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Genes predict outcome in multiple sclerosis

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Pairs of siblings with multiple sclerosis show the same progression of their disease and the same eventual disability and handicap, supporting the theory that genes rather than environment dictate both susceptibility to multiple sclerosis and its outcome.

This is the conclusion of Chataway et al, who have added to the first UK cohort of 177 sibling pairs with multiple sclerosis from 166 families and reanalysed the data for the new total of 262 pairs from 250 families. As before, they looked for concordance in clinical variables in each pair of siblings for course of disease, presenting symptoms, age and year of onset—and this time also included measures of disability, disease progression, and handicap. The data were adjusted for confounding factors associated with analysis of sibling pairs and were analysed with statistical techniques that can include potentially confounding variables.

A third of all sibling pairs had similar presenting symptoms, but this was not statistically significant, nor was the primary affected site. However, 50% of the sibling pairs had an identical course of their multiple sclerosis—relapse-remitting, primary progressive, or secondary progressive—which was a significant result. Severity of the disease at assessment indicated that disability, progression, and handicap were concordant within sibling pairs but relapse rate in the previous year was not.

So although most members of sibling pairs have different initial symptoms, the progress of their disease will converge such that each sibling in a pair will eventually have similar disability and handicap scores.

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