Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-26T20:18:37.890Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology of Multiple Sclerosis: A Critical Overview

Published online by Cambridge University Press:  18 September 2015

A.D. Sadovnick  and
G.C. Ebers
A.D. Sadovnick*
Affiliation:
Multiple Sclerosis Clinic, University Hospital-UBC Site (A.D.S.) and Department of Medical Genetics (A.D.S.). University of British Columbia, Vancouver, and the Multiple Sclerosis Clinic, University Hospital (G.C.E.) and the Department of Clinical Neurological Sciences (G.C.E.). University of Western Ontario, London
G.C. Ebers
Affiliation:
Multiple Sclerosis Clinic, University Hospital-UBC Site (A.D.S.) and Department of Medical Genetics (A.D.S.). University of British Columbia, Vancouver, and the Multiple Sclerosis Clinic, University Hospital (G.C.E.) and the Department of Clinical Neurological Sciences (G.C.E.). University of Western Ontario, London
*
Department of Medical Genetics, University of British Columbia. #226-6174 University Blvd., Vancouver, British Columbia, Canada V6T 1Z3
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The decisive conclusions to be drawn from the available epidemiological data, mostly geography and prevalence, of MS are: (1) a north-south (as well as west-east in the United States) gradient exists independent of genetic/racial factors; (2) major differences in prevalence occur in the absence of latitude differences; (3) individuals from the same ethnic derivation have either similar prevalence rates or very different prevalence rates in widely separated geographical areas and (4) specific resistant isolates are shown to exist regardless of latitude. Existing information leads to the almost inescapable conclusion that the epidemiology of MS cannot be explained by any single known environmental or genetic factor(s) in isolation. A combination of a heterogeneous distribution of both genetic and environmental factors appears to be required to explain the available data on MS.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 20 , Issue 1 , February 1993 , pp. 17 - 29
Copyright
Copyright © Canadian Neurological Sciences Federation 1993

References

1.Fox, JP, Hall, CE, Elveback, LR.Epidemiology: Man and Disease. Toronto: The Macmillan Co, 1970: 185.Google Scholar
2.Charcot, JM.Lectures on the Diseases of the Nervous System. Vol 1. (Translated by Sigerson, G.). London: The New Sydenham Society, 1877: 157–222.Google Scholar
3.Poser, CM, Paty, DW, Scheinberg, L, et al.New diagnostic criteria for multiple sclerosis. Guidelines for research protocols. In: Poser, CM, Paty, DW, Scheinberg, L, Ebers, GC, eds. The Diagnosis of Multiple Sclerosis. New York: Thieme-Stratton Inc, 1984: 225–233.Google Scholar
4.Poskanzer, DC, Schapira, K, Miller, H.Multiple sclerosis and poliomyelitis. The Lancet 1963; ii: 917–921.CrossRefGoogle Scholar
5.Dupont, B, Lisak, RP, Jersild, C, et al.HLA antigens in black American patients with multiple sclerosis. Transpl Proc 1976; 91 (Suppl I): 181–185.Google Scholar
6.Hader, WJ, Feasby, TE, Noseworthy, JH, et al.Multiple sclerosis in Canadian Native People. Neurology 1985; 35 (Suppl 1): 300.Google Scholar
7.McCall, MG, Brereton, T Le G, Dawson, A, et al.Frequency of multiple sclerosis in three Australian centres, Perth, Newcastle and Hobart. J Neurol Neurosurg Psychiatry 1968; 31: 1–9.CrossRefGoogle Scholar
8.Antonovsky, A, Leibowitz, U, Medalie, JM, et al.Reappraisal of possible aetological factors in multiple sclerosis. Am J Public Health 1968; 58: 836–848.CrossRefGoogle Scholar
9.Dean, G.Annual incidence, prevalence and mortality of MS in white South African-born and in white immigrants to South Africa. Br Med J 1967; 2: 724–730.CrossRefGoogle Scholar
