THE FAMILIAL OCCURRENCE OF MULTIPLE SCLEROSIS AND ITS IMPLICATIONS

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Abstract
The adequately descr. and "acceptable" instances of familial multiple sclerosis in the literature to date number 79 with an aggregate of 177 persons. To these the author adds 5 instances including 11 persons (3 brothers and 4 pairs of siblings), making a total of 84 family groups and 188 persons. The literature contains reports of many other cases insufficiently descr. to be appraised, but undoubtedly representing genuinely familial instances. Curtius and his school have shown that the incidence of multiple sclerosis is 5 times as great among the total relatives, and 20 times as great among the siblings, of their German sclerotic patients as the (doubled) incidence among the general Swiss population. However, because of the relatively small nos. involved, Curtius''s work is statistically not too secure. There is no evidence that contagion explains the familial occurrence of multiple sclerosis. The currently available evidence strongly suggests that multiple sclerosis exhibits a familial incidence more frequently than mere chance would determine. On the other hand, multiple sclerosis is too often non-familial for a familial, constitutional factor to be its sole cause. The disease is thus, in this regard, not to be compared with Friedreich''s ataxia or Huntington''s chorea. It may, perhaps, be compared to arterial hypertension or diabetes. The following theory is consistent with our present information: (a) There is a familial, constitutional susceptibility to multiple sclerosis. This susceptibility possibly non-essential and non-specific, is sub-clinical and, per se, inadequate to produce the disease, (b) There is a 2d, non-familial, possibly exogenous cause or group of causes which are competent to evoke the disease, especially when the 1st, or constitutional, factor is already present.

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