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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 73 Secondary issues can include pressure sores related to paralysis, urinary tract infections from bladder weakness, muscle deconditioning leading to atrophy, bone thinning from inactivity and steroid treatments, injuries from falls with a risk of fracture, and pneumonia related to inactivity and/or aspiration due to an impaired swallow reflex. Ultimately, a person with MS may become impaired enough to require assistive equipment in the form of a walker or wheelchair. They may not be able to drive or live independently. The strain of dealing with a chronic long-term illness can also take a toll on relationships and mental health. Depression is a frequent outcome of MS, and it can make treating MS more difficult. Theories About MS: Genetics and Environmental Exposures Genetic mutations that contribute to the risk of developing MS have been identified, and studies done through the International MS Genetics Consortium continue to explore this aspect of the disease. But family history of MS appears to be a relatively minor risk factor. The development of MS is also related to two important types of environmental exposures: sunlight and pathogens. Sunlight, Latitude, and Vitamin D We have known for decades that MS is more common in people who live far away from the equator, but the exact processes that lead to this outcome aren't completely clear. It has been established that the first 12 years of life are a determining factor; children who are born and spend their childhood in the far north or the far south have a greater chance of developing MS than those born closer to the equator. However, children born in northern latitudes can benefit from sun exposure: 30 minutes a day in sunshine (with appropriate sunscreen) appears to reduce the risk of developing MS later in life. This may be especially important for children who have a close relative with MS. Another connection between sunlight exposure and MS lies in the production of vitamin D. We produce vitamin D when we are exposed to the sun. People who have MS often have low serum levels of vitamin D and have fewer flares when they supplement this vitamin. The action of vitamin D as a guard against MS flares isn't fully understood, but it may play a role in immune system function. EBV Many people are familiar with EBV because this is the virus that causes mononucleosis (mono), an infection that begins in the epithelial tissue of the throat and salivary glands, and then moves into the lymph nodes. Mono elicits an aggressive immune system response, leading to fever, sore throat, enlarged and painful lymph nodes (including the spleen), and debilitating fatigue. As we discussed at the beginning of this column, an EBV infection can be subtle and uneventful, but for some people it can lead to much more serious consequences, including pneumonia, cardiomyopathy, CNS inflammation, certain kinds of cancer, and much more. EBV is a member of the Herpesviridae family, along with herpes simplex, varicella zoster (the virus that causes chicken pox and shingles), cytomegalovirus, and others. All members of the Herpesviridae family have one feature in common: they are never fully eradicated from the body. Instead, a viral colony goes dormant inside some target cells. The target cells for EBV are memory B-cells. Scientists have long suspected that MS might be related to a history of pathogenic exposures. This is common in autoimmune disorders: The immune system encounters an invader, and then later mistakes some part of the body as that invader. But interest in EBV as a precipitator for MS recently PATHOLOGY PERSPECTIVES