Consultant in Obstetrics and Gynaecology, London, UK
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 non-Western countries, while relapsing and remitting forms are more common in Northern Europe. More recently, an aggressive, early-onset form of the condition af-flicting women results in prolonged incapacity and early death with a ‘cytotoxic attack’ from the sub-arachnoid space causing widespread damage to cerebral neurones.
Nutrition, sunlight, exercise, stress and social fac-tors all have an impact on disease progression through unknown mechanisms. Postulated mechanisms to ex-plain 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 differentpatterns of physical effort. Some young women may be particularly vulnerable owing to the effects of child-birth on anorectal function. Primary care may be important to both prevention and progression of this chronic and debilitating condition.