Is it time for a new global classification of multiple sclerosis?

•We conducted a systemantic review of current studies on MS epidemiology.•The global prevalence and incidence patterns of MS have dramatically changed.•We suggest the need for a novel classification system based on disease burden.

BackgroundThe geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates.ObjectiveThe aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys.MethodsWe conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012.ResultsMS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5–20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2–335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6–36.2).ConclusionIn the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.