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. 1993 Oct;6(4):382–427. doi: 10.1128/cmr.6.4.382

Epidemiologic evidence for multiple sclerosis as an infection.

J F Kurtzke 1
PMCID: PMC358295  PMID: 8269393

Abstract

The worldwide distribution of multiple sclerosis (MS) can be described within three zones of frequency: high, medium, and low. The disease has a predilection for white races and for women. Migration studies show that changing residence changes MS risk. Studies of persons moving from high- to low-risk areas indicate that in the high-risk areas, MS is acquired by about age 15. Moves from low- to high-risk areas suggest that susceptibility is limited to persons between about ages 11 and 45. MS on the Faroe Islands has occurred as four successive epidemics beginning in 1943. The disease appears to have been introduced by British troops who occupied the islands for 5 years from 1940, and it has remained geographically localized within the Faroes for half a century. What was introduced must have been an infection, called the primary MS affection (PMSA), that was spread to and from successive cohorts of Faroese. In this concept, PMSA is a single widespread systemic infectious disease (perhaps asymptomatic) that only seldom leads to clinical neurologic MS. PMSA is also characterized by a need for prolonged exposure, limited age of susceptibility, and prolonged incubation. I believe that clinical MS is the rare late outcome of a specific, but unknown, infectious disease of adolescence and young adulthood and that this infection could well be caused by a thus-far-unidentified (retro)virus.

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Selected References

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  1. ALTER M., HALPERN L., KURLAND L. T., BORNSTEIN B., LEIBOWITZ U., SILBERSTEIN J. Multiple sclerosis in Israel. Prevalence among immigrants and native inhabitants. Arch Neurol. 1962 Oct;7:253–263. doi: 10.1001/archneur.1962.04210040005001. [DOI] [PubMed] [Google Scholar]
  2. Acheson E. D. Epidemiology of multiple sclerosis. Br Med Bull. 1977 Jan;33(1):9–14. doi: 10.1093/oxfordjournals.bmb.a071407. [DOI] [PubMed] [Google Scholar]
  3. Al-Din A. S. Multiple sclerosis in Kuwait: clinical and epidemiological study. J Neurol Neurosurg Psychiatry. 1986 Aug;49(8):928–931. doi: 10.1136/jnnp.49.8.928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Alperovitch A., Bouvier M. H. Geographical pattern of death rates from multiple sclerosis in France. An analysis of 4912 deaths. Acta Neurol Scand. 1982 Oct;66(4):454–461. doi: 10.1111/j.1600-0404.1982.tb06867.x. [DOI] [PubMed] [Google Scholar]
  5. Alperovitch A., Le Canuet P., Marteau R. Birth order and risk of multiple sclerosis: are they associated and how? Acta Neurol Scand. 1981 Feb;63(2):136–138. doi: 10.1111/j.1600-0404.1981.tb00757.x. [DOI] [PubMed] [Google Scholar]
  6. Alter M., Kahana E., Loewenson R. Migration and risk of multiple sclerosis. Neurology. 1978 Nov;28(11):1089–1093. doi: 10.1212/wnl.28.11.1089. [DOI] [PubMed] [Google Scholar]
  7. Alter M., Leibowitz U., Speer J. Risk of multiple sclerosis related to age at immigration to Israel. Arch Neurol. 1966 Sep;15(3):234–237. doi: 10.1001/archneur.1966.00470150012002. [DOI] [PubMed] [Google Scholar]
  8. Alter M., Okihiro M. When is multiple sclerosis acquired? Neurology. 1971 Oct;21(10):1030–1036. doi: 10.1212/wnl.21.10.1030. [DOI] [PubMed] [Google Scholar]
  9. Alter M., Speer J. Clinical evaluation of possible etiologic factors in multiple sclerosis. Neurology. 1968 Feb;18(2):109–116. doi: 10.1212/wnl.18.2.109. [DOI] [PubMed] [Google Scholar]
  10. Antonen J., Syrjälä P., Oikarinen R., Frey H., Krohn K. Acute multiple sclerosis exacerbations are characterized by low cerebrospinal fluid suppressor/cytotoxic T-cells. Acta Neurol Scand. 1987 Feb;75(2):156–160. doi: 10.1111/j.1600-0404.1987.tb07911.x. [DOI] [PubMed] [Google Scholar]
  11. Arnason B. G., Antel J. P., Reder A. T. Immunoregulation in multiple sclerosis. Ann N Y Acad Sci. 1984;436:133–139. doi: 10.1111/j.1749-6632.1984.tb14785.x. [DOI] [PubMed] [Google Scholar]
  12. BARLOW J. S. Correlation of the geographic distribution of multiple sclerosis with cosmic-ray intensities. Acta Psychiatr Scand Suppl. 1960;35(147):108–131. doi: 10.1111/j.1600-0447.1960.tb08673.x. [DOI] [PubMed] [Google Scholar]
  13. Baum H. M., Rothschild B. B. The incidence and prevalence of reported multiple sclerosis. Ann Neurol. 1981 Nov;10(5):420–428. doi: 10.1002/ana.410100504. [DOI] [PubMed] [Google Scholar]
  14. Beebe G. W., Kurtzke J. F., Kurland L. T., Auth T. L., Nagler B. Studies on the natural history of multiple sclerosis. 3. Epidemiologic analysis of the army experience in World War II. Neurology. 1967 Jan;17(1):1–17. doi: 10.1212/wnl.17.1.1. [DOI] [PubMed] [Google Scholar]
  15. Bennett L., Hamilton R., Neutel C. I., Pearson J. C., Talbot B. Survey of persons with multiple sclerosis in Ottawa, 1974-75. Can J Public Health. 1977 Mar-Apr;68(2):141–147. [PubMed] [Google Scholar]
  16. Blanc M., Clanet M., Berr C., Dugoujon J. M., Ruydavet B., Ducos S. J., Rascol A., Alpérovitch A. Immunoglobulin allotypes and susceptibility to multiple sclerosis. An epidemiological and genetic study in the Hautes-Pyrénées county of France. J Neurol Sci. 1986 Aug;75(1):1–5. doi: 10.1016/0022-510x(86)90045-6. [DOI] [PubMed] [Google Scholar]
  17. Bobowick A. R., Kurtzke J. F., Brody J. A., Hrubec Z., Gillespie M. Twin study of multiple sclerosis: an epidemiologic inquiry. Neurology. 1978 Oct;28(10):978–987. doi: 10.1212/wnl.28.10.978. [DOI] [PubMed] [Google Scholar]
  18. Brady R., Dean G., Secerbegovic S., Secerbegovic A. M. Multiple sclerosis in the Republic of Ireland. Ir Med J. 1977 Nov 18;70(17):500–506. [PubMed] [Google Scholar]
  19. Bray P. F., Bloomer L. C., Salmon V. C., Bagley M. H., Larsen P. D. Epstein-Barr virus infection and antibody synthesis in patients with multiple sclerosis. Arch Neurol. 1983 Jul;40(7):406–408. doi: 10.1001/archneur.1983.04050070036006. [DOI] [PubMed] [Google Scholar]
  20. Buddenhagen F., Pantović M. M. Vergleichende epidemiologische Analyse der Multiplen Sklerose in Gebieten des mittleren und südlichen Europas. Psychiatr Neurol Med Psychol (Leipz) 1985 Oct;37(10):565–572. [PubMed] [Google Scholar]