10.Alter, M, Hapern, L, Kurland, LT, et al.Multiple sclerosis in Israel: prevalence among migrants and native inhabitants. Arch Neurol 1962; 7:253–263.CrossRefGoogle Scholar
11.Alter, M, Leibowitz, U, Speer, J.Risk of multiple sclerosis related to age of immigration to Israel. Arch Neurol 1966; 15: 234–237.CrossRefGoogle ScholarPubMed
12.Kurtzke, JF. A reassessment of the distribution of multiple sclerosis. Part One. Acta Neurol Scand 1975; 51: 110–136.CrossRefGoogle ScholarPubMed
13.Bauer, HJ. Multiple sclerosis in Europe. Symposium Report. J Neurol 1987; 234: 195–206.Google ScholarPubMed
14.Vassallo, L, Elian, M, Dean, G.Multiple sclerosis in southern Europe. II. Prevalence in Malta in 1978. J Epidemiol Comm Health 1979; 33: 111–113.Google ScholarPubMed
15.Dean, G, Grimaldi, G, Kelly, R, et al.Multiple sclerosis in southern Europe. I. Prevalence in Sicily in 1975. J Epidemiol Comm Health 1979; 33: 107–110.CrossRefGoogle ScholarPubMed
16.Kurtzke, JF. A reassessment of the distribution of multiple sclerosis. Part Two. Acta Neurol Scand 1975; 51: 137–157.CrossRefGoogle ScholarPubMed
17.Davenport, CB. Multiple sclerosis from the standpoint of geographic distribution and race. Arch Neurol 1922; 8: 51–58.CrossRefGoogle Scholar
18.Bing, R, Reese, H.Die Multiple Sklerose in der Nordestschweiz. Schweiz Med Wochenschr 1926; 56: 30–34.Google Scholar
19.Allison, RS.Disseminated sclerosis in North Wales: an inquiry into its incidence, frequency, distribution and other etiological factors. Brain 1931; 53: 301–430.CrossRefGoogle Scholar
20.Alter, M, Leewenson, R, Harshe, M.The geographic distribution of multiple sclerosis: an examination of mathematical models. J Chron Dis 1973; 26: 755–767.CrossRefGoogle Scholar
21.Kurtzke, JF.Geography in multiple sclerosis. J Neurol 1977; 215: 1–26.CrossRefGoogle ScholarPubMed
22.Hammond, SR, de, Wytt C, Maxwell, LC, et al.The epidemiology of multiple sclerosis in Queensland, Australia. J Neurol Sei 1987; 80: 185–204.CrossRefGoogle ScholarPubMed
23.Hammond, SR, McLeod, JG, Millingen, KS, et al.The epidemiology of multiple sclerosis in three Australian cities: Perth, Newcastle and Hobart. Brain 1988; 111: 1–25.CrossRefGoogle ScholarPubMed
24.Leiter, E.H., Serreze, D.V., Prochazka, M.The genetics and epidemiology of diabetes in NOD mice. Immunol Today 1990; 11: 147–149.CrossRefGoogle ScholarPubMed
25.Ebers, GC, Sadovnick, AD.The role of genetic factors in multiple sclerosis susceptibility: a critical review. J Neuroimmunol, in press, 1993.Google Scholar
26.Sweeney, VP, Sadovnick, AD, Brandejs, V.Prevalence of multiple sclerosis in British Columbia. Can J Neurol Sci 1986; 13: 47–51.CrossRefGoogle ScholarPubMed
27.Westlund, KB, Kurland, LT.Studies on multiple sclerosis in Winnipeg, Manitoba and New Orleans, Louisiana. I. Prevalence. Comparison between the patient groups in Winnipeg and New Orleans. Am J Hyg 1953; 57: 380–396.Google ScholarPubMed
28.Stazio, A, Kurland, LT, Bell, GL, et al.Multiple sclerosis in Winnipeg, Manitoba. Methodological consideration of epidemiologic survey: ten-year follow-up of a community-wide study and population re-survey. J Chron Dis 1964; 17: 415–438.CrossRefGoogle ScholarPubMed
29.Hader, WJ, Elliot, M, Ebers, GC.Epidemiology of multiple sclerosis in London and Middlesex County. Ontario. Canada. Neurology 1988; 38:617–621.Google ScholarPubMed
30.Alter, M, Allison, RS, Talbert, OR, et al.The geographic distribution of multiple sclerosis. A comparison of prevalence in Charleston County, South Carolina and Halifax County, Nova Scotia. II. Prevalence in Halifax County, Nova Scotia. NS Med Bull 1960; 39: 203–210.Google Scholar
31.White, DN, Wheelan, L.Disseminated sclerosis. A survey of patients in the Kingston, Ontario, area. Neurol 1959; 9: 256–272.Google ScholarPubMed
