Epidemiology Of Multiple Sclerosis

  1. Environmental factors and Multiple Sclerosis
    Lancet Neurol 2008 Mar;7(3):268-77

  2. Bulk List
    Seasonal variations of Relapse & Age of onset in MS

  3. Multiple Sclerosis in Iceland
    Ann Neurol (1994 Dec) 36 Suppl 2:S175-9

  1. Both the HLA-CPB1 and -DRB1 alleles correlate with risk for Multiple Sclerosis in Japanese: clinical phenotypes and gender as important factors
    Tissue Antigens 2000 Mar;55(3):199-205

  2. Genetic Epidemiology of Multiple Sclerosis: a survey
    Ann Neurol 1994 Dec;36 Suppl 2:S194-203

  3. Geographic similarities between varicella and Multiple Sclerosis: an hypothesis on the environmental factor of Multiple Sclerosis
    J Clin Epidemiol 1995 Jun;48(6):731-7

  4. Multiple Sclerosis in black South Africans and Zimbabweans
    J Neurol NeuroSurg Psychiatry 1994 Sep;57(9):1064-9

  5. Higher than expected prevalence of Multiple Sclerosis in northern Colorado: dependence on methodologic issues
    NeuroEpidemiology 1986;5(1):17-28

  6. Multiple Sclerosis sibling pairs: clustered onset and familial predisposition
    Neurology 1990 Oct;40(10):1546-52

  7. Multiple Sclerosis among Chinese in Taiwan
    J Neurol Sci 1976 Apr;27(4):459-84

  8. Multiple Sclerosis: does epidemiology contribute to providing etiological clues?
    J Neurol Sci 1993 Apr;115 Suppl:S16-23

  9. Multiple Sclerosis and Distemper in Iceland 1966-1978
    Acta Neurol Scand 1980 Apr;61(4):244-51

  10. DeMyelinating disorder of the Central Nervous System occurring in black South Africans
    J Neurol NeuroSurg Psychiatry 2001 Apr;70(4):500-5

  11. Genetic evidence for a family-based Scandinavian settlement of Shetland and Orkney during the Viking periods
    Heredity 2005 Aug;95(2):129-35

  12. The dissemination of Multiple Sclerosis: a Viking saga? A historical essay
    Ann Neurol 1994 Dec;36 Suppl 2:S231-43


Both the HLA-CPB1 and -DRB1 Alleles Correlate With Risk For Multiple Sclerosis In Japanese: Clinical Phenotypes And Gender As Important Factors

Fukazawa T, Yamasaki K, Ito H, Kikuchi S, Minohara M, Horiuchi I, Tsukishima E, Sasaki H, Hamada T, Nishimura Y, Tashiro K, Kira J
Tissue Antigens 2000 Mar;55(3):199-205
Hokuyukai Neurology Hospital, Sapporo, Japan
PMID# 10777094; UI# 20236852

The purpose of this study was to clarify the association of HLA-DRB1 and -DPB1 alleles with Multiple Sclerosis (MS) in Japanese, to determine whether Optico-Spinal MS (OS-MS) and conventional MS are ImmunoGenetically distinct, and to verify the role of gender difference in HLA associations of MS.

We studied HLA-DRB1 and -DPB1 PolyMorphisms in 166 Japanese patients with MS. Forty-seven patients were classified as having the Optico-Spinal MS (OS-MS) and 119 as having conventional MS.

A lack of DPB1*0301 and a higher frequency of DPB1*0501 compared with controls (corrected P<0.0074; odds ratio=9.48) were found in OS-MS.

By contrast, we found for the first time an association of DPB1*0301 with conventional MS in Japanese (corrected P=0.0444; odds ratio=3.28).

Logistic analysis, adjusted for sex and age, revealed independent associations of DPB1*0301 (P=0.0004, adjusted odds ratio (aOR)=4.70), DPB1*0501 (P=0.0081, aOR= 2.50) and DRB1*1501 (P=0.0252, aOR=2.21) with conventional MS.

