ~The distribution of MS in Europe by disease course~ ~
 61   II,     5.  5.  3|       countries~The distribution of MS in Europe by severity~The
 62   II,     5.  5.  3|           proportion range for mild MS (EDSS 0-3.5) was 33% (UK)
 63   II,     5.  5.  3|           and 48% (UK) for moderate MS (EDSS 4-6.5) and between
 64   II,     5.  5.  3|             Netherlands) for severe MS (EDSS 7-9.5)~ ~Table 5.5.
 65   II,     5.  5.  3|       selected EUGLOREH countries~ ~MS mortality rates and survival
 66   II,     5.  5.  3|     survival time in Europe~Data on MS mortality must be taken
 67   II,     5.  5.  3|        system over time. Also, when MS patients die from other
 68   II,     5.  5.  3|  certificates is likely to occur as MS is not mentioned (Ford et
 69   II,     5.  5.  3|       mentioned (Ford et al, 2002).~MS is associated with an elevated
 70   II,     5.  5.  3|        highest mortality rates from MS in Austria were observed
 71   II,     5.  5.  3|            median age at death from MS was 59 years between 1990-
 72   II,     5.  5.  3|          Mortality (per 100 000) of MS patients in selected EUGLOREH
 73   II,     5.  5.  3|     countries~ ~The epidemiology of MS in Europe: methodological
 74   II,     5.  5.  3|          epidemiological studies on MS conducted over the past
 75   II,     5.  5.  3|             geographical pattern of MS in Europe is a hard task
 76   II,     5.  5.  3|              public awareness about MS; (d) the impact of different
 77   II,     5.  5.  3|     gradient in the distribution of MS prevalence rates across
 78   II,     5.  5.  3|            to predict the degree of MS prevalence according to
 79   II,     5.  5.  3|       underlying the differences in MS distribution.~A general
 80   II,     5.  5.  3|             current epidemiology of MS in Europe was categorisation,
 81   II,     5.  5.  3|            socio-economic burden of MS in Europe~ ~The disability
 82   II,     5.  5.  3|            evaluating the burden of MS in health economics. DALYs
 83   II,     5.  5.  3|      disability. The total DALY for MS in Europe is 307 000 years
 84   II,     5.  5.  3|         been carried out so far for MS as compared to other neurological
 85   II,     5.  5.  3|         Furthermore, comorbidity in MS and associated symptoms (
 86   II,     5.  5.  3|             when measuring DALYs in MS.~The general decreasing
 87   II,     5.  5.  3|       increased survival time after MS onset will increase the
 88   II,     5.  5.  3|           found to also have higher MS incidence (WHO, 2004), thus
 89   II,     5.  5.  3|           of disease in the future.~MS social costs are high. Cost
 90   II,     5.  5.  3|              The economic burden of MS for the year 2005 was €13
 91   II,     5.  5.  3|             8 billion. The cost per MS case in Europe ranges from €
 92   II,     5.  5.  3|       Distribution of total cost of MS in Europe (year 2005) by
 93   II,     5.  5.  3|             5.3.5.4. Risk factors~ ~MS is a complex multifactorial
 94   II,     5.  5.  3|         influential risk factor for MS is hypothesised to operate
 95   II,     5.  5.  3|        genes operate in determining MS risk especially at familial
 96   II,     5.  5.  3|     relevance for the prevention of MS have not received adequate
 97   II,     5.  5.  3|          tests for the diagnosis of MS. Diagnostic criteria require
 98   II,     5.  5.  3|             widely used criteria in MS epidemiological research
 99   II,     5.  5.  3|           for definite and probable MS, and relevant subcategories:
100   II,     5.  5.  3|  subcategories: clinically definite MS (CDMS), laboratory-supported
101   II,     5.  5.  3|       laboratory-supported definite MS (LSDMS), clinically probable
102   II,     5.  5.  3|         LSDMS), clinically probable MS (CPMS) and laboratory-supported
103   II,     5.  5.  3|       laboratory-supported probable MS (LSPMS). In 2001, an international
104   II,     5.  5.  3|            the category of probable MS and reintroducing that of