32.Hader, WJ. Prevalence of multiple sclerosis in Saskatoon. Can Med Assoc J 1982; 127: 295–297.Google ScholarPubMed
33.Bennett, L, Hamilton, R, Neutel, CI, et al.Survey of persons with multiple sclerosis in Ottawa, 1974-1975. Can J Public Health 1977; 68: 141–147.Google Scholar
34.Pryse-Phillips, WEM. The incidence and prevalence of multiple sclerosis in Newfoundland and Labrador, 1960-1984. Ann Neurol 1986; 20: 323–328.CrossRefGoogle ScholarPubMed
35.Cendrowski, W, Wender, M, Dominik, W.et al.Epidemiological study of multiple sclerosis in Western Poland. Eur Neurol 1968; 2:90–103.CrossRefGoogle Scholar
36.Wender, M, Pruchnik-Grabowska, D, Hertmanowska, H, et al.Epidemiology of multiple sclerosis in Western Poland. Acta Neurol Scand 1985; 72: 210–217.CrossRefGoogle ScholarPubMed
37.Percy, AK, Nobrega, FT, Okazaki, H, et al.Multiple sclerosis in Rochester, Minn: a 60-year appraisal. Arch Neurol 1971; 25: 105–111.CrossRefGoogle Scholar
38.Kranz, JMS, Kurland, LT, Schuman, LM, et al.Multiple sclerosis in Olmsted and Mower Counties, Minnesota. Neuroepidemiology 1983; 2: 206–218.CrossRefGoogle Scholar
39.Wynn, DR, Kurland, LT, O'Fallon, WM, et al.A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota. Neurology 1990; 40: 780–786.CrossRefGoogle ScholarPubMed
40.Wynn, DR, Rodriguez, M, O'Fallon, WM, et al.Update on the epidemiology of multiple sclerosis. Mayo Clinic Proc 1989; 64: 808–817.CrossRefGoogle ScholarPubMed
41.Larsen, JP, Aarli, JA, Riise, T.Western Norway, a high risk area for multiple sclerosis. A prevalence/incidence study in the county of Hordaland. Neurology 1984; 34: 1202–1207.CrossRefGoogle ScholarPubMed
42.Midgard, R, Riise, T, Nyland, H.Epidemiologic trends in multiple sclerosis in More and Romsdal, Norway. A prevalence/incidence study in a stable population. Neurology 1991; 41: 887–892.Google ScholarPubMed
43.Granieri, E, Rosati, G.Italy: A medium- or high-risk area for multiple sclerosis? An epidemiologic study in Barbagia, Sardinia, southern Italy. Neurology 1982; 32: 466–472.CrossRefGoogle ScholarPubMed
44.Granieri, E, Rosati, G, Tola, R, et al.The frequency of multiple sclerosis in Mediterranean Europe. An incidence and prevalence study in Barbagia, Sardinia, insular Italy. Acta Neurol Scand 1983; 68: 84–89.Google ScholarPubMed
45.Presthus, J.Report on the multiple sclerosis investigations in West-Norway. Acta Psychiat Neurol Scand 1960; 35 (Suppl 147): 88–92.CrossRefGoogle ScholarPubMed
46.Garcia, JR, Rodriguez, S, Henriquez, MS, et al.Prevalence of multiple sclerosis in Lanzarote (Canary Islands). Neurol 1989; 39: 265–267.CrossRefGoogle ScholarPubMed
47.Gilbert, JJ, Sadler, M.Unsuspected multiple sclerosis. Arch Neurology 1983; 40: 533–536.CrossRefGoogle ScholarPubMed
48.Kurtzke, JF, Bui, QH.Multiple sclerosis in a migrant population. II. Half-orientals immigrating in childhood. Ann Neurol 1980; 8: 256–260.Google Scholar
49.Detels, R, Visscher, BR, Haile, RW, et al.Multiple sclerosis and age at migration. Am J Epidemiol 1978; 108: 386–393.CrossRefGoogle ScholarPubMed
50.Elian, M, Nightingale, S, Dean, G.Multiple sclerosis among the United Kingdom born children of immigrants from the Indian Subcontinent, Africa and the West Indies. J Neurol Neurosurg Psychiatry 1990; 53:906–911.CrossRefGoogle ScholarPubMed
51.Biton, V, Abramsky, O.New study fails to support environmental factors in etiology of multiple sclerosis. Neurology 1986; 36 (Suppl 1): 184.Google Scholar
52.McKusick, VA.Mendelian Inheritance in Man. 5th Edition. Baltimore: The John Hopkins University Press, 1978, pp IX.Google Scholar
53.Sheremata, WA, Poskanzer, DC, Withum, DG, et al.Unusual occurrence on a tropical island of multiple sclerosis. The Lancet 1985; ii: 618.CrossRefGoogle Scholar