  21. Bulman D. E., Sadovnick A. D., Ebers G. C. Age of onset in siblings concordant for multiple sclerosis. Brain. 1991 Apr;114(Pt 2):937–950. doi: 10.1093/brain/114.2.937. [DOI] [PubMed] [Google Scholar]
  22. CAMPBELL A. M. G., HERDAN G., TATLOW W. F. T., WHITTLE E. G. Lead in relation to disseminated sclerosis. Brain. 1950;73(1):52–71. doi: 10.1093/brain/73.1.52. [DOI] [PubMed] [Google Scholar]
  23. Compston D. A., Vakarelis B. N., Paul E., McDonald W. I., Batchelor J. R., Mims C. A. Viral infection in patients with multiple sclerosis and HLA-DR matched controls. Brain. 1986 Apr;109(Pt 2):325–344. doi: 10.1093/brain/109.2.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Cook S. D., Cromarty J. I., Tapp W., Poskanzer D., Walker J. D., Dowling P. C. Declining incidence of multiple sclerosis in the Orkney Islands. Neurology. 1985 Apr;35(4):545–551. doi: 10.1212/wnl.35.4.545. [DOI] [PubMed] [Google Scholar]
  25. Cook S. D., Gudmundsson G., Benedikz J., Dowling P. C. Multiple sclerosis and distemper in Iceland 1966-1978. Acta Neurol Scand. 1980 Apr;61(4):244–251. doi: 10.1111/j.1600-0404.1980.tb01489.x. [DOI] [PubMed] [Google Scholar]
  26. Cook S. D., MacDonald J., Tapp W., Poskanzer D., Dowling P. C. Multiple sclerosis in the Shetland Islands: an update. Acta Neurol Scand. 1988 Feb;77(2):148–151. doi: 10.1111/j.1600-0404.1988.tb05885.x. [DOI] [PubMed] [Google Scholar]
  27. De Rossi A., Gallo P., Tavolato B., Callegaro L., Chieco-Bianchi L. Search for HTLV-I and LAV/HTLV-III antibodies in serum and CSF of multiple sclerosis patients. Acta Neurol Scand. 1986 Aug;74(2):161–164. doi: 10.1111/j.1600-0404.1986.tb04644.x. [DOI] [PubMed] [Google Scholar]
  28. DeFreitas E., Saida T., Iwasaki Y., Koprowski H. Association of human T-lymphotropic viruses in chronic neurological disease. Ann Neurol. 1987 Feb;21(2):215–216. doi: 10.1002/ana.410210219. [DOI] [PubMed] [Google Scholar]
  29. Dean G. Annual incidence, prevalence, and mortality of multiple sclerosis in white South-African-born and in white immigrants to South Africa. Br Med J. 1967 Jun 17;2(5554):724–730. doi: 10.1136/bmj.2.5554.724. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. 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 Community Health. 1981 Jun;35(2):110–113. doi: 10.1136/jech.35.2.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Dean G., Grimaldi G., Kelly R., Karhausen L. Multiple sclerosis in southern Europe. I: Prevalence in Sicily in 1975. J Epidemiol Community Health. 1979 Jun;33(2):107–110. doi: 10.1136/jech.33.2.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Dean G., Kurtzke J. F. On the risk of multiple sclerosis according to age at immigration to South Africa. Br Med J. 1971 Sep 25;3(5777):725–729. doi: 10.1136/bmj.3.5777.725. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Dean G., McLoughlin H., Brady R., Adelstein A. M., Tallett-Williams J. Multiple sclerosis among immigrants in Greater London. Br Med J. 1976 Apr 10;1(6014):861–864. doi: 10.1136/bmj.1.6014.861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Decker J. L., Malone D. G., Haraoui B., Wahl S. M., Schrieber L., Klippel J. H., Steinberg A. D., Wilder R. L. NIH conference. Rheumatoid arthritis: evolving concepts of pathogenesis and treatment. Ann Intern Med. 1984 Dec;101(6):810–824. doi: 10.7326/0003-4819-101-6-810. [DOI] [PubMed] [Google Scholar]
  35. Delasnerie-Lauprêtre N., Alpérovitch A. Migration and age at onset of multiple sclerosis: some pitfalls of migrant studies. Acta Neurol Scand. 1992 Jun;85(6):408–411. doi: 10.1111/j.1600-0404.1992.tb06038.x. [DOI] [PubMed] [Google Scholar]
  36. Detels R., Brody J. A., Edgar A. H. Multiple sclerosis among American, Japanese and Chinese migrants to California and Washington. J Chronic Dis. 1972 Jan;25(1):3–10. doi: 10.1016/0021-9681(72)90016-1. [DOI] [PubMed] [Google Scholar]
  37. Detels R. Epidemiology of multiple sclerosis. Adv Neurol. 1978;19:459–473. [PubMed] [Google Scholar]
  38. Detels R., Visscher B. R., Haile R. W., Malmgren R. M., Dudley J. P., Coulson A. H. Multiple sclerosis and age at migration. Am J Epidemiol. 1978 Nov;108(5):386–393. doi: 10.1093/oxfordjournals.aje.a112636. [DOI] [PubMed] [Google Scholar]
  39. Detels R., Visscher B. R., Malmgren R. M., Coulson A. H., Lucia M. V., Dudley J. P. Evidence for lower susceptibility to multiple sclerosis in Japanese-Americans. Am J Epidemiol. 1977 Apr;105(4):303–310. doi: 10.1093/oxfordjournals.aje.a112387. [DOI] [PubMed] [Google Scholar]
  40. Eastman R., Sheridan J., Poskanzer D. C. Multiple sclerosis clustering in a small Massachusetts community, with possible common exposure 23 years before onset. N Engl J Med. 1973 Oct 11;289(15):793–794. doi: 10.1056/NEJM197310112891507. [DOI] [PubMed] [Google Scholar]
  41. Ebers G. C., Bulman D. E., Sadovnick A. D., Paty D. W., Warren S., Hader W., Murray T. J., Seland T. P., Duquette P., Grey T. A population-based study of multiple sclerosis in twins. N Engl J Med. 1986 Dec 25;315(26):1638–1642. doi: 10.1056/NEJM198612253152603. [DOI] [PubMed] [Google Scholar]
  42. Eldridge R., McFarland H., Sever J., Sadowsky D., Krebs H. Familial multiple sclerosis: clinical, histocompatibility, and viral serological studies. Ann Neurol. 1978 Jan;3(1):72–80. doi: 10.1002/ana.410030111. [DOI] [PubMed] [Google Scholar]
  43. Elian M., Dean G. Multiple sclerosis among the United Kingdom-born children of immigrants from the West Indies. J Neurol Neurosurg Psychiatry. 1987 Mar;50(3):327–332. doi: 10.1136/jnnp.50.3.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Epstein L., Blumberg B., Crowley J., Samuel K., Goudsmit J., Cook S., Dowling P. Serum antibodies to HTLV-I in human demyelinating disease. Acta Neurol Scand. 1987 Apr;75(4):231–233. doi: 10.1111/j.1600-0404.1987.tb07925.x. [DOI] [PubMed] [Google Scholar]
  45. Fewster M. E., Kies B. HLA antigens in multiple sclerosis in coloured South Africans. J Neurol Sci. 1984 Nov-Dec;66(2-3):175–181. doi: 10.1016/0022-510x(84)90005-4. [DOI] [PubMed] [Google Scholar]
  46. Fog M., Hyllested K. Prevalence of disseminated sclerosis in the Faroes, the Orkneys and Shetland. Acta Neurol Scand. 1966;42(Suppl):9–11. doi: 10.1111/j.1600-0404.1966.tb01996.x. [DOI] [PubMed] [Google Scholar]