105   II,     5.  5.  3|      reintroducing that of possible MS (McDonald et al, 2001).
106   II,     5.  5.  3|          can receive a diagnosis of MS or possible MS. Because
107   II,     5.  5.  3|         diagnosis of MS or possible MS. Because of the retrospective
108   II,     5.  5.  3|       retrospective methods used in MS epidemiological studies
109   II,     5.  5.  3|     classification in such surveys. MS is diagnosed more often
110   II,     5.  5.  3|              The clinical course of MS shows heterogeneity among
111   II,     5.  5.  3|         following categorisation of MS clinical course has been
112   II,     5.  5.  3|              a) relapsing-remitting MS (RR-MS), a clearly defined
113   II,     5.  5.  3|            b) progressive-relapsing MS (PR-MS), progressive disease
114   II,     5.  5.  3|            c) secondary-progressive MS (SP-MS), initial RR course
115   II,     5.  5.  3|              d) primary-progressive MS (PP-MS), disease with progression
116   II,     5.  5.  3|          epidemiological studies on MS, the disease course is often
117   II,     5.  5.  3|            to measure disability in MS, aimed at evaluating the
118   II,     5.  5.  3|         interventional programs. In MS epidemiological descriptive
119   II,     5.  5.  3|            1983). Disability due to MS can be measured within functional
120   II,     5.  5.  3|     helpless and 10 is death due to MS.~ ~Treatment~There is no
121   II,     5.  5.  3|      Treatment~There is no cure for MS, but there are drugs able
122   II,     5.  5.  3|        symptoms. Goals for treating MS may include reducing the
123   II,     5.  5.  3|      warranted in all patients with MS or at risk of developing
124   II,     5.  5.  3|            or at risk of developing MS (eg., ‘clinically isolated
125   II,     5.  5.  3|        cases in the early stages of MS is difficult and there is
126   II,     5.  5.  3|           the initial management of MS are available in Europe,
127   II,     5.  5.  3|           of worsening forms of RR- MS and SP-MS. Besides the method
128   II,     5.  5.  3|            life and productivity of MS patients’ . An understanding
129   II,     5.  5.  3|       cladribine.~Rehabilitation in MS implies comprehensive, multidisciplinary,
130   II,     5.  5.  3|             many people affected by MS are forced to give up work
131   II,     5.  5.  3|      effectively to the symptoms of MS and ensure both access and
132   II,     5.  5.  3|          towards people affected by MS. The Code of Good Practice
133   II,     5.  5.  3|            Code of Good Practice on MS ( see below) calls for information
134   II,     5.  5.  3|            for those diagnosed with MS regarding the Directive,
135   II,     5.  5.  3|             redress.~A new study on MS and employment in the EU
136   II,     5.  5.  3|          Early published studies on MS patients and their employment
137   II,     5.  5.  3|         unemployed individuals with MS. The important conclusion
138   II,     5.  5.  3|      workforce. Keeping people with MS in the workforce can be
139   II,     5.  5.  3|            situation of people with MS in Europe, but only reports
140   II,     5.  5.  3|            unemployed people due to MS, number of people actively
141   II,     5.  5.  3|         from unemployed people with MS;~o identifying factors that
142   II,     5.  5.  3|         enable employed people with MS to stay in the workforce;~
143   II,     5.  5.  3|           the rights of people with MS to obtain and maintain employment,
144   II,     5.  5.  3|           employment of people with MS to help guarantee appropriate
145   II,     5.  5.  3|       treatment towards people with MS in the European Union~In
146   II,     5.  5.  3|      Finland -herself a person with MS - analysed the experiences
147   II,     5.  5.  3|          experiences of people with MS in Europe. It did so with
148   II,     5.  5.  3|          Code of Best Practice” for MS patients.~European Code