54.Irvine, DG, Schiefer, HB, Hader, WJ. Geotoxicology of multiple sclerosis: the Henribourg, Saskatchewan, cluster focus. II. The soil. Sci Total Environment 1988; 77: 175–188.CrossRefGoogle ScholarPubMed
55.Stein, EC, Schiffer, RB, Hall, J, et al.Multiple sclerosis and the workplace: report of an industry-based cluster. Neurology 1987; 37: 1672–1677.CrossRefGoogle ScholarPubMed
56.Murray, TJ. An unusual occurrence of multiple sclerosis in a small rural community. Can J Neurol Sci 1976; 3: 163–166.CrossRefGoogle Scholar
57.Kinnunen, E.Multiple sclerosis in Finland: evidence of increasing frequency and uneven geographic distribution. Neurology 1984; 34: 457–461.CrossRefGoogle ScholarPubMed
58.Larsen, JP, Riise, T, Nyland, H, et al.Clustering of multiple sclerosis in the county of Hordaland, Western Norway. Acta Neurol Scand 1985; 71: 390–395.CrossRefGoogle ScholarPubMed
59.Hoffman, RE, Zack, MM, Davis, LE, et al.Increased incidence and prevalence of multiple sclerosis in Los Alamos County, New Mexico. Neurology 1981; 31: 1489–1492.CrossRefGoogle ScholarPubMed
60.Eastman, R, Sheridan, J, Poskanzer, DC. Multiple sclerosis clustering in a small Massachusetts community, with possible common exposure 23 years before onset. N Engl J Med 1973; 289: 793–794.CrossRefGoogle Scholar
61.Poskanzer, DC, Prenney, LB, Sheridan, JL, et al.Multiple sclerosis in the Orkney and Shetland Islands. 1. Epidemiology, clinical factors and methodology. J Epidemiol Comm Health 1980; 34: 229–239.CrossRefGoogle Scholar
62.Poskanzer, DC, Walker, AM, Prenney, LB, et al.The etiology of multiple sclerosis: temporal-spatial clustering indicating two environmental exposures before onset. Neurology 1981; 31: 708–713.CrossRefGoogle ScholarPubMed
63.Conomy, JP, Namey, M, Rudick, R, et al.Multiple sclerosis in Galion, Ohio: a cluster in time or a cluster in space? Neurology 1989; 39 (Suppl I): 284.Google Scholar
64.Kurtzke, JF, Hyllested, K.Multiple sclerosis in the Faroe Islands. I. Clinical and epidemiological features. Ann Neurol 1979; 5: 6–21.CrossRefGoogle ScholarPubMed
65.Kurtzke, JF, Hyllested, K.Multiple sclerosis in the Faroe Islands. II. Clinical update, transmission, and the nature of multiple sclerosis. Neurology 1986; 36: 307–328.Google ScholarPubMed
66.Acheson, ED.The pattern of the disease. In: Matthews, WB, Acheson, ED, Batchelor, JR, Weller, RO, eds. McAlpine's Multiple Sclerosis. New York: Churchill Livingstone, 1985: 22–25.Google Scholar
67.Poser, CM, Hibberd PL, Benedikz, et al.Analysis of the “epidemic” of multiple sclerosis in the Faroe Islands. 1. Clinical and epidemiological aspects. Neuroepidemiology 1988; 7: 168–180.Google ScholarPubMed
68.Poser, CM, Hibberd, PL.Analysis of the “epidemic” of multiple sclerosis in the Faroe Islands. I. Biostatistical aspects. Neuroepidemiology 1988; 7: 181–189.CrossRefGoogle ScholarPubMed
69.Kurtzke, JF, Hyllested, K.Validity of the epidemics of multiple sclerosis in the Faroe Islands. Neuroepidemiology 1988; 7: 190–227.CrossRefGoogle ScholarPubMed
70.Kurtzke, JF, Gudmundsson, KR, Bergmann, S.Multiple sclerosis in Iceland: I. Evidence of a postwar epidemic. Neurology 1982; 32: 143–150.CrossRefGoogle ScholarPubMed
71.Acheson, ED.Epidemiology of multiple sclerosis. Br Med Bull 1977; 33:9–14.CrossRefGoogle ScholarPubMed
72.Ebers, GC.Multiple sclerosis and other demyelinating diseases. In: Asbury, A, McKhann, G, McDonald, I, eds. Diseases of the Nervous System. Pennsylvania: WB Saunders Company, 1986: 1268–1281.Google Scholar
73.Weinshenker, BG, Bass, B, Rice, GP, et al.The natural history of multiple sclerosis: a geographically-based study. I. Clinical course and disability. Brain 1989; 112: 133–146.Google ScholarPubMed