  47. Francis D. A., Batchelor J. R., McDonald W. I., Hing S. N., Dodi I. A., Fielder A. H., Hern J. E., Downie A. W. Multiple sclerosis in north-east Scotland. An association with HLA-DQw1. Brain. 1987 Feb;110(Pt 1):181–196. doi: 10.1093/brain/110.1.181. [DOI] [PubMed] [Google Scholar]
  48. Fredrikson S., Michelsberg J., Hillert J., Wang Z., Sun J. B., Olerup O., Olsson T., Link H. Conjugal multiple sclerosis: immunogenetic characterization and analysis of T- and B-cell reactivity to myelin proteins. Neurology. 1992 Mar;42(3 Pt 1):577–582. doi: 10.1212/wnl.42.3.577. [DOI] [PubMed] [Google Scholar]
  49. GOLDBERG I. D., KURLAND L. T. Mortality in 33 countries from diseases of the nervous system. World Neurol. 1962 Jun;3:444–465. [PubMed] [Google Scholar]
  50. Gallou M., Madigand M., Masse L., Morel G., Oger J., Sabouraud O. Epidémiologie de la sclérose en plaques en Bretagne. Presse Med. 1983 Apr 9;12(16):995–999. [PubMed] [Google Scholar]
  51. Gessain A., Abel L., De-The G., Vernant J. C., Raverdy P., Guillard A. Lack of antibody to HTLV-I and HIV in patients with multiple sclerosis from France and French West Indies. Br Med J (Clin Res Ed) 1986 Aug 16;293(6544):424–425. doi: 10.1136/bmj.293.6544.424-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Gorodezky C., Najera R., Rangel B. E., Castro L. E., Flores J., Velázquez G., Granados J., Sotelo J. Immunogenetic profile of multiple sclerosis in Mexicans. Hum Immunol. 1986 Aug;16(4):364–374. doi: 10.1016/0198-8859(86)90063-7. [DOI] [PubMed] [Google Scholar]
  53. Granieri E., Rosati G. Italy: a medium- or high-risk area for multiple sclerosis? An epidemiologic study in Barbagia, Sardinia, southern Italy. Neurology. 1982 May;32(5):466–472. doi: 10.1212/wnl.32.5.466. [DOI] [PubMed] [Google Scholar]
  54. Granieri E., Rosati G., Tola R., Pinna L., Carreras M., Manca M., Boldrini P. The frequency of multiple sclerosis in Mediterranean Europe. An incidence and prevalence study in Barbagia, Sardinia, insular Italy. Acta Neurol Scand. 1983 Aug;68(2):84–89. doi: 10.1111/j.1600-0404.1983.tb04821.x. [DOI] [PubMed] [Google Scholar]
  55. Granieri E., Tola R., Paolino E., Rosati G., Carreras M., Monetti V. C. The frequency of multiple sclerosis in Italy: a descriptive study in Ferrara. Ann Neurol. 1985 Jan;17(1):80–84. doi: 10.1002/ana.410170117. [DOI] [PubMed] [Google Scholar]
  56. Grønning M., Mellgren S. I. Multiple sclerosis in the two northernmost counties of Norway. Acta Neurol Scand. 1985 Sep;72(3):321–327. doi: 10.1111/j.1600-0404.1985.tb00878.x. [DOI] [PubMed] [Google Scholar]
  57. Hader W. J., Elliot M., Ebers G. C. Epidemiology of multiple sclerosis in London and Middlesex County, Ontario, Canada. Neurology. 1988 Apr;38(4):617–621. doi: 10.1212/wnl.38.4.617. [DOI] [PubMed] [Google Scholar]
  58. Hader W. J. Prevalence of multiple sclerosis in Saskatoon. Can Med Assoc J. 1982 Aug 15;127(4):295–297. [PMC free article] [PubMed] [Google Scholar]
  59. Hafler D. A., Buchsbaum M., Johnson D., Weiner H. L. Phenotypic and functional analysis of T cells cloned directly from the blood and cerebrospinal fluid of patients with multiple sclerosis. Ann Neurol. 1985 Oct;18(4):451–458. doi: 10.1002/ana.410180407. [DOI] [PubMed] [Google Scholar]
  60. Haile R. W., Hodge S. E., Iselius L. Genetic susceptibility to multiple sclerosis: a review. Int J Epidemiol. 1983 Mar;12(1):8–16. doi: 10.1093/ije/12.1.8. [DOI] [PubMed] [Google Scholar]
  61. Hamida M. B. La sclêrose en plaques en Tunisie. Etude clinifue de 100 observations. Rev Neurol (Paris) 1977 Feb;133(2):109–117. [PubMed] [Google Scholar]
  62. Hammond S. R., McLeod J. G., Millingen K. S., Stewart-Wynne E. G., English D., Holland J. T., McCall M. G. The epidemiology of multiple sclerosis in three Australian cities: Perth, Newcastle and Hobart. Brain. 1988 Feb;111(Pt 1):1–25. doi: 10.1093/brain/111.1.1. [DOI] [PubMed] [Google Scholar]
  63. Hammond S. R., de Wytt C., Maxwell I. C., Landy P. J., English D., McLeod J. G., McCall M. G. The epidemiology of multiple sclerosis in Queensland, Australia. J Neurol Sci. 1987 Sep;80(2-3):185–204. doi: 10.1016/0022-510x(87)90154-7. [DOI] [PubMed] [Google Scholar]
  64. Helmick C. G., Wrigley J. M., Zack M. M., Bigler W. J., Lehman J. L., Janssen R. S., Hartwig E. C., Witte J. J. Multiple sclerosis in Key West, Florida. Am J Epidemiol. 1989 Nov;130(5):935–949. doi: 10.1093/oxfordjournals.aje.a115426. [DOI] [PubMed] [Google Scholar]
  65. Hennessy A., Swingler R. J., Compston D. A. The incidence and mortality of multiple sclerosis in south east Wales. J Neurol Neurosurg Psychiatry. 1989 Sep;52(9):1085–1089. doi: 10.1136/jnnp.52.9.1085. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Ho S. Y., Catalanotto F. A., Lisak R. P., Dore-Duffy P. Zinc in multiple sclerosis. II: Correlation with disease activity and elevated plasma membrane-bound zinc in erythrocytes from patients with multiple sclerosis. Ann Neurol. 1986 Dec;20(6):712–715. doi: 10.1002/ana.410200610. [DOI] [PubMed] [Google Scholar]
  67. Hoffman R. E., Zack M. M., Davis L. E., Burchfiel C. M. Increased incidence and prevalence of multiple sclerosis in Los Alamos County, New Mexico. Neurology. 1981 Nov;31(11):1489–1492. doi: 10.1212/wnl.31.11.1489. [DOI] [PubMed] [Google Scholar]
  68. Ilonen J., Nurmi T., Reunanen M., Salmi A. NK activity and NK-like non-specific cytolysis after PPD, rubella and measles antigen stimulation in multiple sclerosis. J Neurol Sci. 1987 Jan;77(1):77–85. doi: 10.1016/0022-510x(87)90208-5. [DOI] [PubMed] [Google Scholar]
  69. Ingalls T. H. Endemic clustering of multiple sclerosis in time and place, 1934-1984. Confirmation of a hypothesis. Am J Forensic Med Pathol. 1986 Mar;7(1):3–8. doi: 10.1097/00000433-198603000-00002. [DOI] [PubMed] [Google Scholar]
  70. Isager H., Andersen E., Hyllested K. Risk of multiple sclerosis inversely associated with birth order position. Acta Neurol Scand. 1980 Jun;61(6):393–396. doi: 10.1111/j.1600-0404.1980.tb01509.x. [DOI] [PubMed] [Google Scholar]
  71. Jain S., Maheshwari M. C. Multiple sclerosis: Indian experience in the last thirty years. Neuroepidemiology. 1985;4(2):96–107. doi: 10.1159/000110220. [DOI] [PubMed] [Google Scholar]