However, the frequencies of DRB1*1501 and DPB1*0501 in male patients with conventional MS were equal to those in male controls while the DPB1*0301 frequency was increased in both male and female patients.

We did not find any association of these HLA alleles with disease course and severity.

In conclusion, OS-MS is a DPB1*0501-associated distinct subtype of MS, and DPB1*0301 is the most strongly associated allele with conventional MS in Japanese. In addition, gender plays an important role in HLA association with MS.


Genetic Epidemiology Of Multiple Sclerosis
A Survey

Sadovnick AD
Ann Neurol 1994 Dec;36 Suppl 2:S194-203
Univ of British Columbia, Dept of Medical Genetics, Vancouver, Canada
PMID# 7998788; UI# 95091472

The possible role of Genetic factors in the Etiology of Multiple Sclerosis (MS) has been debated for over a century.

It is now clear that Genetic and environmental interactions must exist. It is likely that MS susceptibility is under the control of several Genes encoded both within and outside the Major Histocompatibility Complex (MHC).

It is therefore unlikely that MS has a purely transmissible cause for these and other reasons, including:

  • the low concordance rate in dizygotic twins,
  • low concordance rate in conjugal pairs,
  • negative birth order in multiplex MS sibships,
  • the relatively high rate of MS in second - and third-degree relatives of MS patients,
  • the identification of groups resistant to MS in otherwise high-risk areas


Geographic Similarities Between Varicella And Multiple Sclerosis: An Hypothesis On The Environmental Factor Of Multiple Sclerosis

Ross RT, Cheang M
J Clin Epidemiol 1995 Jun;48(6):731-7
Univ of Manitoba, Faculty of Medicine, Section of Neurology, Winnipeg, Canada
PMID# 7769403; UI# 95287170

The environmental factor causing Multiple Sclerosis (MS) is unknown. Kurtzke et al. (Neurology 1979; 29: 1228-1235) depicted a north to south diminishing gradient in the case/control ratios for MS among American veterans in the United States.

A similar, but less precise, gradient emerged when the incidence rates of Varicella from 37 states during 1978-91 were compared.

A loose correlation appears to exist between the mean incidence of Varicella and the MS risk ratio (n = 0.344 Spearman rank correlation coefficient, p = 0.037).

Further, the data on the fate of migrants moving from a high risk MS country to a low risk country and the reverse, plus the great importance of the age at migration, raise the question of a possible connection between the two diseases.

Because of these Epidemiological and other similarities between the two diseases a further comparative study was suggested.


Multiple Sclerosis In Black South Africans And Zimbabweans

Dean G, Bhigjee AI, Bill PL, Fritz V, Chikanza IC, Thomas JE, Levy LF, Saffer D
J Neurol NeuroSurg Psychiatry 1994 Sep;57(9):1064-9
Medico-Social Research Board, Dublin, Ireland
PMID# 8089669; UI# 94376095

Multiple Sclerosis is rare among the indigenous black people of Africa. The first account of a black patient with Multiple Sclerosis in South Africa was published as late as 1987.

Since then a search to find black patients with Multiple Sclerosis in Southern Africa has continued.

Seven black patients have now been traced in South Africa and five in Zimbabwe in whom a diagnosis of Multiple Sclerosis can be accepted. Six of the 12 patients became blind, or nearly so, from severe Optic Neuritis.

Multiple Sclerosis in these few black patients more often resembled the disorder as it occurs in Oriental people than among white people in southern Africa or the black people of North America or the Caribbean.


Higher Than Expected Prevalence Of Multiple Sclerosis In Northern Colorado: Dependence On Methodologic Issues

Nelson LM, Hamman RF, Thompson DS, Baum HM, Boteler DL, Burks JS, Franklin GM
NeuroEpidemiology 1986;5(1):17-28

PMID# 3489193; UI# 86311552

A population-based study of Multiple Sclerosis (MS) was conducted in 2 northern Colorado counties in 1982 to determine MS prevalence, to compare the rates with recent North American surveys and to compare the methods used in these studies.

