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  • Review Article
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Environmental factors and their timing in adult-onset multiple sclerosis

Nature Reviews Neurology volume 6, pages 156–166 (2010)Cite this article

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Abstract

Multiple sclerosis (MS) is a common, complex neurological disease. Epidemiological data implicate both genetic and environmental factors in the etiology of MS, with various factors interacting with one another. Environmental exposures might occur long before the disease becomes clinically evident, as suggested by the wide range in onset age. In this Review, we examine the key time periods during which the environment might contribute to MS susceptibility, as well as the potential environmental factors involved. Understanding the nature of environmental influences in MS is highly relevant to the development of public health measures that are aimed at preventing this debilitating disease.

Key Points

  • Evidence from studies of disease risk in relation to the month of birth implicates early-life environmental factors in multiple sclerosis (MS) susceptibility

  • Migration data, and variability in disease onset and relapse rates, suggest that environmental factors might also act later in life and during the course of MS

  • Vitamin D is an attractive candidate factor implicated by the association of MS risk with latitude and month of birth, and is likely to act early in life

  • Epstein–Barr virus is also linked to MS and seems to act in adolescence or early adulthood to alter susceptibility

  • Smoking is associated with increased susceptibility to adult-onset MS when individuals are exposed later in life, and can alter the course of established MS

  • Strategies aimed at preventing or treating multiple sclerosis by manipulating environmental factors may provide a powerful way of reducing the prevalence of this often devastating disease

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Figure 1: End-of-summer sunlight and MS prevalence in France.
Figure 2: Pedigree diagram showing maternal parent-of-origin effects in MS.
Figure 3: Vitamin D levels and MS.
Figure 4: Effect size of environmental factors on MS risk during different life periods.

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Acknowledgements

We would like to thank the Canadian Collaborative Study Group for many helpful discussions.

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Authors and Affiliations

  1. University Department of Clinical Neurology, Level 3, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK

    Adam E. Handel, George C. Ebers & Sreeram V. Ramagopalan

  2. Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, E1 2AT, London, UK

    Gavin Giovannoni

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Handel, A., Giovannoni, G., Ebers, G. et al. Environmental factors and their timing in adult-onset multiple sclerosis. Nat Rev Neurol 6, 156–166 (2010). https://doi.org/10.1038/nrneurol.2010.1

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