Journal of Isfahan Medical School

Journal of Isfahan Medical School

A Case-Control Study on Risk Factors in Pediatric Multiple Sclerosis Population, Isfahan Province, Iran: Highlighting the Role of Puberty

Document Type : Original Article (s)

Authors
Masoud Etemadifar 1
Pedram Moeini 2
Sanaz Masoumi 2
Amin Bagheri-Ghalehsalimi 3
Ali Alavi 4
Mahboobeh Fereidan-Esfahani 4
1 Professor, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: There is no a comprehensive study on early-onset multiple sclerosis (EOMS) population on the role of well-known MS risk factors. Moreover, age at puberty and the critical window exposure to environmental risk factors is never investigated in neither adult nor pediatric MS population.Methods: A case-control study, including 97 patients with early-onset MS and 97 matched controls, was conducted in Isfahan Multiple Sclerosis Society. Information on age at puberty, gestational risk factors, environmental exposures, and past medical history was obtained from medical charts and interviews.Findings: In logistic regression model, every year of decreasing in pubertal onset in females and males was associated with 1.766 and 2.250 folds increase in risk of early-onset MS, respectively. In utero exposure to cigarette smoking was significantly associated with 2.33 (P = 0.010), and having smoker parents or passive smokers before puberty had 2.88 (P =0.006) fold in risk of early-onset MS. One hour less daily sun exposure increased the risk of early-onset MS as 2.007 folds (P < 0.001) after adjustment for age and sex.Conclusion: In utero and parental exposure to smoking as well as history of measles and appendectomy are risk factors for early-onset MS. Future studies should shed more light on the true interaction between pineal gland, gender, smoking, sunlight and other environmental and genetic risk factors in adult and pediatric MS population.
Keywords
Multiple Sclerosis
Early-onset
Pediatric
Risk Factors
Puberty
Cigarette smoking
  1. Etemadifar M, Abtahi SH, Akbari M, Murray RT, Ramagopalan SV, Fereidan-Esfahani M. Multiple sclerosis in Isfahan, Iran: an update. Mult Scler 2014; 20(8): 1145-7.
  2. Alonso A, Cook SD, Maghzi AH, Divani AA. A case-control study of risk factors for multiple sclerosis in Iran. Mult Scler 2011; 17(5): 550-5.
  3. Fereidan-Esfahani M, Ramagopalan SV, Etemadifar M, Sadri S, Abtahi SH. Vitamin D: shining a light on clinical and sex specific effects in multiple sclerosis? Int J Prev Med 2013; 4(5): 499-500.
  4. Etemadifar M, Nourian SM, Nourian N, Abtahi SH, Sayahi F, Saraf Z, et al. Early-onset multiple sclerosis in Isfahan, Iran: Report of the demographic and clinical features of 221 patients. J Child Neurol 2016; 31(7): 932-7.
  5. Etemadifar M, Sajjadi S, Nasr Z, Firoozeei TS, Abtahi SH, Akbari M, et al. Epidemiology of multiple sclerosis in Iran: a systematic review. Eur Neurol 2013; 70(5-6): 356-63.
  6. Chitnis T, Tenembaum S, Banwell B, Krupp L, Pohl D, Rostasy K, et al. Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis. Mult Scler 2012; 18(1): 116-27.
  7. Ramagopalan SV, Valdar W, Criscuoli M, DeLuca GC, Dyment DA, Orton SM, et al. Age of puberty and the risk of multiple sclerosis: a population based study. Eur J Neurol 2009; 16(3): 342-7.
  8. Lulu S, Graves J, Waubant E. Menarche increases relapse risk in pediatric multiple sclerosis. Mult Scler 2016; 22(2): 193-200.
  9. Graves JS. Is Season of Birth Important for Multiple Sclerosis Risk? JAMA Neurol 2016; 73(8): 912-3.
  10. Fiddes B, Wason J, Kemppinen A, Ban M, Compston A, Sawcer S. Confounding underlies the apparent month of birth effect in multiple sclerosis. Ann Neurol 2013; 73(6): 714-20.
  11. Nielsen NM, Bager P, Stenager E, Pedersen BV, Koch-Henriksen N, Hjalgrim H, et al. Cesarean section and offspring's risk of multiple sclerosis: a Danish nationwide cohort study. Mult Scler 2013; 19(11): 1473-7.
  12. Maghzi AH, Etemadifar M, Heshmat-Ghahdarijani K, Nonahal S, Minagar A, Moradi V. Cesarean delivery may increase the risk of multiple sclerosis. Mult Scler 2012; 18(4): 468-71.
  13. Mikaeloff Y, Caridade G, Tardieu M, Suissa S. Parental smoking at home and the risk of childhood-onset multiple sclerosis in children. Brain 2007; 130(Pt 10): 2589-95.
  14. Simon KC, van der Mei IA, Munger KL, Ponsonby A, Dickinson J, Dwyer T, et al. Combined effects of smoking, anti-EBNA antibodies, and HLA-DRB1*1501 on multiple sclerosis risk. Neurology 2010; 74(17): 1365-71.
  15. Sandyk R. Multiple sclerosis: the role of puberty and the pineal gland in its pathogenesis. Int J Neurosci 1993; 68(3-4): 209-25.
Journal of Isfahan Medical School
Volume 35, Issue 424 - Serial Number 424
January and February 2017
Pages 335-339

  • Receive Date 13 January 2017
  • Accept Date 06 April 2022