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Midway evaluation- Marianna Cortese

Midway evaluation - Marianna Cortese

Midway evaluation for the PhD degree at the University of Bergen for candidate Marianna Cortese

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Maraianna Cortese is affiliated to the Department of Clinical Medicine. Supervisors are Kjell- Morten Myhr og Trond Riise.

 

PhD project

Environmental risk factors and pre-diagnostic signs of Multiple Sclerosis

By Marianna Cortese

 

Abstract

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) caused by a complex interplay between environmental and genetic risk factors. The disease is among the most common disabling diseases in young adults with onset usually between 20 and 40 years of age, but may be seen even in childhood and adolescence.

The diagnosis is based on detection of disseminated disease in time (episodes) and space (location) of the CNS, documented by clinical or magnetic resonance imaging (MRI) disease activity. Although without a history of previous symptoms of MS, we often experience MRI evidence of long-lasting disease at the time of clinical onset and diagnosis. Further, chronic problems like cognitive impairment and fatigue may be present early in the course of the disease. Thus the “biological onset” often precedes the clinical onset of the disease and vague symptoms that are difficult to detect might be present prior to the clinical MS onset.

A number of environmental risk factors such as low vitamin D, smoking and late infection by Epstein-Barr virus seem to play an important role in the development of MS. Overweight has, in previous studies, also been associated with the risk of developing the disease. However, the association is less clear in men. The exact cause of the condition, and if there is a critical age-period of exposure of any risk factors is, however, largely unknown.

We therefore aimed to study possible pre-diagnostic symptoms and signs of MS by linking data from the conscription database of the Norwegian Vernepliktsverk (including men aged 18-19 years) with the Norwegian MS Registry, to more precisely define a typical age at onset of the disease. We also aimed to study the association between BMI and MS risk among young men and whether there is any critical age-period for the influence of vitamin D on the risk of developing MS. For this purpose we used data from the same registry-linkage as well as data from a large multi-national multicentre case-control study of Environmental Factors In Multiple Sclerosis (EnvIMS Study).