  72. Jones J. F., Ray C. G., Minnich L. L., Hicks M. J., Kibler R., Lucas D. O. Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies. Ann Intern Med. 1985 Jan;102(1):1–7. doi: 10.7326/0003-4819-102-1-. [DOI] [PubMed] [Google Scholar]
  73. KURLAND L. T. AN APPRAISAL OF POPULATION STUDIES OF MULTIPLE SCLEROSIS. Ann N Y Acad Sci. 1965 Mar 31;122:520–541. doi: 10.1111/j.1749-6632.1965.tb20233.x. [DOI] [PubMed] [Google Scholar]
  74. KURTZKE J. F. FAMILIAL INCIDENCE AND GEOGRAPHY IN MULTIPLE SCLEROSIS. Acta Neurol Scand. 1965;41:127–139. doi: 10.1111/j.1600-0404.1965.tb04286.x. [DOI] [PubMed] [Google Scholar]
  75. KURTZKE J. F. ON THE TIME OF ONSET IN MULTIPLE SCLEROSIS. Acta Neurol Scand. 1965;41:140–158. doi: 10.1111/j.1600-0404.1965.tb04287.x. [DOI] [PubMed] [Google Scholar]
  76. Kalafatova O. I. Epidemiology of multiple sclerosis in Bulgaria. Acta Neurol Scand. 1987 Mar;75(3):186–189. doi: 10.1111/j.1600-0404.1987.tb07915.x. [DOI] [PubMed] [Google Scholar]
  77. Kinnunen E., Juntunen J., Ketonen L., Koskimies S., Konttinen Y. T., Salmi T., Koskenvuo M., Kaprio J. Genetic susceptibility to multiple sclerosis. A co-twin study of a nationwide series. Arch Neurol. 1988 Oct;45(10):1108–1111. doi: 10.1001/archneur.1988.00520340062013. [DOI] [PubMed] [Google Scholar]
  78. Kinnunen E. Multiple sclerosis in Finland: evidence of increasing frequency and uneven geographic distribution. Neurology. 1984 Apr;34(4):457–461. doi: 10.1212/wnl.34.4.457. [DOI] [PubMed] [Google Scholar]
  79. Koch-Henriksen N. An epidemiological study of multiple sclerosis. Familial aggregation social determinants, and exogenic factors. Acta Neurol Scand Suppl. 1989;124:1–123. [PubMed] [Google Scholar]
  80. Koch-Henriksen N., Brønnum-Hansen H., Hyllested K. Incidence of multiple sclerosis in Denmark 1948-1982: a descriptive nationwide study. Neuroepidemiology. 1992;11(1):1–10. doi: 10.1159/000110900. [DOI] [PubMed] [Google Scholar]
  81. Koch-Henriksen N., Hyllested K. Epidemiology of multiple sclerosis: incidence and prevalence rates in Denmark 1948-64 based on the Danish Multiple Sclerosis Registry. Acta Neurol Scand. 1988 Nov;78(5):369–380. doi: 10.1111/j.1600-0404.1988.tb03672.x. [DOI] [PubMed] [Google Scholar]
  82. Koch M. J., Reed D., Stern R., Brody J. A. Multiple sclerosis. A cluster in a small Northwestern United States community. JAMA. 1974 Jun 17;228(12):1555–1557. doi: 10.1001/jama.228.12.1555. [DOI] [PubMed] [Google Scholar]
  83. Kolstad A., Hannestad K., Vandvik B., Vartdal F. Multiple sclerosis patients have a high frequency of an HLA-DQ beta epitope defined by a human-human hybridoma antibody. Tissue Antigens. 1989 May;33(5):546–549. doi: 10.1111/j.1399-0039.1989.tb01706.x. [DOI] [PubMed] [Google Scholar]
  84. Koprowski H., DeFreitas E. C., Harper M. E., Sandberg-Wollheim M., Sheremata W. A., Robert-Guroff M., Saxinger C. W., Feinberg M. B., Wong-Staal F., Gallo R. C. Multiple sclerosis and human T-cell lymphotropic retroviruses. Nature. 1985 Nov 14;318(6042):154–160. doi: 10.1038/318154a0. [DOI] [PubMed] [Google Scholar]
  85. Koren G., Butt W., Rajchgot P., Mayer J., Whyte H., Pape K., MacLeod S. M. Intravenous paraldehyde for seizure control in newborn infants. Neurology. 1986 Jan;36(1):108–111. doi: 10.1212/wnl.36.1.108. [DOI] [PubMed] [Google Scholar]
  86. Kuroda Y., Shibasaki H., Sato H., Okochi K. Incidence of antibody to HTLV-I is not increased in Japanese MS patients. Neurology. 1987 Jan;37(1):156–158. doi: 10.1212/wnl.37.1.156. [DOI] [PubMed] [Google Scholar]
  87. Kurtzke J. F. A reassessment of the distribution of multiple sclerosis. Part one. Acta Neurol Scand. 1975 Feb;51(2):110–136. doi: 10.1111/j.1600-0404.1975.tb01364.x. [DOI] [PubMed] [Google Scholar]
  88. Kurtzke J. F. A reassessment of the distribution of multiple sclerosis. Acta Neurol Scand. 1975 Feb;51(2):137–157. doi: 10.1111/j.1600-0404.1975.tb01365.x. [DOI] [PubMed] [Google Scholar]
  89. Kurtzke J. F. An epidemiologic approach to multiple sclerosis. Arch Neurol. 1966 Feb;14(2):213–222. doi: 10.1001/archneur.1966.00470080097015. [DOI] [PubMed] [Google Scholar]
  90. Kurtzke J. F., Beebe G. W., Norman J. E., Jr Epidemiology of multiple sclerosis in U.S. veterans: 1. Race, sex, and geographic distribution. Neurology. 1979 Sep;29(9 Pt 1):1228–1235. doi: 10.1212/wnl.29.9_part_1.1228. [DOI] [PubMed] [Google Scholar]
  91. Kurtzke J. F., Beebe G. W., Norman J. E., Jr Epidemiology of multiple sclerosis in US veterans: III. Migration and the risk of MS. Neurology. 1985 May;35(5):672–678. doi: 10.1212/wnl.35.5.672. [DOI] [PubMed] [Google Scholar]
  92. Kurtzke J. F., Bui-Quoc-Huong Multiple sclerosis in a migrant population: 2. Half-orientals immigrating in childhood. Ann Neurol. 1980 Sep;8(3):256–260. doi: 10.1002/ana.410080306. [DOI] [PubMed] [Google Scholar]
  93. Kurtzke J. F., Dean G., Botha D. P. A method for estimating the age at immigration of white immigrants to South Africa, with an example of its importance. S Afr Med J. 1970 Jun 6;44(23):663–669. [PubMed] [Google Scholar]
  94. Kurtzke J. F. Epidemiologic contributions to multiple sclerosis: an overview. Neurology. 1980 Jul;30(7 Pt 2):61–79. doi: 10.1212/wnl.30.7_part_2.61. [DOI] [PubMed] [Google Scholar]
  95. Kurtzke J. F. Further considerations on the geographic distribution of multiple sclerosis. Acta Neurol Scand. 1967;43(3):283–298. doi: 10.1111/j.1600-0404.1967.tb05734.x. [DOI] [PubMed] [Google Scholar]
  96. Kurtzke J. F. Further features of the Fennoscandian focus of multiple sclerosis. Acta Neurol Scand. 1974;50(4):478–502. doi: 10.1111/j.1600-0404.1974.tb02795.x. [DOI] [PubMed] [Google Scholar]
  97. Kurtzke J. F. Geographic distribution of multiple sclerosis: An update with special reference to Europe and the Mediterranean region. Acta Neurol Scand. 1980 Aug;62(2):65–80. doi: 10.1111/j.1600-0404.1980.tb03006.x. [DOI] [PubMed] [Google Scholar]
  98. Kurtzke J. F. Geography in multiple sclerosis. J Neurol. 1977 Apr 28;215(1):1–26. doi: 10.1007/BF00312546. [DOI] [PubMed] [Google Scholar]
  99. Kurtzke J. F., Gudmundsson K. R., Bergmann S. Multiple sclerosis in Iceland: 1. Evidence of a postwar epidemic. Neurology. 1982 Feb;32(2):143–150. doi: 10.1212/wnl.32.2.143. [DOI] [PubMed] [Google Scholar]
