Abstract

Data have been reviewed on sib risk and the dizygotic twin concordance rate in multiple sclerosis. Even when rigorous criteria are applied, the dizygotic twin concordance rate for multiple sclerosis is apparently higher (perhaps 10 times higher) than could be explained by the sib risk. In contrast, twins with Parkinson's disease have low concordance rates even when ascertainment is by informal methods. It is concluded that such methods of ascertainment are not as biased as has been suggested, and that the high concordance rates reported for multiple sclerosis are a characteristic of the disease rather than an artifact of the ascertainment. Three hypotheses are considered which might, in principle, explain this high dizygotic twin concordance rate in multiple sclerosis: 1 One is certainly false, viz, that it is due to an excessive liability of dizygotic twins to the disease. 2 It is possible that a pathogen occurs in early infancy or in pregnancy itself. 3 It seems more likely that the high concordance rate may be explained in terms of age related events or sequences of events. (If such events were pathogenic for one member of a sibship, they would be pathogenic for another only if it were a co-twin).