74.Weinshenker, BG, Bass, B, Rice, GP, et al.The natural history of multiple sclerosis: a geographically-based study. 2. The predictive value of the early clinical course. Brain 1989; 112: 1419–1428.Google ScholarPubMed
75.Duquette, P, Murray, TJ.Pleines, J, et al.Multiple sclerosis in child-hood: clinical profile in 125 patients. J Pediat 1987; 111: 359–363.CrossRefGoogle Scholar
76.Sadovnick, AD, Ebers, GC, Eisen, K, et al.Cause of death in patients attending multiple sclerosis clinics. Neurology 1991; 41: 1193–1196.CrossRefGoogle ScholarPubMed
77.Weitkamp, LR. Multiple sclerosis susceptibility: interaction between sex and HLA. Arch Neurol 1983; 40: 399–401.CrossRefGoogle ScholarPubMed
78.Sadovnick, AD, Bulman, DE, Ebers, GC. Influence of gender on the susceptibility to multiple sclerosis in siblings. Arch Neurol 1991; 48: 586–588.CrossRefGoogle Scholar
79.Grufferman, S.Cole, PG.Lukes, RJ.Hodgkin's disease in siblings. N Engl J Med 1977; 296: 248–250.CrossRefGoogle ScholarPubMed
80.Schumacher, GA, Beebe, G, Kibler, RF, et al.Problems of experimental trials of therapy in multiple sclerosis: report by the panel on the evaluation of experimental trials of therapy in multiple sclerosis. Ann NY Acad Med 1965: 122: 552–568.CrossRefGoogle Scholar
81.Matthews, WB.Course and prognosis. In: Matthews, WB, Acheson, ED, Batchelor, JR, Weller, RO, eds. McAlpine's Multiple Sclerosis. New York: Churchill Livingstone, 1985: 49–52.Google Scholar
82.Noseworthy, J, Paly, DW, Wonnacott, T, et al.Multiple sclerosis after age 50. Neurology 1983; 33: 1537–1544.CrossRefGoogle ScholarPubMed
83.Bulman, DE.Sadovnick, AD, Ebers, GC.Age of onset in siblings concordant for multiple sclerosis. Brain 1991; 114: 937–950.CrossRefGoogle ScholarPubMed
84.Sadovnick, AD, Hashimoto, LL, Hashimoto, SA.Heterogeneity in multiple sclerosis’, comparison of clinical manifestations in relatives. Can J Neurol Sci 1990, 17: 387–439.CrossRefGoogle ScholarPubMed
85.Swank, RL.Multiple sclerosis, correlation of its incidence with dietary fat. Am J Med Sci 1951; 220: 421–430.CrossRefGoogle Scholar
86.Butler, EJ.Chronic neurological disease as a possible form of lead poisoning. J Neurol Neurosurg Psychiatry 1952; 15: 119–128.Google Scholar
87.Matthews, WB.Some aspects of the natural history. In: Matthews, WB, Acheson, ED, Batchelor, JR, Weller, RO. eds. McAlpine's Multiple Sclerosis. New York: Churchill Livingstone, 1985: 73–95.Google Scholar
88.Cook, SD, Dowling, PC.A possible association between housepets and multiple sclerosis. The Lancet 1977; i: 980–982.CrossRefGoogle Scholar
89.Bunnell, DH, Visscher, BR, Detels, R.Multiple sclerosis and house clogs: a case control study. Neurology 1979; 29: 1027–1029.CrossRefGoogle Scholar
90.Poskanzer, DC, Prenney, LB, Sheridan, JL.Housepets and multiple sclerosis. Lancet 1977; i: 1204.CrossRefGoogle Scholar
91.Read, D.Nassim, D, Smith, P, et al.Multiple sclerosis and dog ownership: a case-control investigation. J Neurol Sci 1982; 55: 359–367.CrossRefGoogle ScholarPubMed
92.Sibley, WA, Bamford, CR, Clark, K.Clinical viral infections and multiple sclerosis. Lancet 1985; 1313–1315.CrossRefGoogle Scholar
93.Gay, D, Dick, G, Upton, G.Multiple sclerosis associated with sinusitis: case-controlled study in general practice. Lancet 1986; i: 815–819.CrossRefGoogle Scholar
94.Sibley, WA, Foley, JM.Infection and immunization in mutliple sclerosis. Ann NY Acad Sci 1965; 122: 457–468.CrossRefGoogle Scholar
95.D'Hooghe, MB, Ebers, GC.A population-based study of seasonal onset of multiple sclerosis in London, Ontario. Abstract. Neurology 1989; 39 (Suppl I): 284.Google Scholar
96.Bamford, CR, Sibley, WA, Thies, C, et al.Trauma as an etiologic and aggravating factor in multiple sclerosis. Neurology 1981; 31: 1229–1234.CrossRefGoogle ScholarPubMed