  100. Kurtzke J. F., Hyllested K. MS epidemiology in Faroe Islands. Riv Neurol. 1987 Mar-Apr;57(2):77–87. [PubMed] [Google Scholar]
  101. Kurtzke J. F., Hyllested K. Multiple sclerosis in the Faroe Islands. II. Clinical update, transmission, and the nature of MS. Neurology. 1986 Mar;36(3):307–328. doi: 10.1212/wnl.36.3.307. [DOI] [PubMed] [Google Scholar]
  102. Kurtzke J. F., Hyllested K. Multiple sclerosis in the Faroe Islands. III. An alternative assessment of the three epidemics. Acta Neurol Scand. 1987 Nov;76(5):317–339. doi: 10.1111/j.1600-0404.1987.tb03590.x. [DOI] [PubMed] [Google Scholar]
  103. Kurtzke J. F., Hyllested K. Multiple sclerosis in the Faroe Islands: I. Clinical and epidemiological features. Ann Neurol. 1979 Jan;5(1):6–21. doi: 10.1002/ana.410050104. [DOI] [PubMed] [Google Scholar]
  104. Kurtzke J. F., Hyllested K. Multiple sclerosis: an epidemic disease in the Faeroes. Trans Am Neurol Assoc. 1975;100:213–215. [PubMed] [Google Scholar]
  105. Kurtzke J. F., Hyllested K. Validity of the epidemics of multiple sclerosis in the Faroe Islands. Neuroepidemiology. 1988;7(4):190–227. doi: 10.1159/000110154. [DOI] [PubMed] [Google Scholar]
  106. Kurtzke J. F. ICD 9: a regression. Am J Epidemiol. 1979 Apr;109(4):383–393. doi: 10.1093/oxfordjournals.aje.a112694. [DOI] [PubMed] [Google Scholar]
  107. Kurtzke J. F., Kurland L. T., Goldberg I. D. Mortality and migration in multiple sclerosis. Neurology. 1971 Dec;21(12):1186–1197. doi: 10.1212/wnl.21.12.1186. [DOI] [PubMed] [Google Scholar]
  108. Kurtzke J. F., Lux W. E., Jr In defense of death data: an example with multiple sclerosis. Neurology. 1985 Dec;35(12):1787–1790. doi: 10.1212/wnl.35.12.1787. [DOI] [PubMed] [Google Scholar]
  109. Kurtzke J. F. Multiple sclerosis among immigrants. Br Med J. 1976 Jun 19;1(6024):1527–1528. doi: 10.1136/bmj.1.6024.1527-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  110. Kurtzke J. F. Multiple sclerosis and infection from an epidemiologic aspect. Neurology. 1968 Jan;18(1 Pt 2):170–175. doi: 10.1212/wnl.18.1_part_2.170. [DOI] [PubMed] [Google Scholar]
  111. Kurtzke J. F. Multiple sclerosis: what's in a name? Neurology. 1988 Feb;38(2):309–314. doi: 10.1212/wnl.38.2.309. [DOI] [PubMed] [Google Scholar]
  112. Kurtzke J. F. Neuroepidemiology. Ann Neurol. 1984 Sep;16(3):265–277. doi: 10.1002/ana.410160302. [DOI] [PubMed] [Google Scholar]
  113. Kurtzke J. F. On the fine structure of the distribution of multiple sclerosis. Acta Neurol Scand. 1967;43(3):257–282. doi: 10.1111/j.1600-0404.1967.tb05733.x. [DOI] [PubMed] [Google Scholar]
  114. Kurtzke J. F. Some epidemiologic features compatible with an infectious origin for multiple sclerosis. Int Arch Allergy Appl Immunol. 1969;36(Suppl):59–82. [PubMed] [Google Scholar]
  115. Kurtzke J. F. The risk of multiple sclerosis in Denmark. Acta Neurol Scand. 1978 Feb;57(2):141–150. doi: 10.1111/j.1600-0404.1978.tb02831.x. [DOI] [PubMed] [Google Scholar]
  116. LIMBURG C. C. The geographic distribution of multiple sclerosis and its estimated prevalence in the United States. Res Publ Assoc Res Nerv Ment Dis. 1950;28:15–24. [PubMed] [Google Scholar]
  117. Larsen J. P., Aarli J. A., Nyland H., Riise T. Western Norway, a high-risk area for multiple sclerosis: a prevalence/incidence study in the county of Hordaland. Neurology. 1984 Sep;34(9):1202–1207. doi: 10.1212/wnl.34.9.1202. [DOI] [PubMed] [Google Scholar]
  118. Larsen J. P., Kvaale G., Riise T., Nyland H., Aarli J. A. An increase in the incidence of multiple sclerosis in western Norway. Acta Neurol Scand. 1984 Aug;70(2):96–103. doi: 10.1111/j.1600-0404.1984.tb00809.x. [DOI] [PubMed] [Google Scholar]
  119. Larsen P. D., Bloomer L. C., Bray P. F. Epstein-Barr nuclear antigen and viral capsid antigen antibody titers in multiple sclerosis. Neurology. 1985 Mar;35(3):435–438. doi: 10.1212/wnl.35.3.435. [DOI] [PubMed] [Google Scholar]
  120. Lević Z., Pantović M., Sepcić J. Epidemiologic studies of multiple sclerosis in Yugoslavia. Neurologija. 1985;34(1-4):89–96. [PubMed] [Google Scholar]
  121. Marcadet A., Massart C., Semana G., Fauchet R., Sabouraud O., Merienne M., Dausset J., Cohen D. Association of class II HLA-DQ beta chain DNA restriction fragments with multiple sclerosis. Immunogenetics. 1985;22(1):93–96. doi: 10.1007/BF00430598. [DOI] [PubMed] [Google Scholar]
  122. Martin J. R. Troop-related multiple sclerosis outbreak in the Orkneys? J Epidemiol Community Health. 1987 Jun;41(2):183–184. doi: 10.1136/jech.41.2.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  123. Martin R., McFarland H. F., McFarlin D. E. Immunological aspects of demyelinating diseases. Annu Rev Immunol. 1992;10:153–187. doi: 10.1146/annurev.iy.10.040192.001101. [DOI] [PubMed] [Google Scholar]
  124. Materljan E., Sepcić J., Antonelli L., Sepić-Grahovac D. Multiple sclerosis in Istria, Yugoslavia. Neurologija. 1989;38(3):201–212. [PubMed] [Google Scholar]
  125. McCall M. G., Sutherland J. M., Acheson E. D. The frequency of multiple sclerosis in Western Australia. Acta Neurol Scand. 1969;45(2):151–165. doi: 10.1111/j.1600-0404.1969.tb01229.x. [DOI] [PubMed] [Google Scholar]
  126. McDonald W. I. Multiple sclerosis: epidemiology and HLA associations. Ann N Y Acad Sci. 1984;436:109–117. doi: 10.1111/j.1749-6632.1984.tb14781.x. [DOI] [PubMed] [Google Scholar]
  127. McFarland H. F., Greenstein J., McFarlin D. E., Eldridge R., Xu X. H., Krebs H. Family and twin studies in multiple sclerosis. Ann N Y Acad Sci. 1984;436:118–124. doi: 10.1111/j.1749-6632.1984.tb14782.x. [DOI] [PubMed] [Google Scholar]
  128. McFarland H. F. Twin studies and multiple sclerosis. Ann Neurol. 1992 Dec;32(6):722–723. doi: 10.1002/ana.410320603. [DOI] [PubMed] [Google Scholar]
  129. Meyer-Reinecker H. J., Buddenhagen F. Grundlagen und Problematik der Epidemiologie der Multiplen Sklerose. Psychiatr Neurol Med Psychol (Leipz) 1983 Dec;35(12):697–707. [PubMed] [Google Scholar]
  130. Middleton L. T., Dean G. Multiple sclerosis in Cyprus. J Neurol Sci. 1991 May;103(1):29–36. doi: 10.1016/0022-510x(91)90279-g. [DOI] [PubMed] [Google Scholar]
