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Lancet Neurol. 2004 Dec;3(12):709-18.

Environmental risk factors in multiple sclerosis aetiology.

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Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.


The epidemiology of multiple sclerosis (MS) has been intensively studied. It is conceptualised as a complex disease in which genetic and environmental factors act together to cause disease. There are temporal and geographic variations in disease risk, and risk of disease may be affected by migration between regions of differing risk. Numerous potential causal factors including infection, immunisations, physical and emotional stressors, climate, diet, and occupational exposures have been studied using various observational study designs. Thus far, no single environmental exposure has been consistently identified as a causal factor in MS, but sufficient data have accumulated that causal pathways should be postulated and tested. This review will focus on the environmental epidemiology of MS.

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