97.McAlpine, D, Compston, ND.Some aspects of the natural history of disseminated sclerosis. J of Med 1952; 21: 135–167.Google ScholarPubMed
98.Millar, JHD, Allison, RS, Cheesman, EA.et al.Pregnancy as a factor influencing relapse in disseminated sclerosis. Brain 1959; 82: 417–426.CrossRefGoogle ScholarPubMed
99.Koopmans, RA, Li, DKB, Oger, J J-F, et al.The lesion of multiple sclerosis: imaging of acute and chronic stages. Neurology 1989a; 39: 959–963.CrossRefGoogle ScholarPubMed
100.Willoughby, EW.Grochowski, E, Li, DKB.et al.Serial magnetic resonance scanning in multiple sclerosis: a second prospective study in relapsing patients. Ann Neurol 1989; 25: 43–49.CrossRefGoogle ScholarPubMed
101.Isaac, C, Li, DKB, Genton, M, et al.Multiple sclerosis: a serial study using MRI in relapsing patients. Neurology 1988; 38: 1511–1515.CrossRefGoogle ScholarPubMed
102.Birk, K.Ford, C, Smeltzer, S, et al.The clinical course of multiple sclerosis during pregnancy and the Puerperium. Arch Neurol 1990; 47: 738–742.CrossRefGoogle ScholarPubMed
103.Sadovnick, AD, Paty, DW, Hashimoto, SA, et al.Multiple sclerosis and pregnancy: a prospective study. Abstract. Neurol 1990; 40 (Suppl 1): 141.Google Scholar
104.Barnett, GO, Justice, NS, Somand, ME.et al.COSTAR – a computer-based medical information system for ambulatory care. Proc IEEE 1979; 67: 1226–1237.CrossRefGoogle Scholar
105.Holmes, FF, Stubbs, DW, Larsen, WE.Systemic lupus erythematosus and multiple sclerosis in identical twins. Arch Intern Med 1967; 119: 302.CrossRefGoogle ScholarPubMed
106.Margolis, LN, Graves, RW.The occurrence of myasthenia gravis in a patient with multiple sclerosis. NC Med J 1945; 24: 243–244.Google Scholar
107.Aita, JF, Snyder, DH, Reichl, W.Myasthenia gravis and multiple sclerosis: an usual combination of diseases. Neurology 1974; 24: 72–75.CrossRefGoogle Scholar
108.Shakir, RA, Hussuen, JM, Trontelj, JV.Myasthenia gravis and multiple sclerosis. J Neuroimmunol 1983; 4: 161–165.CrossRefGoogle ScholarPubMed
109.Matthews, WB.The neurological complications of ankylosing spondylitis. J Neurol Sei 1968; 5: 561–573.CrossRefGoogle Scholar
110.Thomas, DJ, Kendall, MJ, Whitfield, AGW.Nervous system involvement in ankylosing spondylitis. Br Med J 1974; 1: 148–150.CrossRefGoogle ScholarPubMed
111.Sadovnick, AD, Paty, DW, Yannakoulias, G.Concurrence of multiple sclerosis and inflammatory bowel disease. N Engl J Med 1989: 321: 762–763.Google ScholarPubMed
112.Trostle, DC, Helfrich, D, Medsger, TA Jr.Systemic sclerosis (scleroderma) and multiple sclerosis. Arthritis Rheum 1986; 29: 124–127.CrossRefGoogle ScholarPubMed
113.Bias, WB, Reveille, JD, Beaty, TH, et al.Evidence that autoimmunity in man is a Mendelian dominant trait. Am J Hum Genet 1986; 39: 584–602.Google Scholar
114.Wynn, DR, Codd, MB, Kurland, LT, et al.Multiple sclerosis: a population-based investigation of the association with possible autoimmune diseases and diabetes mellitus. Abstract. Neurology 1987; 37 (Suppl 1): 272.Google Scholar
115.Linos, A, Worthington, JW, O'Fallon, WM, et al.The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence and mortality. Am J Epidemiol 1980; 111: 87–98.CrossRefGoogle ScholarPubMed
116.Furszyfer, J, Kurland, LT, McConahey, WM, et al.Epidemiologic aspects of Hashimoto's thyroiditis and Graves disease in Rochester, Minnesota (1935-1967), with special reference to temporal trends. Metabolism 1972; 3: 197–204.CrossRefGoogle Scholar
117.Warren, S, Warren, KG.Multiple sclerosis and associated diseases: a relationship to diabetes mellitus. Can J Neurol Sei 1981: 8: 35–39.CrossRefGoogle Scholar