149   II,     5.  5.  3|          Life of People Affected by MS~ ~The Code was drawn up
150   II,     5.  5.  3|         lives of people affected by MS, including policy makers
151   II,     5.  5.  3|              the person affected by MS.~The Code is a political
152   II,     5.  5.  3|    importance to people affected by MS. It provides a practical
153   II,     5.  5.  3|   empowerment of people affected by MS;~· It signposts core consensus
154   II,     5.  5.  3|          Life of People affected by MS.~· Equal rights and access
155   II,     5.  5.  3|     Sclerosis;~· A shared agenda in MS research;~· Employment and
156   II,     5.  5.  3|             and care of people with ms within and across the EU
157   II,     5.  5.  3|    reference papers in the areas of MS referred to in the Code~·
158   II,     5.  5.  3|                 The European Map of MS database provides information
159   II,     5.  5.  3|         data on the epidemiology of MS and the availability and
160   II,     5.  5.  3|           resources for people with MS at country level. The contents
161   II,     5.  5.  3|         Immunomodulatory Therapy of MS Consensus PaperCurrent
162   II,     5.  5.  3|          Recent clinical studies in MS provide new data on the
163   II,     5.  5.  3|           for the optimised care of MS patients. The multiple sclerosis
164   II,     5.  5.  3|             ensuring Europeans with MS have access to the best
165   II,     5.  5.  3|           Paper based on the German MS Society’s report “Mehr Lebensqualität,
166   II,     5.  5.  3|          Sympomatische Therapie bei MS”. (Henze et al, 2006).~Although
167   II,     5.  5.  3|     critically edited by a group of MS neurologists. The Consensus
168   II,     5.  5.  3|          some of the most important MS symptoms such as motor function
169   II,     5.  5.  3|       patients severely affected by MS in Europe to have access
170   II,     5.  5.  3|             Excellence Guideline on MS Services (UK)~The National
171   II,     5.  5.  3|      Guideline on the management of MS provides clear, evidence-based
172   II,     5.  5.  3|             managing all aspects of MS and offers a blueprint for
173   II,     5.  5.  3|      quality of life of people with MS (Trisolini et al, 2002)~
174   II,     5.  5.  3|       organizations for people with MS.~ ~UN Convention on the
175   II,     5.  5.  3|          life of people affected by MS. The UN Convention, once
176   II,     5.  5.  3|          life of people affected by MS, drawing on key policy developments
177   II,     5.  5.  3|     National Level~There are active MS societies in all 27 member
178   II,     5.  5.  3|        participation of people with MS in society. Advances in
179   II,     5.  5.  3|            policies for people with MS and the creation of an economic
180   II,     5.  5.  3|          the cost of the disease of MS on the individual and society
181   II,     5.  5.  3|            issues on which national MS societies campaign tenaciously.~
182   II,     5.  5.  3|       disease. There is no cure for MS, but medicines may slow
183   II,     5.  5.  3|           and voices of people with MS must be formally sought.
184   II,     5.  5.  3|           i.e. the strengthening of MS society foothold in the
185   II,     5.  5.  3|           advocacy role of national MS societies in contributing
186   II,     5.  5.  3|     affected by Multiple Sclerosis (MS). It will create a standardised
187   II,     5.  5.  3|         national care approaches to MS, which will allow good practice
188   II,     5.  5.  3|         treatment and management of MS. More specifically, the
189   II,     5.  5.  3|     strategy to analyse and compare MS data; prevalence and epidemiology
190   II,     5.  5.  3|             good practice review of MS treatments and therapies,
191   II,     5.  5.  3|      benefits of best management of MS. The project will also analyse
192   II,     5.  5.  3|             the cost of illness of) MS.~This project will contribute
