Fischman H R
Neurology. 1982 Aug;32(8):864-70. doi: 10.1212/wnl.32.8.864.
Recent analysis of the Faroe Islands MS outbreak suggests that initiation of MS could occur at any time of life (before menopause), with puberty acting as an inducer for those with early onset of disease. It was further suggested that disease induction relates to hormonoimmunologic factors. This paper critiques current epidemiologic knowledge of MS and suggest where the Faroe Islands analysis leads. The generally accepted unimodality of the age-incidence curve is challenged with several examples of bimodality, and the concept of the hormonoimmunologic nature of MS induction is strengthened by analogies with tuberculosis, postvaccinal rabies encephalitis, and systemic lupus erythematosus (SLE). Major hormonal, lipid, and neurologic changes occur during the puberty period, but their roles in MS induction are undetermined. The concept of bimodality suggests that the search for etiologic risk factor relationships using small age at onset groups is more appropriate than using total MS populations. The question of the representativeness of the Faroe Islands outbreak can only be resolved by studies in other populations.
近期对法罗群岛多发性硬化症疫情的分析表明，多发性硬化症可能在生命中的任何时候（绝经前）发病，青春期对于疾病早发者起到诱发作用。研究还进一步表明，疾病诱发与激素免疫因素有关。本文对当前关于多发性硬化症的流行病学知识进行了批判，并指出法罗群岛的分析能带来哪些启示。年龄发病率曲线通常被认为是单峰的，但本文通过几个双峰的例子对这一观点提出了挑战，同时通过与结核病、疫苗接种后狂犬病脑炎和系统性红斑狼疮（SLE）进行类比，强化了多发性硬化症诱发的激素免疫性质这一概念。青春期会发生重大的激素、脂质和神经变化，但其在多发性硬化症诱发中的作用尚不确定。双峰的概念表明，使用发病年龄较小的群体来寻找病因风险因素关系比使用整个多发性硬化症患者群体更为合适。法罗群岛疫情的代表性问题只能通过对其他人群的研究来解决。
