Sreeram Ramagopalan, PhD

The worldwide sex ratio of MS has been substantially changing over the last century. Environmental factor/s appear to be at work in a sex-specific manner.

A series of studies unequivocally show a true absence of autoimmune disease aggregation in MS patients and their families.

The overall decreased cancer prevalence in patients with MS warrants further study and may represent an effect of increased immune surveillance in this autoimmune disease.

Venous thromboembolism is twice as likely to develop in patients with multiple sclerosis than in controls. Although the absolute risk of VTE is low in MS patients, thromboprophylaxis may need to be considered.

Meta-analyses of all available data have shown that smoking is associated with a 50% increased risk of MS.

Population-based studies have firmly established that relatives of patients with MS are at increased risk for the disease.

Although genetics risk explains the familial clustering of MS, it cannot fully explain the geographic distribution of MS and the changes in risk that occur with migration. Infections have been suggested as a possible explanation. The most convincing candidate for involvement in MS is the Epstein-Barr virus.

Even at disease onset, patients with MS have significantly lower bone mineral density than healthy controls. Close attention needs to be paid to the bone health of these patients.

Evidence for a treatment effect of vitamin D in modifying the course of MS is less compelling than evidence of a preventive effect.