What triggers MS and MS attacks?

Hi again from the American Academy of Neurology meeting in San Diego. There have been some intriguing reports from researchers looking for risk factors that contribute to making a person more likely to get multiple sclerosis, and other reports focused on factors that might trigger MS attacks or even progression. To me, this line of research is really important because it could lead to ways to take control of disease activity and even to strategies to prevent people from getting MS.

Danish researchers have noted that the incidence of MS has doubled in women in Denmark since 1970, and they’ve been working to understand what’s behind this alarming rise. The Danish MS Registry captures information on most people in their country who have MS. They found that pregnancy offered significant protection against developing MS lasting up to five years after giving birth. I’m certainly not advocating that women should get pregnant to prevent MS. But this study and others like it offer more clues that will help to determine the influence of hormones and other factors in MS.

It was also exciting to hear firsthand results from recent studies reporting that dietary salt might have a role in increasing the risk for MS. The take-home message from these studies was that higher than average physiological levels of salt can increase the aggressiveness of immune cells that are thought to play an important role in MS. They also showed that adding salt to the diet of mice led to a more severe form of an MS-like disease called experimental autoimmune encephalomyelitis. There was a lot of discussion and debate about whether the high-salt western diet might be responsible for the increased incidence of MS. We will have to just wait for more studies to know for sure, but it is probably still a good idea to keep the fast-food burgers to a minimum.

This year’s Dystel Prize winner Professor George Ebers presented his work on the influences of the environment and genes passed down through families during a special prize lecture. You can read about his work here. In a nutshell, his studies have led to the understanding that where you live, and how much sun exposure you get (and consequently how much vitamin D your body makes from the sun), are some of the key factors that influence the risk of developing MS. I’m looking forward to results from clinical trials that are testing whether vitamin D supplements can reduce disease activity in people who already have MS.

What about triggers for MS attacks? Dr. Mauricio Farez of Argentina analyzed whether common vaccinations are linked to the risk of developing MS or triggering MS attacks. He failed to find evidence that any common vaccines contribute to the risk of MS, and he confirmed previous reports suggesting that flu vaccines, including H1N1, don’t appear to trigger relapses. But the big surprise for me was his report that a less common vaccine that protects against yellow fever may substantially increase the risk of relapse. Even though this is a preliminary finding, I recommend that if you are traveling to an exotic land (luck you!) and need this vaccine, you should talk with you MS doc about how to weigh these risks.

We don’t know yet why some people’s MS progresses slowly and others experience rapid progression, but I found a small study from investigators at Louisiana State University interesting. They asked whether blood sugar is linked to levels of MS disability, and found that people with higher levels of glucose were more likely to experience progression. This needs more study, but it opens up the possibility that strategies used to treat diabetes should be tested in MS.

I’ve only scratched the surface of what’s being reported here, and I hope you’ll read the upcoming summary that will give you more details. In the meantime, summaries (abstracts) of the meeting can be viewed on the AAN Website.
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Bruce Bebo, PhD

Bruce Bebo, PhD, is Executive Vice President, Research at the National MS Society, and was previously a research immunologist focusing on the influence of sex hormones on MS. He is a driven and passionate Society volunteer, successful fundraiser and advocate, fueled in part by the fact that his mother had MS.