118.Wynn, DR, Codd, MB, Kurland, LT, et al.Multiple sclerosis: a population-based investigation of the association with neoplastic disorders. Abstract. Neurology 1987; 37 (Suppl I): 151.Google Scholar
119.Sibley, WA, Bamford, CR, Laguna, JF.Anamnestic studies in multiple sclerosis: a relationship between familial multiple sclerosis and neoplasia. Neurology 1978; 28: 125–128.CrossRefGoogle ScholarPubMed
120.Zimmerman, HM, Netsky, MG.The pathology of multiple sclerosis. Res Publ Assoc Res Nerv Ment Dis 1950; 28: 271–312.Google ScholarPubMed
121.Castaigne, P.Escourelle, R, Brunet, P, et al.Reticulosarcome cerebral primitif associe a des lesions de sclerose en plaques. Res Neurol 1974; 130: 181–188.Google Scholar
122.Currie, S.Urich, H.Concurrence of multiple sclerosis and glioma. J Neurol Neurosurg Psychiatry 1974; 37: 598–605.CrossRefGoogle ScholarPubMed
123.Reagan, TJ, Frieman, IS.Multiple cerebral gliomas in multiple sclerosis. J Neurol Neurosurg Psychiatry 1973; 36: 523–528.CrossRefGoogle ScholarPubMed
124.Lynch, PG.Multiple sclerosis and malignant glioma. Br Med J 1974; 3: 577. Poskanzer DC, Prenney LB, Sheridan JL, Kondy JY. Multiple sclerosis in the Orkney and Shetland Islands. I. Epidemiology, clinical factors and methodology. J Epidemiol and Comm Health 1980; 34: 229-239.CrossRefGoogle Scholar
125.Allen, IV, Millar, JHD, Hutchinson, MJ. General disease in 120 necropsy-proven cases of multiple sclerosis. Neuropathol App Neurobiol 1978; 4:279–284.CrossRefGoogle ScholarPubMed
126.Warren, S, Warren, KG.Prevalence of multiple sclerosis in Barrhead County, Alberta, Canada. Can J Neurol Sei 1992: 19: 72–75.CrossRefGoogle ScholarPubMed
127.Klein, GM, Seland, TP, Barclay, L, Orman, AV.An epidemiological study of multiple sclerosis in the Crowsnest Pass and Cardston regions of southern Alberta. Can J Neurol Sci 1990; 17: 241.Google Scholar
128.Gallou, M, Madigand, M, Masse, L, et al.Epidemiologie de la sclerose en plaques en Bretagne. Presse Med 1983; 12: 995–999.Google Scholar
129.Lauer, K, Firnhaber, W, Reining, R, et al.Epidemiological investigations into multiple sclerosis in Southern Hesse. I. Methodological problems and basic epidemiological characteristics. Acta Neurol Scand 1984; 70: 257–265.Google ScholarPubMed
130.Milonas, I, Tsounis, S, Logothetis, I.Epidemiology of multiple sclerosis in northern Greece. Acta Neurol Scand 1990; 81: 43–47.CrossRefGoogle ScholarPubMed
131.Yu, YL, Woo, E, Hawkins, BR, et al.Multiple sclerosis amongst Chinese in Hong Kong. Brain 1989; 112: 1445–1467.CrossRefGoogle ScholarPubMed
132.Palffy, G.MS in Hungary, including the gipsie population. In: Kuroiwa, Y, Kurland, LT, eds. Multiple Sclerosis. East and West. Kyushu: Kyushu University Press, 1982: 149–157.Google Scholar
133.Wadia, NH, Bhatia, K.Multiple sclerosis is prevalent in the Zoroastrians (Parsis) of India. Ann Neurol 1990; 28: 177–179.CrossRefGoogle ScholarPubMed
134.Leibowitz, U, Kahana, E, Alter, M.Multiple sclerosis in immigrant and native populations of Israel. The Lancet 1970; 1: 1323–1325.Google Scholar
135.Sironi, L, Mamoli, A, D'Alessandro, G, et al.Frequency of multiple sclerosis in Valle d'Aosta, 1971-1985. Neuroepidemiology 1991; 10: 66–69.CrossRefGoogle Scholar
136.Kuroiwa, Y, Shibasaki, H, Ikeda, M.Prevalence of multiple sclerosis and its north-south gradient in Japan. Neuroepidemiology 1983: 2: 62–69.CrossRefGoogle Scholar
137.Kim, SW, Kim, SY.Multiple sclerosis in Busan, Korea. Clinical features and prevalence. In: Kuroiwa, Y, Kurland, LT, eds. Multiple Sclerosis. East and West. Kyushu: Kyushu University Press, 1982: 57–69.Google Scholar
138.Park CS. Multiple sclerosis in Korea. Neurology 1966; 16: 919–926.CrossRefGoogle Scholar
139.Al-Din, ASN.Multiple sclerosis in Kuwait: clinical and epidemiological study. J Neurol Neurosurg Psychiatry 1986; 49: 928–931.CrossRefGoogle ScholarPubMed