193   II,     5.  5.  3|     knowledge database available on MS, with the long-term added
194   II,     5.  5.  3|            reports on the status of MS using the Open Method of
195   II,     5.  5.  3|    mortality rates among Danes with MS. Int MS J 13:66-71.~Buehler
196   II,     5.  5.  3|            among Danes with MS. Int MS J 13:66-71.~Buehler JW.
197   II,     5.  5.  3|             Götze U, et al (2005): [MS registry in Germanydesign
198   II,     5.  5.  3|             Elias WG, et al (2007): MS Register in Germanyresults
199   II,     5.  5.  3|            AE (1993): Prevalence of MS in South Estonia. Evidence
200   II,     5.  5.  3|       unemployment of patients with MS. Journal of Chronic Disability
201   II,     5.  5.  3|         Immunomodulatory Therapy of MS Consensus Paper , Revised
202   II,     5.  5.  3|             worldwide prevalence of MS. Clinical Neurology and
203   II,     5.  5.  3|            2001). The prevalence of MS in the world: an update.
204   II,     5.  5.  3|           Estimation of the cost of MS in Europe: Extrapolations
205   II,     5.  5.  3|      quality of life of people with MS (International Federation
206   II,     5.  5.  3|          Magnetic Resonance Imaging~MS~Multiple Sclerosis~MS-ID~
207   II,     5.  8.  7|              Zheng JP, Zhong NS, Ip MS, Vermeire PA. Increasing
208   II,     5. 15.Acr|        Mendelian Inheritance in Man~MS~Member States~NORD~National
209   II,     5. 15.  4|          level or at Member States (MS) level.~Regulation No 141/
210   II,     5. 15.  4|            programmes; encourage EU MS in developing national health
211   II,     5. 15.  4|         policies and initiatives at MS level and EU level.~ ~A
212   II,     5. 15.  5|   developments~ ~The EU and several MS have well identified the
213   II,     8.  1.  4|           first discussion with all MS on this module has been
214   II,     8.  2.  1|         participating countries (13 MS and 1 EEA country).~The
215   II,     9.  1.  1|          Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts
216   II,     9.  1.  1|         Paris, 2000:173-192.~Kramer MS, Demissie K, Yang H, Platt
217   II,     9.  1.  1|          Gibson KA, Wu YW, Croughan MS (2004): Perinatal outcomes
218   II,     9.  1.  1|             103(3):551-63.~ ~Kramer MS, Demissie K, Yang H, Platt
219   II,     9.  1.  1|         Jama 284(7):843-9.~ ~Kramer MS, Seguin L, Lydon J, Goulet
220   II,     9.  1.  1|             14(3):194-210.~ ~Kramer MS, Platt RW, Yang H, Haglund
221   II,     9.  3.  2|    singleton deliveries in European MS for 1990 to 2005~ ~ ~ ~ ~
222   II,     9.  3.  2|          Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts
223   II,     9.  3.  2|          Gibson KA, Wu YW, Croughan MS (2004): Perinatal outcomes
224   II,     9.  3.  2|              2000:173-192.~ ~Kramer MS, Demissie K, Yang H, Platt
225   II,     9.  3.  2|         2000;284(7):843-9.~ ~Kramer MS, Platt RW, Yang H, Haglund
226   II,     9.  3.  2|          2002;16(1):16-22.~ ~Kramer MS, Seguin L, Lydon J, Goulet
227  III,    10.  1.  3|             147-164.~Jebb SA, Moore MS (1999): Contribution of
228  III,    10.  1.  3|        Miller NS, Giannini AJ, Gold MS (1992): Suicide risk associated
229  III,    10.  1.  3|          Miller NS, Mahler JC, Gold MS (1991): Suicide risk associated
230  III,    10.  2.  1|              Data from 5 additional MS as well as from 4 West Balkan
231  III,    10.  2.  1|  Health Promotion Studies.~ ~Kramer MS, Morin I, Yang H, Platt
232  III,    10.  4.  2|         MRLs~Maximum Residue Limits~MS~Mass Spectrometry~OECD~Organisation
233  III,    10.  4.  2|            consumption data from 14 MS, 41 diet sets for different
234  III,    10.  4.  2|            DAR at EU level with all MS, applicant(s) and public
235   IV,    13.  2.  2|         been carried out so far for MS as compared to other neurological
236   IV,    13.  2.  2|         Furthermore, comorbidity in MS and associated symptoms (
237   IV,    13.  2.  2|             when measuring DALYs in MS.~· In terms of years lived