  131. Miller D. H., Hornabrook R. W., Dagger J., Fong R. Ethnic and HLA patterns related to multiple sclerosis in Wellington, New Zealand. J Neurol Neurosurg Psychiatry. 1986 Jan;49(1):43–46. doi: 10.1136/jnnp.49.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  132. Moffie D. De geografische verbreiding van multipele sclerose. Ned Tijdschr Geneeskd. 1966 Aug 13;110(33):1454–1457. [PubMed] [Google Scholar]
  133. Morganti G., Naccarato S., Elian M., Ferrari P., Kelly R., Karhausen L., Dean G. Multiple sclerosis in the Republic of San Marino. J Epidemiol Community Health. 1984 Mar;38(1):23–28. doi: 10.1136/jech.38.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  134. Morimoto C., Hafler D. A., Weiner H. L., Letvin N. L., Hagan M., Daley J., Schlossman S. F. Selective loss of the suppressor-inducer T-cell subset in progressive multiple sclerosis. Analysis with anti-2H4 monoclonal antibody. N Engl J Med. 1987 Jan 8;316(2):67–72. doi: 10.1056/NEJM198701083160202. [DOI] [PubMed] [Google Scholar]
  135. Murray T. J. An unusual occurrence of multiple sclerosis in a small rural community. Can J Neurol Sci. 1976 Aug;3(3):163–166. doi: 10.1017/s0317167100025683. [DOI] [PubMed] [Google Scholar]
  136. Murrell T. G., Harbige L. S., Robinson I. C. A review of the aetiology of multiple sclerosis: an ecological approach. Ann Hum Biol. 1991 Mar-Apr;18(2):95–112. doi: 10.1080/03014469100001442. [DOI] [PubMed] [Google Scholar]
  137. Nelson L. M., Hamman R. F., Thompson D. S., Baum H. M., Boteler D. L., Burks J. S., Franklin G. M. Higher than expected prevalence of multiple sclerosis in northern Colorado: dependence on methodologic issues. Neuroepidemiology. 1986;5(1):17–28. doi: 10.1159/000110809. [DOI] [PubMed] [Google Scholar]
  138. Norman J. E., Jr, Kurtzke J. F., Beebe G. W. Epidemiology of multiple sclerosis in U.S. veterans: 2. Latitude, climate and the risk of multiple sclerosis. J Chronic Dis. 1983;36(8):551–559. doi: 10.1016/0021-9681(83)90142-x. [DOI] [PubMed] [Google Scholar]
  139. Operskalski E. A., Visscher B. R., Malmgren R. M., Detels R. A case-control study of multiple sclerosis. Neurology. 1989 Jun;39(6):825–829. doi: 10.1212/wnl.39.6.825. [DOI] [PubMed] [Google Scholar]
  140. POSKANZER D. C., SCHAPIRA K., MILLER H. MULTIPLE SCLEROSIS AND POLIOMYELITIS. Lancet. 1963 Nov 2;2(7314):917–921. doi: 10.1016/s0140-6736(63)90624-x. [DOI] [PubMed] [Google Scholar]
  141. Page W. F., Kurtzke J. F., Murphy F. M., Norman J. E., Jr Epidemiology of multiple sclerosis in U.S. veterans: V. Ancestry and the risk of multiple sclerosis. Ann Neurol. 1993 Jun;33(6):632–639. doi: 10.1002/ana.410330612. [DOI] [PubMed] [Google Scholar]
  142. Paty D. W., Oger J. J., Kastrukoff L. F., Hashimoto S. A., Hooge J. P., Eisen A. A., Eisen K. A., Purves S. J., Low M. D., Brandejs V. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology. 1988 Feb;38(2):180–185. doi: 10.1212/wnl.38.2.180. [DOI] [PubMed] [Google Scholar]
  143. Pedneault L., Katz B. Z., Miller G. Detection of Epstein-Barr virus in the brain by the polymerase chain reaction. Ann Neurol. 1992 Aug;32(2):184–192. doi: 10.1002/ana.410320210. [DOI] [PubMed] [Google Scholar]
  144. Percy A. K., Nobrega F. T., Okazaki H., Glattre E., Kurland L. T. Multiple sclerosis in Rochester, Minn. A 60-year appraisal. Arch Neurol. 1971 Aug;25(2):105–111. doi: 10.1001/archneur.1971.00490020023002. [DOI] [PubMed] [Google Scholar]
  145. Petrescu A., Verdeş F. Epidemiology of multiple sclerosis in Romania. Neurol Psychiatr (Bucur) 1989 Oct-Dec;27(4):261–271. [PubMed] [Google Scholar]
  146. Phadke J. G., Downie A. W. Epidemiology of multiple sclerosis in the north-east (Grampian region) of Scotland--an update. J Epidemiol Community Health. 1987 Mar;41(1):5–13. doi: 10.1136/jech.41.1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  147. Popescu D., Popescu V. G. Contribuţii la studiul factorilor de risc în scleroza multiplă: cercetări epidemiologice în judeţul Argeş. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Neurol Psihiatr Neurochir. 1981 Jan-Mar;26(1):23–31. [PubMed] [Google Scholar]
  148. Portnoy J., Ahronheim G. A., Ghibu F., Clecner B., Joncas J. H. Recovery of Epstein-Barr virus from genital ulcers. N Engl J Med. 1984 Oct 11;311(15):966–968. doi: 10.1056/NEJM198410113111507. [DOI] [PubMed] [Google Scholar]
  149. Poser C. M., Benedikz J., Hibberd P. L. The epidemiology of multiple sclerosis: the Iceland model. Onset-adjusted prevalence rate and other methodological considerations. J Neurol Sci. 1992 Sep;111(2):143–152. doi: 10.1016/0022-510x(92)90062-p. [DOI] [PubMed] [Google Scholar]
  150. Poser C. M., Hibberd P. L. Analysis of the 'epidemic' of multiple sclerosis in the Faroe Islands. II. Biostatistical aspects. Neuroepidemiology. 1988;7(4):181–189. doi: 10.1159/000110153. [DOI] [PubMed] [Google Scholar]
  151. Poser C. M., Hibberd P. L., Benedikz J., Gudmundsson G. Analysis of the 'epidemic' of multiple sclerosis in the Faroe Islands. I. Clinical and epidemiological aspects. Neuroepidemiology. 1988;7(4):168–180. doi: 10.1159/000110152. [DOI] [PubMed] [Google Scholar]
  152. Poser C. M., Paty D. W., Scheinberg L., McDonald W. I., Davis F. A., Ebers G. C., Johnson K. P., Sibley W. A., Silberberg D. H., Tourtellotte W. W. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983 Mar;13(3):227–231. doi: 10.1002/ana.410130302. [DOI] [PubMed] [Google Scholar]
  153. Poskanzer D. C., Prenney L. B., Sheridan J. L., Kondy J. Y. Multiple sclerosis in the Orkney and Shetland Islands. I: Epidemiology, clinical factors, and methodology. J Epidemiol Community Health. 1980 Dec;34(4):229–239. doi: 10.1136/jech.34.4.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  154. Poskanzer D. C., Sheridan J. L., Prenney L. B., Walker A. M. Multiple sclerosis in the Orkney and Shetland Islands. II: The search for an exogenous aetiology. J Epidemiol Community Health. 1980 Dec;34(4):240–252. doi: 10.1136/jech.34.4.240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  155. Poskanzer D. C. Tonsillectomy and multiple sclerosis. Lancet. 1965 Dec 18;2(7425):1264–1266. doi: 10.1016/s0140-6736(65)92281-6. [DOI] [PubMed] [Google Scholar]
  156. Prange A. J., Lauer K., Poser S., Palffy G., Minderhoud J. M., Firnhaber W., Dassel H., Bauer H. Epidemiological aspects of multiple sclerosis: a comparative study of four centres in Europe. Neuroepidemiology. 1986;5(2):71–79. doi: 10.1159/000110816. [DOI] [PubMed] [Google Scholar]
