Barts-MS rose-tinted-odometer: ★

Do you live in Scotland? Thes latest MS incidence (new cases) and prevalence (all cases) figures from the Scottish Highlands should make Scottish public health officials shiver. 

In the Scottish Highlands, there are now over 18 people diagnosed with MS every year per 100,000 population with a total of 376 people with MS per 100,000 population. These figures may be artificially low as a lot of people born in the highlands may move away, for example to University or to work, and don’t get counted or included in these figures. 

This is one of the highest, if not the highest, MS incidence rates in the world and about 30% higher than the figure from about a decade ago. This would indicate that we are still living through an MS epidemic and something needs to be done about it as urgently as possible. 

What can be done? If MS is preventable the Scots should be setting-up and testing various MS prevention strategies to see if they can lower the incidence or at least stop its continual rise. This may be an opportune time to look into vitamin D prevention trials and campaigns to get first and second degree relatives to sign-up for more targeted MS prevention studies. 

Francisco Javier Carod-Artal. The epidemiology of multiple sclerosis in the Scottish Highlands: Prevalence, incidence and time to confirmed diagnosis and treatment initiation. Mult Scler Relat Disord. 2020 Nov 28;47:102657.

Introduction: Although multiple sclerosis (MS) is frequent in the northern hemisphere, there have not been recent epidemiological studies in the Scottish Highlands about MS.

Objectives: To get updated data regarding MS prevalence, incidence and mortality in the Highlands. Time between symptom onset and MS diagnosis was also evaluated in incident MS cases and the pattern of use of disease-modifying therapies (DMTs) was analysed.

Methods: Study population was people with MS under the care of the Highland Health and Social Care Partnership. The catchment area included North area (Wick, Thurso, Brora, Invergordon), Center (Inverness, Aviemore, Nairn, Fort William), and West coast (Ullapool, Skye). Data were obtained from the MS database at Raigmore hospital (prevalence, midyear 2017) and the prospective hospital-register based study (diagnosis) that was carried out over a 12-month period, in 2016. The 2010 McDonald criteria for diagnosis of new MS cases were used. Crude prevalence and incidence and 95% confidence interval (CI) were calculated for the MS adult onset population, and data was standardised to the European standard population 2013; cause-specific mortality rate was analysed. Pattern of use of DMTs during the first year of diagnosis was also registered.

Results: 745 patients were registered in the MS database. 75.4% (562 cases) were females, and female/male ratio was 3:1. Mean age of population was 54.1 ± 14.1 years (range: 15-95 years). Mean number of years since diagnosis was 8.5 ± 4.6 years. Estimated prevalence for the population aged 15 and older was 376 cases per 100,000 inhabitants (95% CI: 354-399). 36 incident MS cases were registered in 2016 (88.8% females; mean age 40.4 ± 12.1 years). Annual incidence in Highlands was 18.2 per 100,000 inhabitants (95% CI: 14-24). The mean period of time from symptom onset to diagnosis was 38.8 ± 43.2 months. 47.2% (17/36) did not take any DMT during the first year after the diagnosis.

Conclusion: Prevalence and incidence of MS in the Scottish Highlands is high. Although the gap period between symptom onset and diagnosis is moderate, a significant proportion of recently diagnosed MS patients were not keen to start a DMT the first year after the diagnosis.

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Twitter: @gavinGiovannoni                                 Medium: @gavin_24211

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Would an EBV vaccine potentially cure people with MS if you could do a study (phase2/3 clinical trial) in the relapsing remitting population ?

  • Why are pregnant women still not appropriately supplied with vitamin D? They are now advised, or some are given, 400 IU. This is woefully insufficient if living in Scotland! That is the same amount a 4-5kg baby receives. Just as with iron, protein or any other nutrient, one must go by bodyweight. So, a pregnant woman needs at least 10 times as much as a baby. Or, even better, check their blood level, then aim for them to reach a level above 75 nmol/l (30ng/ml). Why is it so hard to accept science? I mean real science, including observations, applied Bradford Hill criteria, genetic evidence, molecular/bio-chemical evidence, birthday observations on both sides of the globe…..Why do MS societies not rebel more?? Vitamin D is cheap and safe, why hesitate? What are they waiting for?
    Couldn’t Gov’s or MS societies AT LEAST write letters to those who have MS, advising that their children, daughters, nieces take sufficient vitamin D BEFORE falling pregnant AND throughout any pregnancy? That is what we did in our general practice in Edinburgh, we also had posters up to alert all those with a family history of MS.

    • I believe ProfEbers tried to get the Scottish Government to advise about Vitamin D supplementation but it never went anywhere

  • Although the pandemic is short-lived I wonder what the repercussions on vit D levels? Will the future be one of greater time spent indoors utilizing technology for our jobs and lessening sun exposure? If there is an inverse correlation of lower vit D and increased MS then MS cases will be expected to rise even more.

  • I come from one of the highest risk areas of Scotland, the north isles, with Norse ancestry, so plenty of MS risk genes no doubt. I’ve been disappointed by quite a few doctors over the years, their lack of awareness and dismissive attitudes before I was diagnosed.

By Prof G



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