How Far Can Epidemiology Take Us in Finding the Cause of Multiple Sclerosis?
John F Kurtzke MD, FACP, FAAN
This monograph is part of our annual Whitaker Memorial Lecture series. The 2013 lecture was given by John Kurtzke MD, FACP, FAAN. His presentation summarizes the major findings on the epidemiology of multiple sclerosis (MS) over the last century, with a focus on the work from John’s long and distinguished research career. In the text and slides, John meticulously leads us through the population-based studies that point to an infection as the underlying cause for MS.
New Study of Gulf War Era Veterans Shows High MS Incidence Rates in Diverse Demographic Groups
This paper introduces a new large demographically diverse military multiple sclerosis (MS) cohort of Vetearns from the Gulf War era (1990-2007). Key findings were that African Americans had the highest MS incidence rates compared with Whites, Hispanics, Asian/Pacific Islanders and Native Americans/Pacific Islanders. The Gulf War MS cohort will be an important resource for further studies of MS risk factors for onset and progression.
Meyer-Schwickerath R, Haug C, Hacker A, et al. Intracranial venous pressure is normal in patients with multiple sclerosis. Mult Scler. 2011;17(5):637-638.
Baracchini C, Perini P, Calabrese M, Causin F, Rinaldi F, Gallo P. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol. 2011;69(1):90-99.
Turner AP, Kivlahan DR, Haselkorn JK "Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life." Archives of physical medicine and rehabilitation 2009 Mar; 90; 3; 420-8
Study of Veterans with MS does not support theory that chronic cerebral venous insufficiency (CCSVI) exists in MS.
Recently published studies suggest that the perivenous inflammation and perhaps the disease itself are initiated by cerebral venous hypertension or chronic cerebrospinal venous insufficiency. This study failed to detect a significant difference in the Zamboni et al criteria for impairment to cerebral venous drainage in patients with MS compared with control subjects.
The Centers of Excellence maintain a national MS Data Repository as a part of our mission. The MSCOE repository contains the VHA medial data of every patient diagnosed with MS since 1998; over 44,000 unique and deidentified cases. It is the largest collection of information on men with MS in the world. They comprise more than 80% of the repository with an average age in the mid 50's.
Repository data has been used in our studies of exercise, obesity, pain, spasticity, falls, access to specialty care, disease modifying therapies, complementary and alternative medicine, telehealth, rural medicine, cost of care, and causes of death among VHA patients with Multiple Sclerosis. The Centers of Excellence also use it to contact those patients and caregivers who are within driving distance of upcoming MSCOE educational events, as well as for the delivery of our newsletter.
MS researchers can make use of this data. Please contact Steven.Leipertz@va.gov for details.