Abstract
When patients are given the news that they have a serious and debilitating condition, one of the questions they ask is ‘what caused this, why me?’ In the case of multiple sclerosis (MS) we can say that while we know that for some patients genetic factors certainly play a role, for many we can only offer broad explanations that allude to multifactorial environmental issues in susceptible individuals. The incidence of MS is increasing worldwide but especially so in the UK; females are more likely to develop the disease. HLA-DR15 serotype confers a significantly higher risk of early onset MS (as well as a variety of other auto-immune conditions) and this may help to explain geographical variation in incidence. However, genetic predisposition cannot by itself be responsible for every case of MS. As with other chronic diseases where auto-immune factors are relevant, it is thought that a double hit hypothesis allows an environmental stimulus to initiate the disease process in individuals with a genetic predisposition. This is the subject of the review by Young which considers some of the environmental factors that have …
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