Provisional cases were identified from: the patient rolls of MS service organizations, chart reviews in 2 neurology practices, a survey of physicians and a review of hospital discharge diagnoses. Crude-point prevalence for the 2-county region was 84 per 100,000.

The age-adjusted rate was higher than the rate for the region above the 37th parallel projected from data in a 1976 national survey, but was comparable to rates obtained in localized surveys conducted in the northern tier of the country.

The methodological results revealed that the highest yield sources were the MS service organizations and the neurology practice chart reviews.

MS prevalence surveys which neglect these methods may underestimate MS prevalence by as much as 20-40%.


Multiple Sclerosis Sibling Pairs: Clustered Onset And Familial Predisposition

Doolittle TH, Myers RH, Lehrich JR, Birnbaum G, Sheremata W, Franklin GM, Nelson LM, Hauser SL
Neurology 1990 Oct;40(10):1546-52
Massachusetts General Hospital, NeuroImmunology Unit, Boston 02114
PMID# 2215946; UI# 91015770

We evaluated 48 Relapsing/Remitting Multiple Sclerosis (Relapsing/Remitting MS) sibling pairs derived from 44 families for age and date of onset of MS symptoms, clinical course, and family history of MS.

Age and sex-matched R/R MS clinic patients provided a statistical comparison group. The age of onset tended to cluster within multiplex families. The initial symptom of MS occurred within 5 years of age in 30/48 sibling pairs compared with 16/48 controls.

A positive family history of MS (other than siblings) was present in 43% of the multiplex families compared with 20% among simplex controls.

In 1st-, 2nd-, and 3rd-degree relatives who had lived into the age at risk, 22/1,134 family members of multiplex sibling pairs had probable or definite MS compared with 10/1,215 control family members.

Age of onset clustering in siblings concordant for R/R MS and an increased risk of MS in other family members suggest that factors influencing disease onset may be in part inherited in these kindreds.


Multiple Sclerosis Amongst Chinese In Taiwan

Hung TP, Landsborough D, Hsi MS
J Neurol Sci 1976 Apr;27(4):459-84

PMID# 1262905; UI# 76171062

Twenty-five cases of Multiple Sclerosis (MS), including 2 autopsy cases, collected during the past 20 years from among the Chinese of Taiwan, are reported. These cases fulfilled all the clinical diagnostic criteria of MS.

    The following observations were made:
  • Multiple Sclerosis does exist among Chinese in Taiwan. It is uncommon, but is by no means a very rare disease. The prevalence rate in northern Taiwan near Taipei is estimated as 0.8/100.000 population.

  • Female preponderence was conspicuous (F:M = 3.2.:1) in our MS cases as well as in other DeMyelinating Diseases.

  • On the whole, the onset of the disease was earlier in female patients, and those who had their initial symptoms before the age of 20 years were all females.

  • The Optic Nerve was most frequently involved at the onset, and it was involved in the majority of patients during the whole clinical course.

  • Involvement of the Optic Nerve and Spinal Cord, with or without the BrainStem, was the commonest form of our MS cases, especially among female patients.

  • More malignant forms of MS, with acute onset and rapid clinical course leading to severe incapacity or fatality, were more common among female patients.

  • Painful Tonic Spasms were relatively frequently encountered, and they were usually seen in patients with severe Spinal Cord involvement.

  • Marked elevation of the CSF total protein and of Leukocytes was relatively frequent during severe relapses in patients with Spinal Cord lesions.

  • Severe and extensive DeMyelinating lesions, both old and recent, in the Optic Nerve and Spinal Cord were seen in 2 autopsy cases. The relationship between MS and NMO in Oriental patients is briefly discussed.

  • It seems likely that cases of MS which are atypical as compared with Western MS are more frequently seen in Oriental countries, and perhaps also in tropical regions where MS is known to be rare.