  157. Pryse-Phillips W. E. The incidence and prevalence of multiple sclerosis in Newfoundland and Labrador, 1960-1984. Ann Neurol. 1986 Sep;20(3):323–328. doi: 10.1002/ana.410200309. [DOI] [PubMed] [Google Scholar]
  158. Rasmussen H. B., Kvinesdal B. B., Clausen J. Seroreactivity to human T cell leukemia/lymphoma virus type 1 and related retroviruses in multiple sclerosis patients from Denmark and the Faroes. Acta Neurol Scand. 1992 Jul;86(1):91–94. doi: 10.1111/j.1600-0404.1992.tb08061.x. [DOI] [PubMed] [Google Scholar]
  159. Riise T., Grønning M., Klauber M. R., Barrett-Connor E., Nyland H., Albrektsen G. Clustering of residence of multiple sclerosis patients at age 13 to 20 years in Hordaland, Norway. Am J Epidemiol. 1991 May 1;133(9):932–939. doi: 10.1093/oxfordjournals.aje.a115972. [DOI] [PubMed] [Google Scholar]
  160. Riise T., Klauber M. R. Relationship between the degree of individual space-time clustering and age at onset of disease among multiple sclerosis patients. Int J Epidemiol. 1992 Jun;21(3):528–532. doi: 10.1093/ije/21.3.528. [DOI] [PubMed] [Google Scholar]
  161. Roberts D. F., Papiha S. S., Poskanzer D. C. Polymorphisms and multiple sclerosis in Orkney. J Epidemiol Community Health. 1979 Dec;33(4):236–242. doi: 10.1136/jech.33.4.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  162. Roberts D. F., Roberts M. J., Poskanzer D. C. Genetic analysis of multiple sclerosis in Orkney. J Epidemiol Community Health. 1979 Dec;33(4):229–235. doi: 10.1136/jech.33.4.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  163. Rosati G., Aiello I., Granieri E., Pirastru M. I., Becciu S., Demontis G., Mannu L., Zoccheddu A. Incidence of multiple sclerosis in Macomer, Sardinia, 1912-1981: onset of the disease after 1950. Neurology. 1986 Jan;36(1):14–19. doi: 10.1212/wnl.36.1.14. [DOI] [PubMed] [Google Scholar]
  164. Rosati G., Aiello I., Mannu L., Pirastru M. I., Agnetti V., Sau G., Garau M., Gioia R., Sanna G. Incidence of multiple sclerosis in the town of Sassari, Sardinia, 1965 to 1985: evidence for increasing occurrence of the disease. Neurology. 1988 Mar;38(3):384–388. doi: 10.1212/wnl.38.3.384. [DOI] [PubMed] [Google Scholar]
  165. Rosati G., Aiello I., Pirastru M. I., Mannu L., Demontis G., Becciu S., Sau G., Zoccheddu A. Sardinia, a high-risk area for multiple sclerosis: a prevalence and incidence study in the district of Alghero. Ann Neurol. 1987 Feb;21(2):190–194. doi: 10.1002/ana.410210212. [DOI] [PubMed] [Google Scholar]
  166. Rosati G., Granieri E., Carreras M., Pinna L., Paolino E., Tola R., Aiello I., De Bastiani P. Multiple sclerosis in northern Italy. Prevalence in the province of Ferrara in 1978. Ital J Neurol Sci. 1981 Jan;2(1):17–23. doi: 10.1007/BF02351683. [DOI] [PubMed] [Google Scholar]
  167. Rosman K. D., Jacobs H. A., van der Merwe C. A. A new multiple sclerosis epidemic? A pilot survey. S Afr Med J. 1985 Aug 3;68(3):162–163. [PubMed] [Google Scholar]
  168. Ryan D. E., Holzbecher J., Stuart D. C. Trace elements in scalp-hair of persons with multiple sclerosis and of normal individuals. Clin Chem. 1978 Nov;24(11):1996–2000. [PubMed] [Google Scholar]
  169. SAINT E. G., SADKA M. The incidence of multiple sclerosis in Western Australia. Med J Aust. 1962 Aug 18;49(2):249–250. [PubMed] [Google Scholar]
  170. SCHAPIRA K., POSKANZER D. C., MILLER H. Familial and conjugal multiple sclerosis. Brain. 1963 Jun;86:315–332. doi: 10.1093/brain/86.2.315. [DOI] [PubMed] [Google Scholar]
  171. SCHUMACHER G. A., BEEBE G., KIBLER R. F., KURLAND L. T., KURTZKE J. F., MCDOWELL F., NAGLER B., SIBLEY W. A., TOURTELLOTTE W. W., WILLMON T. L. 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 N Y Acad Sci. 1965 Mar 31;122:552–568. doi: 10.1111/j.1749-6632.1965.tb20235.x. [DOI] [PubMed] [Google Scholar]
  172. STAZIO A., KURLAND L. T., BELL L. G., SAUNDERS M. G., ROGOT E. MULTIPLE SCLEROSIS IN WINNIPEG, MANITOBA: METHODOLOGICAL CONSIDERATIONS OF EPIDEMIOLOGIC SURVEY. TEN YEAR FOLLOW-UP OF A COMMUNITY WIDE STUDY, AND POPULATION RE-SURVEY. J Chronic Dis. 1964 May;17:415–438. doi: 10.1016/0021-9681(64)90102-x. [DOI] [PubMed] [Google Scholar]
  173. SUTHERLAND J. M. Observations on the prevalence of multiple sclerosis in Northern Scotland. Brain. 1956 Dec;79(4):635–654. doi: 10.1093/brain/79.4.635. [DOI] [PubMed] [Google Scholar]
  174. SUTHERLAND J. M., TYRER J. H., EADIE M. J. The prevalence of multiple sclerosis in Australia. Brain. 1962 Mar;85:149–164. doi: 10.1093/brain/85.1.149. [DOI] [PubMed] [Google Scholar]
  175. Savettieri G., Elian M., Giordano D., Grimaldi G., Ventura A., Dean G. A further study on the prevalence of multiple sclerosis in Sicily: Caltanissetta city. Acta Neurol Scand. 1986 Jan;73(1):71–75. doi: 10.1111/j.1600-0404.1986.tb03243.x. [DOI] [PubMed] [Google Scholar]
  176. Shepherd D. I., Downie A. W. Prevalence of multiple sclerosis in north-east Scotland. Br Med J. 1978 Jul 29;2(6133):314–316. doi: 10.1136/bmj.2.6133.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  177. Sheremata W. A., Poskanzer D. C., Withum D. G., MacLeod C. L., Whiteside M. E. Unusual occurrence on a tropical island of multiple sclerosis. Lancet. 1985 Sep 14;2(8455):618–618. doi: 10.1016/s0140-6736(85)90621-x. [DOI] [PubMed] [Google Scholar]
  178. Shibasaki H., Okihiro M. M., Kuroiwa Y. Multiple sclerosis among Orientals and Caucasians in Hawaii: a reappraisal. Neurology. 1978 Feb;28(2):113–118. doi: 10.1212/wnl.28.2.113. [DOI] [PubMed] [Google Scholar]
  179. Skegg D. C., Corwin P. A., Craven R. S., Malloch J. A., Pollock M. Occurrence of multiple sclerosis in the north and south of New Zealand. J Neurol Neurosurg Psychiatry. 1987 Feb;50(2):134–139. doi: 10.1136/jnnp.50.2.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  180. Sosa Enríguez M., Betancor León P., Rosas C., Navarro M. C. La esclerosis múltiple en la provincia de Las Palmas. Arch Neurobiol (Madr) 1983 May-Jun;46(3):161–166. [PubMed] [Google Scholar]
  181. Spielman R. S., Nathanson N. The genetics of susceptibility to multiple sclerosis. Epidemiol Rev. 1982;4:45–65. doi: 10.1093/oxfordjournals.epirev.a036251. [DOI] [PubMed] [Google Scholar]
