Environmental factors related to multiple sclerosis progression

Authors:  Riadh Gouider, Amira Souissi, Saloua Mrabet,Alya Gharbi, Youssef Abida, Imen Kacem, Amina Gargouri-Berrechid

Editor's Choice
Journal of the Neurological Sciences.  REVIEW ARTICLE| VOLUME 464, 123161, September 15, 2024

DOI: https://doi.org/10.1016/j.jns.2024.123161

Highlights

• Multiple Sclerosis is a complex disease with an interplay between genetic and environmental factors.
• Key environmental factors associated with MS progression include low sunlight exposure and vitamin D levels, smoking, viral infections, comorbidities, physical activity and pollution.
• Knowledge about MS modifiable risk factors of progression is crucial to improve disease outcomes.

Multiple Sclerosis (MS) is a complex neurological disease which prevalence is increasing worldwide. The impact of environmental factors on MS susceptibility has already been defined and highlighted in many previous reports, particularly vitamin D or ultraviolet B light exposure, Epstein–Barr virus (EBV) infection, obesity, and smoking. 

There is increasing evidence that environmental and lifestyle factors are not only important in triggering MS but are also implicated in MS progression. Low sun exposure and vitamin D deficiency exhibit a strong relationship with disease progression in both animal and human studies. The gestational period seems also to impact long-term disease progression as January's babies had a higher risk of requiring walking assistance than those born in other months.

The implication of EBV in neurodegeneration and MS progression was also suggested even though its specific targets and mechanisms are still unclear. Cigarette smoking is correlated with faster clinical progression. The association of obesity and smoking seems to be associated with a faster progression and an increased rate of brain atrophy. Although the effect of air pollution on MS pathogenesis remains not fully understood, exposure to polluted air can stimulate several mechanisms that might contribute to MS severity.

People with MS with active disease have an altered microbiota compared to patients in the remission phase. Cardiovascular comorbidities, epilepsy, and depression are also associated with a more severe disability accrual. Knowledge about MS modifiable risk factors of progression need to be incorporated into everyday clinical practice in order to ameliorate disease outcomes.