title: Multiple sclerosis in twins from continental Italy and Sardinia: a nationwide study.
abstract: Knowledge about the balance between heritable and nonheritable risk in multiple sclerosis (MS) is based on twin studies in high-prevalence areas. In a study that avoided ascertainment limitations and directly compared continental Italy (medium-prevalence) and Sardinia (high-prevalence), we ascertained 216 pairs from 34,549 patients. This gives a twinning rate of 0.62% among MS patients, significantly less than that of the general population. In continental Italy, probandwise concordance was 14.5% (95% confidence interval, 5.1-23.8) for monozygotic and 4.0% (95% confidence interval, 0.8-7.1) for dizygotic twins. Results in Sardinia resemble those in northern populations but in limited numbers. Monozygotic concordance was 22.2% (95% confidence interval, 0-49.3) probandwise, but no concordant dizygotic pairs were identified. A questionnaire on 80 items possibly related to disease cause was administered to 70 twin pairs, 135 sporadic patients, and 135 healthy volunteers. Variables positively (7) or negatively (2) associated with predisposition and concordance in twins largely overlapped and were mainly linked to infection. If compared with previous studies, our data demonstrate that penetrance in twins appears to correlate with MS prevalence. They highlight the relevance of nonheritable variables in Mediterranean areas. The apparent underrepresentation of MS among Italian twins draws attention to protective factors, shared by twins, that may influence susceptibility.
authors.affiliation: Neurology and Center for Experimental Neurological Therapy, S. Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ristori
authors.forename: Stefania
authors.initials: S
authors.lastname: Cannoni
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Stazi
authors.forename: Nicola
authors.initials: N
authors.lastname: Vanacore
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Cotichini
authors.forename: Marco
authors.initials: M
authors.lastname: Alfò
authors.forename: Maura
authors.initials: M
authors.lastname: Pugliatti
authors.forename: Stefano
authors.initials: S
authors.lastname: Sotgiu
authors.forename: Claudio
authors.initials: C
authors.lastname: Solaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Bomprezzi
authors.forename: Simone
authors.initials: S
authors.lastname: Di Giovanni
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Figà Talamanca
authors.forename: Lorenza
authors.initials: L
authors.lastname: Nisticò
authors.forename: Corrado
authors.initials: C
authors.lastname: Fagnani
authors.forename: Michael C
authors.initials: MC
authors.lastname: Neale
authors.forename: Isabella
authors.initials: I
authors.lastname: Cascino
authors.forename: Gabriele
authors.initials: G
authors.lastname: Giorgi
authors.forename: Mario A
authors.initials: MA
authors.lastname: Battaglia
authors.forename: Carla
authors.initials: C
authors.lastname: Buttinelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Tosi
authors.forename: Marco
authors.initials: M
authors.lastname: Salvetti
mesh_terms: D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000235:genetics; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014427:Twins