The combination of unidentified genes, geographic location, and an abnormal immune response to myelin has led scientists to consider that MS may be caused by a virus. Some viruses can infect the CNS, including, in rare instances, viruses that cause common childhood diseases. Polio, a once-common scourge that has been virtually eradicated in industrialized nations, was, like MS, more common in temperate climates than in the tropics. One hypothesis is that paralytic polio does not develop in the less stringent sanitary conditions and close living arrangements that are common in warmer climates and favor the occurrence of infections earlier in childhood, when maternal antibodies are still present and paralysis is much less likely.
The notion of an infectious cause of MS gained support when the disease emerged in the Faroe Islands, off the coast of England, after occupation by British troops during World War II. It has been speculated that dogs kept as pets by the British brought canine distemper or another virus to the island, exposing the native human inhabitants. However, no links to the canine distemper virus have been demonstrated.
Scientists have also speculated that MS results from altered immune response to one or more common viral infections, and that this abnormal response is more likely to occur when infection is acquired later in childhood. Many other viruses have been implicated and continue to be studied by researchers as possible causes of MS. One large study found that the disease was seven times more common in people who have had infectious mononucleosis, which is caused by the Epstein-Barr virus. But, however appealing the idea, there is no direct proof that any one virus causes the disease.
Other pieces of the puzzle remain unsolved as well. During their reproductive years, women are more susceptible to MS than men. Female hormones, such as estrogen and progesterone, significantly influence immune function. During pregnancy, women with MS seem to be relatively protected from neurologic attacks. However, the disease has a greater tendency to flare within the first six months of the postpartum period. These observations, however, are not absolute. A great majority of women successfully manage both pregnancy and the postpartum period.
Emotional stress, common infections such as colds or sinusitis, and trauma to the CNS also have been studied as possible causes both of MS and of periodic exacerbations. Except for the observation that common viral infections often precede exacerbations, no cause-and-effect relationship has been validated in scientifically controlled studies.
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