Eight hundred thirty-four patients with multiple sclerosis (MS) in King and Pierce Counties, Washington, and in Los Angeles County, California, with symptomatic onset between 1960 and 1969 were followed up for disability status in 1980. A higher proportion of the 375 patients who were not walking or deceased in 1980 had a late age of onset, resided in Los Angeles County, had motor or coordination symptoms at onset, and reported adverse responses to heat exposure and favorable responses to cold exposure, whereas a higher proportion of the 299 patients still walking without aids had early onset age and vision, speech, or sensory symptoms, or all three, at onset. The results suggest (1) that both host factors (age at first manifestation of symptoms and types of symptoms at onset) and environmental factors (place of residence and exposure to heat and cold) are determinants of disease course and (2) that most patients with MS should avoid exposure to heat.
Clark VA, Detels R, Visscher BR, Valdiviezo NL, Malmgren RM, Dudley JP. Factors Associated With a Malignant or Benign Course of Multiple Sclerosis. JAMA. 1982;248(7):856–860. doi:10.1001/jama.1982.03330070044028
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