Multiple Sclerosis: Does Epidemiology Contribute To Providing Etiological Clues?

Granieri E, Casetta I, Tola MR, Govoni V, Paolino E, Malagu S, Monetti VC, Carreras M
J Neurol Sci 1993 Apr;115 Suppl:S16-23
Univ of Ferrara, Institute of Clinical Neurology, Italy
PMID# 8340788; UI# 93340680

The Epidemiological approach has undoubtedly contributed to our knowledge of Multiple Sclerosis (MS) by providing some Etiological hypotheses in spite of the fact that a definitive basis for the conclusive resolution of its enigma is still lacking.

Epidemiological studies have indicated that MS has an uneven geographical distribution and a changing incidence over time at least in several areas of the world: this suggests an Etiological role of both Genetic and environmental factors.

The racial difference in disease risk, the results of familial and twin studies as well as the association between MS and some HLA markers, support the great importance of Genetic factors.

On the other hand, the evidence of temporal trends and the data from migrant studies seem to underline the etiological contribution of environmental factors.

In the light of these results much of the present views have emerged interpreting the disease as caused by multiple factors acting at a susceptible age in Genetically predisposed subjects.


Multiple Sclerosis & Distemper
In Iceland 1966-1978

Cook SD, Gudmundsson G, Benedikz J, Dowling PC
Acta Neurol Scand 1980 Apr;61(4):244-51

PMID# 7376823; UI# 80194491

A highly restricted epidemic of Canine Distemper occurred in southwest Iceland in 1966-67. We have determined the extent of dog contact and exposure to dogs during the Distemper epidemic in Icelandic MS patients with onset since 1966.

Further, age of onset, and annual incidence of MS from 1966 through 1978 have been determined. Thirty-five of 36 MS patients had close dog contact prior to onset of their illness, and 34 were in the area of the Distemper epidemic during 1966-67.

A significant decrease in age of onset of MS (31.6 to 26.5) from 1956-1965 to 1967-1978 was noted, consistent with exposure of a susceptible cohort to a point infection with a varible incubation period.

A review of incidence of MS in the 10-year periods after Distemper epidemics in Iceland in 1921-1922, and 1941-1942 reveal significantly more MS than in comparable time periods before these epidemics.

These collective findings are consistent with, but do not prove, a relationship between dogs, Distemper and MS.


CSN DeMyelinating Disorder Occurring In Black South Africans

Modi G, Mochan A, Modi M, Saffer D
J Neurol NeuroSurg Psychiatry 2001 Apr;70(4):500-5
Univ of the Witwatersrand, Faculty of Health Sciences, Neurology Unit, Dept of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
PMID# 11254774; UI# 21154182

To investigate the nature and cause in eight black South African patients of a recurrent (multiphasic), Remitting/Relapsing DeMyelinating Disease of the CNS.

The clinical and laboratory investigations and radiological manifestations of these patients were documented.

Each patient had two or more acute attacks of DeMyelinating Disease affecting the CNS. The clinical presentations of the patients were predominantly those of multiphasic NeuroMyelitis Optica (NMO).

Brain MRI in these patients showed features consistent with those described for Acute Disseminated EncephaloMyelitis (ADEM), as well as lesions that are described in Multiple Sclerosis.

There was involvement of the Corpus Callosum in addition to typical ADEM lesions. Laboratory investigations excluded all other known causes of multiphasic CNS DeMyelination.

OligoClonal AntiBododies were not detected in these patients at any time. The patients were all from a population with a low risk for MS (black South Africans).

The patients described here represent a new phenotypic expression of a recurrent (multiphasic), Steroid sensitive, inflammatory DeMyelinating Disorder of the CNS occurring in black South Africans.

The disorder is either a distinct inflammatory DeMyelinating Disorder of the CNS of as yet unknown Etiology, or a varied form of MS (ADEM/NMO) occurring in a population with a low risk (where the Genetic trait and environmental risk factors for MS do not exist) for MS.

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