Sunday, 6 May 2018

MS on the increase

MS is on the increase, notably in women,
What's the cause?

Is it their shoes?


The Scandinavian registries are a fantastic source of information and they have been monitoring the health of their citizens for decades. 

In this report they again show what other studies have found and this is that the occurrence of MS is increasing, notably in women.

What is the cause?

Although it could be because people are abit more mobile these days and their gene pool is mxing, however it tends to suggests that environment is a big factor and the question is what are the factors?

Because this suggests that susceptibility can be modified. 

As a solution we can trot out the usual suspects, like smoking and eating, eating salt:-), which we all know are important health issues. 

However, could it be more Mulburry bags, Looboutin shoes? 
(Yes I know they are spelt wrong).

Daft idea, yep as the Danes no doubt have their own preference, but the point is made that you have no idea what is important. Smoking has some data, but ice cream consumption could be more important. Last week NDG had sheep and the most read post on the blog is about MS and pets.

However,  unless you do something about it and you modify the behaviour and it has a positive (or negative) impact on disease.

Problem is, this is just like diets, there is little will to fund the studies. 

Is MS preventable?

Koch-Henriksen N, Thygesen LC, Stenager E, Laursen B, Magyari M.Incidence of MS has increased markedly over six decades in Denmark particularly with late onset and in women. Neurology. 2018 May 2. pii: 10.1212/WNL.0000000000005612

OBJECTIVE:To describe the pattern of development of incidence of multiple sclerosis (MS) over 60 years in Denmark with age-period-cohort analyses and seasonality of birth.
METHODS:Data on virtually all patients with onset of MS have since 1950 been prospectively recorded and kept in the Danish Multiple Sclerosis Registry with multiple sources of notification. Annualized incidence rates per 100,000 were directly standardized to the European Standard Population.
RESULTS: We have registered 19,536 cases with clinical onset of confirmed MS in Denmark from 1950 to 2009. From the 1950-1959 to the 2000-2009 onset period, incidence more than doubled in women, with an increase from 5.91 (95% confidence interval [CI]: 5.60-6.24) to 12.33 (95% CI: 11.91-12.75) per 100,000 per year compared with a modest 24% increase in men from 4.52 (95% CI: 4.24-4.81) to 6.08 (95% CI: 5.79-6.38). With age at onset of 50 years and older, incidence increased with a factor 4.30 in women and 2.72 in men. The female/male sex ratio increased over time and with year of birth. Age-period-cohort analysis revealed a significant birth cohort effect in addition to the age and period effect. We found no statistically significant seasonality of births.
CONCLUSION: The incidence of MS has doubled in women, most pronounced with late onset, and has only modestly increased in men. Lifestyle changes in the female population that could include fewer childbirths, increased occurrence of obesity, and increased cigarette consumption may have a role.

19 comments:

  1. Is there a possibility the observed changes stem from changes in diagnosing over time? I suspect for example in the 50-80s it wasn't as common to get as many MRIs and diagnoses may have been less common for less aggressive MS

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    1. And also possible correlations seen as causations - for example, I suspect the number of women dying of or shortly after childbirth has dropped since 1950s - but if those women were dying of complications caused by undiagnosed MS, they would be causing the later life increase if they survived these days - statistics are notoriously slippery.

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  2. Hasn't this been shown decades ago? How is this news? I hate to think how much money is wasted by researchers redoing the same thing over and over again. What happened to prof g's prevent ms institute? He has the cash to do something about it now?

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    1. In terms of cost, this research would have a minimal cost, besides the time of the person doing the research.

      "The same thing over and over" You do need replication of results.

      The prevent Institute....I belive DrRuth will be starting soon

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  3. I've never smoked or drunk alcohol; I eat a reasonably healthy diet and I'm not overweight; I'm so grateful I've been able to have five children. I was diagnosed with multiple sclerosis in my mid forties. What I did have, as a young teenager, was glandular fever which forced me to miss several months of school. MS certainly seems to be a very complex disease.

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    1. Glandular fever (Epstein Barr virus) infection, particularly as a young adult would seem to be a significant factor.

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    2. I had Glandular fever badly as a teenager (~16). Id like to think (as someone who over exercises, over drinks, and is not the kindest person to himself), that the virus theory is king (and that killing the body's memory of said virus is what retrospectively combats ms).

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  4. Might there be a link with the increased use of hormonal contraceptives?

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    1. More likely perhaps to be linked with far greater use of sunscreens after skin cancer campaigns. UV filters SPF are now routinely added in loads of make-up products (anti-ageing). Also there has been a huge increase of MS in women in Iran (previously low risk)coinciding with the mandatory wearing of the veil since the Islamic revolution.

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    2. That's an amazing discovery - do you have the study / cite the source?

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    3. Article on this here. The article skirts round the issue of the veil in Iran, postrevolution, which I suppose is understandable given the source of the article and obviously a sensitive issue in many Islamic societies.
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506754/

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    4. A more explicit piece here.
      https://www.smithsonianmag.com/science-nature/what-is-causing-irans-spike-in-ms-cases-36463584/

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    5. Thank you! I believe that ms is an unfortunate consequence of a few risk factors. I firmly believe in the vitamin D theory, as I do he western lifestyle. Coupled with a genetic suseptisuscept.

      As an identical make twin, born mid febFebru, who had glandular fever. You can see why.

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  5. Every time I read about MS increasing I remember something a long-retired GP once told me whenever he suspected a patient had MS 'I didn't tell them'.

    To put it in context, there were no treatments and there was a good chance the patient would die of something else before MS got too bad. Perhaps registry data from pre dmt era should be viewed cautiously.

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    1. Yes it will be the same about "progressive MS"...with no treatment options this term was avoided. It has contributed to the slow recruitment of the proximus study

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    2. In a similar vein, my neurologist told me when I was diagnosed that men used to be told of their diagnosis, women were not. So where is the reliable historical data, is there any? And was MS not possibly misdiagnosed as other things? Hysteria, for example? I once had a particularly poor old duffer of a GP say to me before I was diagnosed; "I have more patients who think they have MS than actually have MS." And another didn't even read my notes from a prior medical practice on my neurological symptoms and consultations. She prescribed me relaxing audio CDs for OCD.

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  6. If I were a scientist, or had a lot of money (which I do not have), I would invest in research to find out if the answer lies in the hormones and how their interaction with the genus can cause susceptibility to MS.

    And maybe the clue is in contraceptives, especially oral contraceptives. We women nowadays consume oral contraceptives, which we did not do 50 years ago, for example.

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    1. I think women (and men) have very different lives now in many respects compared to 50 years ago, I don't know that there's really any evidence to implicate our oral contraceptive use? I thought the gender bias of MS is mostly put down to having two X chromosomes and no Y?

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