140.Radhakrishnan, K, Ashok, PP, Sridharan, R, et al.Prevalence and pattern of multiple sclerosis in Benghazi, North-Eastern Libya. J Neurol Sci 1985; 70: 39–46.CrossRefGoogle ScholarPubMed
141.Tan, C-T.Multiple sclerosis in Malaysia. Arch Neurol 1988; 45: 624–627.CrossRefGoogle ScholarPubMed
142.Alter, M, Olivares, L.Multiple sclerosis in Mexico. Arch Neurol 1970; 23: 451–459.CrossRefGoogle ScholarPubMed
143.Skegg, DCG, Corwin, PA, Craven, RS. et al.Occurrence of multiple sclerosis in the north and south of New Zealand. J Neurol Neurosurg Psychiatry 1987: 50: 134–139.CrossRefGoogle ScholarPubMed
144.Yaquib, BA, Daif, AK.Multiple sclerosis in Saudi Arabia. Neurology 1988; 38: 621–623.CrossRefGoogle Scholar
145.Geogi, F, Hall, P, Muller, HR.Zur Problematik der multiplen Sklerose. Karger, Basel New York, 1961. (Cited by Bauer13).Google Scholar
146.Bartschi-Rochaix, W.MS in Switzerland Canton Wallis. In: Bauer, HJ, Poser, S, Ritter, G, eds. Progress in Multiple Sclerosis Research. New York: Springer, 1980: 535–538.CrossRefGoogle Scholar
147.Hung, T-P.Multiple sclerosis in Taiwan: a reappraisal. In: Kuroiwa, Y, Kurland, LT, eds. Multiple Sclerosis. East and West. Kyushu: Kyushu University Press. 1982: 83–96.Google Scholar
148.Ben, Hamida M.La sclerose en plaques en Tunisie: etude clinique de 100 observations. Rev Neurol (Paris) 1977: 33: 109–117.Google Scholar
149.Williams, ES, McKeran, RO.Prevalence of multiple sclerosis in a south London borough. Br Med J 1986; 293: 237–239.CrossRefGoogle Scholar
150.Swingler, RJ, Compston, DAS.The prevalence of multiple sclerosis in South East Wales. J Neurol Neurosurg Psychiatry 1988: 51: 1520–1524.CrossRefGoogle ScholarPubMed
151.Phadke, JG, Downie, AW.Epidemiology of multiple sclerosis in the north-east (Grampian Region) of Scotland – an update. J Epidemiol Comm Health 1987; 41: 5–13.CrossRefGoogle ScholarPubMed
152.Cook, SD, MacDonald, J, Tapp, W.et al.Multiple sclerosis in the Shetland Islands: an update. Acta Neurol Scand 1988; 77: 148–151.CrossRefGoogle ScholarPubMed
153.Cook, SD, Cromarty, JI, Tapp, W.et al.Declining incidence of multiple sclerosis in the Orkney Islands. Neurology 1985; 35: 545–551.CrossRefGoogle ScholarPubMed
154.Dean, G, Goodall, J, Downie, A.The prevalence of multiple sclerosis in the Outer Hebrides compared with north-east Scotland and the Orkney and Shetland Islands. J Epidemiol Comm Health 1981: 35: 110–113.CrossRefGoogle ScholarPubMed
155.Alter, M, Okihiro, M, Rowley, W, et al.Multiple sclerosis among orientals and Caucasians in Hawaii. Neurology 1971; 21: 122–130.CrossRefGoogle ScholarPubMed
156.Enstrom, JE, Operskalski, EA.Multiple sclerosis among Spanish-surnamed Californians. Neurology 1978; 28: 434–438.CrossRefGoogle ScholarPubMed
157.Visscher, BR, Detels, R, Coulson, AHet al.Latitude, migration and the prevalence of multiple sclerosis. Am J Epidemiol 1977; 106: 470–475.CrossRefGoogle ScholarPubMed
158.Sepcic, J, Antonelli, L, Materljan, E, et al.Multiple sclerosis cluster in Gorski Kotar, Croatia, Yugoslavia. In: Battaglia, MA, ed. Multiple Sclerosis Research. Amsterdam: Elsevier Science Pub, 1989: 165–169.Google Scholar
159.Rosati, G, Aiello, I, Pirastru, MI.et al.Sardinia: a high-risk area for multiple sclerosis: a prevalence and incidence study in the district of Alghero. Ann Neurol 1987; 21: 190–194.CrossRefGoogle ScholarPubMed
160.Salerni, E, D'Aurizio, CD, Andrea, FD. et al.A prevalence study of multiple sclerosis in L*Aquila, central Italy. Clin Neurol Neurosurg 1988; 90: 112–116.CrossRefGoogle ScholarPubMed
161.Granieri, E, Tola, R, Paolino, E, et al.The frequency of multiple sclerosis in Italy: a descriptive study in Ferrara. Ann Neurol 1985; 17: 80–84.CrossRefGoogle ScholarPubMed