Lifestyle factors in multiple sclerosis; a common mechanism?

Jelinek et al raise some important questions about the impact of lifestyle factors on disease progression in multiple sclerosis (MS). Different patterns of MS conform to Burkitts’ definition of a ‘disease of modern Western civilization’, though the evidence to support an ‘autoimmune’ aetiology is limited. MS presenting as neuromyelitis optica is an emerging pattern of the disease in nonWestern countries, while relapsing and remitting forms are more common in Northern Europe.More recently, an aggressive, early-onset form of the condition afflicting women results in prolonged incapacity and early death with a ‘cytotoxic attack’ from the subarachnoid space causing widespread damage to cerebral neurones. Nutrition, sunlight, exercise, stress and social factors all have an impact on disease progression through unknown mechanisms. Postulated mechanisms to explain some of Burkitts’ diseases include neuropathic injuries, often to the autonomic nervous system, caused by prolonged physical efforts during defaecation. Injuries at different anatomical sites result from changes in physical size and shape, together with different patterns of physical effort. Some young women may be particularly vulnerable owing to the effects of childbirth on anorectal function. Primary care may be important to both prevention and progression of this chronic and debilitating condition.