  182. Sriram S., Stewart G. J., Buhler M., Grumet C., Engleman E. HLA-DR antigens in multiple sclerosis: two-dimensional gel electrophoresis. Neurology. 1985 Feb;35(2):248–251. doi: 10.1212/wnl.35.2.248. [DOI] [PubMed] [Google Scholar]
  183. Stazio A., Paddison R. M., Kurland L. T. Multiple sclerosis in New Orleans, Louisiana, and Winnipeg, Manitoba, Canada: follow-up of a previous survey in New Orleans, and comparison between the patient populations in the two communities. J Chronic Dis. 1967 May;20(5):311–332. doi: 10.1016/0021-9681(67)90059-8. [DOI] [PubMed] [Google Scholar]
  184. Sumaya C. V., Myers L. W., Ellison G. W., Ench Y. Increased prevalence and titer of Epstein-Barr virus antibodies in patients with multiple sclerosis. Ann Neurol. 1985 Apr;17(4):371–377. doi: 10.1002/ana.410170412. [DOI] [PubMed] [Google Scholar]
  185. Sweeney V. P., Sadovnick A. D., Brandejs V. Prevalence of multiple sclerosis in British Columbia. Can J Neurol Sci. 1986 Feb;13(1):47–51. doi: 10.1017/s0317167100035782. [DOI] [PubMed] [Google Scholar]
  186. Swingler R. J., Compston D. A. The prevalence of multiple sclerosis in south east Wales. J Neurol Neurosurg Psychiatry. 1988 Dec;51(12):1520–1524. doi: 10.1136/jnnp.51.12.1520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  187. Swingler R. J., Compston D. The distribution of multiple sclerosis in the United Kingdom. J Neurol Neurosurg Psychiatry. 1986 Oct;49(10):1115–1124. doi: 10.1136/jnnp.49.10.1115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  188. Thompson A. J., Brazil J., Martin E. A., Hutchinson M., Whelan C. A., Feighery C. Suppressor T cell changes in active multiple sclerosis: analysis with three different monoclonal antibodies. J Neurol Neurosurg Psychiatry. 1985 Oct;48(10):1062–1064. doi: 10.1136/jnnp.48.10.1062. [DOI] [PMC free article] [PubMed] [Google Scholar]
  189. Thompson A. J., Brazil J., Whelan C. A., Martin E. A., Hutchinson M., Feighery C. Peripheral blood T lymphocyte changes in multiple sclerosis: a marker of disease progression rather than of relapse? J Neurol Neurosurg Psychiatry. 1986 Aug;49(8):905–912. doi: 10.1136/jnnp.49.8.905. [DOI] [PMC free article] [PubMed] [Google Scholar]
  190. Tienari P. J., Wikström J., Sajantila A., Palo J., Peltonen L. Genetic susceptibility to multiple sclerosis linked to myelin basic protein gene. Lancet. 1992 Oct 24;340(8826):987–991. doi: 10.1016/0140-6736(92)93007-a. [DOI] [PubMed] [Google Scholar]
  191. Van Lambalgen R., Sanders E. A., D'Amaro J. Sex distribution, age of onset and HLA profiles in two types of multiple sclerosis. A role for sex hormones and microbial infections in the development of autoimmunity? J Neurol Sci. 1986 Nov;76(1):13–21. doi: 10.1016/0022-510x(86)90138-3. [DOI] [PubMed] [Google Scholar]
  192. Vergnon J. M., Vincent M., de Thé G., Mornex J. F., Weynants P., Brune J. Cryptogenic fibrosing alveolitis and Epstein-Barr virus: an association? Lancet. 1984 Oct 6;2(8406):768–771. doi: 10.1016/s0140-6736(84)90702-5. [DOI] [PubMed] [Google Scholar]
  193. Visscher B. R., Detels R., Dudley J., Haile R. W., Malmgren R. M., Terasaki P. I., Park M. S. Genetic susceptibility to multiple sclerosis. Neurology. 1979 Oct;29(10):1354–1360. doi: 10.1212/wnl.29.10.1354. [DOI] [PubMed] [Google Scholar]
  194. Visscher B. R., Liu K. S., Sullivan C. B., Valdiviezo N. L., Detels R. Birth order and multiple sclerosis. Acta Neurol Scand. 1982 Aug;66(2):209–215. doi: 10.1111/j.1600-0404.1982.tb04518.x. [DOI] [PubMed] [Google Scholar]
  195. Visscher B. R., Sullivan C. B., Detels R., Madden D. L., Sever J. L., Terasaki P. I., Park M. S., Dudley J. P. Measles antibody titers in multiple sclerosis patients and HLA-matched and unmatched siblings. Neurology. 1981 Sep;31(9):1142–1145. doi: 10.1212/wnl.31.9.1142. [DOI] [PubMed] [Google Scholar]
  196. WESTLUND K. B., KURLAND L. T. Studies on multiple sclerosis in Winnepeg, Manitoba, and New Orleans, Louisiana. I. Prevalence; comparison between the patient groups in Winnipeg and New Orleans. Am J Hyg. 1953 May;57(3):380–396. doi: 10.1093/oxfordjournals.aje.a119582. [DOI] [PubMed] [Google Scholar]
  197. Waksman B. H., Reynolds W. E. Multiple sclerosis as a disease of immune regulation. Proc Soc Exp Biol Med. 1984 Mar;175(3):282–294. doi: 10.3181/00379727-175-41798. [DOI] [PubMed] [Google Scholar]
  198. Wender M., Pruchnik-Grabowska D., Hertmanowska H., Kowal P., Zielińska M., Namysł I., Marcinkowski J. Epidemiology of multiple sclerosis in western Poland--a comparison between prevalence rates in 1965 and 1981. Acta Neurol Scand. 1985 Aug;72(2):210–217. doi: 10.1111/j.1600-0404.1985.tb00866.x. [DOI] [PubMed] [Google Scholar]
  199. Westlund K. Distribution and mortality time trend of multiple sclerosis and some other diseases in Norway. Acta Neurol Scand. 1970;46(4):455–483. doi: 10.1111/j.1600-0404.1970.tb05806.x. [DOI] [PubMed] [Google Scholar]
  200. Wikström J., Ritter G., Poser S., Firnhaber W., Bauer H. J. Das Vorkommen von Multipler Sklerose in Südniedersachsen. Ergebnisse einer Feldstudie über 12 Jahre. Nervenarzt. 1977 Sep;48(9):494–499. [PubMed] [Google Scholar]
  201. Wikström J., Westermarck T., Palo J. Selenium, vitamin E and copper in multiple sclerosis. Acta Neurol Scand. 1976 Sep;54(3):287–290. doi: 10.1111/j.1600-0404.1976.tb04806.x. [DOI] [PubMed] [Google Scholar]
  202. Williams E. S., McKeran R. O. Prevalence of multiple sclerosis in a south London borough. Br Med J (Clin Res Ed) 1986 Jul 26;293(6541):237–239. doi: 10.1136/bmj.293.6541.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  203. Wynn D. R., Rodriguez M., O'Fallon W. M., Kurland L. T. A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota. Neurology. 1990 May;40(5):780–786. doi: 10.1212/wnl.40.5.780. [DOI] [PubMed] [Google Scholar]
  204. Wynn D. R., Rodriguez M., O'Fallon W. M., Kurland L. T. Update on the epidemiology of multiple sclerosis. Mayo Clin Proc. 1989 Jul;64(7):808–817. doi: 10.1016/s0025-6196(12)61754-6. [DOI] [PubMed] [Google Scholar]
  205. Yaqub B. A., Daif A. K. Multiple sclerosis in Saudi Arabia. Neurology. 1988 Apr;38(4):621–623. doi: 10.1212/wnl.38.4.621. [DOI] [PubMed] [Google Scholar]

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