Hygiene and living conditions in the patients with multiple sclerosis

Multiple sclerosis (MS) is a disease characterized by demyelination in the central nervous system considered to be triggered by complex interactions between various genetic and environmental factors. The leading environmental factors include geographical and racial distribution, age at the time of migration, altitude and sunlight, vitamin D, and the infectious agents. Thus, many studies were conducted on hygienic conditions of the patients with MS during their growth period. The hygiene hypothesis has been suggested especially in the western countries due to reduced incidence rates of the infectious diseases. Can the living conditions in the region play a role in development of auto-immune diseases such as MS in advanced ages by exerting effects on immunity system of T cells in early years of life? Objective of the present study was to determine living conditions of the patients with MS in early years of their live in terms of hygienic conditions and thus establishing whether hygienic conditions are risk factors in development of the disease. The present study included a total of 127 patients with MS being followed in outpatient clinic of demyelinating diseases of Neurology Department of Hospital of Afyon Kocatepe University between January 2009 and March 2013 and 127 healthy volunteers living in the same region at similar sociocultural level as control subjects. The subjects underwent semi-structured interviews to find out their hygienic conditions since their birth. There were no significant differences between two groups in terms of the last living place, educational level, income level per capita, animal shelters close to home of the patient, number of rooms in the home, number of persons living in the home, living in a house with soil floor, heat source used in the home, history of parasitic diseases and known allergic conditions, setting of their birth, having meals in common dishes with family members, the patient?s and his/her mother?s being sensitive on subject of cleanness, and average frequency of having bath during the last year (P > 0.05). Statistically significant differences were found between two groups in terms of living place between years 0 and 15 of life, rate of dealing with livestock between years 0 and 15 of life, toilet system in the house, type of drinking water, using cow dung as fuel, and whether everybody in the home had separate tooth brush between years 0 and 15 of life (P < 0.05). This difference indicated more urban life style of the patients with MS and that they grew up in more hygienic and sterile environments. We found that the patients with MS living in Afyon region were coming from urban life, having less contact with the animals, grew up with more sensitive conditions in terms of individual oral cleanness, contamination of drinking water, and toilet system in the house, and they heated their environment with healthier methods. Thus, it was concluded that the patients with MS in our region grew up in more hygienic conditions than the healthy control group with similar socioeconomic and cultural level. This supports the thesis that growing in excessively sterile conditions in the early years of life might be an environmental risk factor in MS.