Dear Professor Gavin Giovannoni
Significant increase in the incidence of multiple sclerosis in Iran has been always puzzling.
With strong evidence from Danish MS Registry (Nielson et all) early environment rather than ones genetic is the primary etiological agent for Multiple sclerosis. Iran was exposed to this agent much earlier than other Gulf countries. British and Russian troops invaded Iran in the 1940s and left after 1946. Since the USA and late Shah of Iran had a friendly relation, it has been documented 25,000 USA military technicians and up to 850,000 Americans stayed or visited Iran till 1979 and left after the Iranian revolution. This viral agent is the most likely cause of high incidence of MS.
During the Gulf War in 1990, there was a massive movement of Allied troops within the Gulf countries and caused the spread of this MS virus to other Gulf countries. We have documented evidence of increased MS in Kuwait and Saudi Arabia published in 2005 and 2016. We are going to see more MS cases in other Gulf countries like Iran in the coming years and in the Indian Subcontinent and the rest of the world (the article by Zahoor titled MS in India Iceberg or Volcano is interesting to read in the journal of NeuroImmunology 2017 March 22nd).
Dr. V Santharam
Retired Accident & Emergency Medicine consultant and has been interested in MS over 40 years and support Dr Geoffrey Dean migration theory
1 Iran and United States Relations Wikipedia
2 Epidemiology of MS in Kuwait AF Alshubaili European Neurology 2005:53:125-131
3 Environmental exposure and risk of MS Osama Al Wutayd BMC Neurology June 2016