Multiple sclerosis primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Julinka Auta Fernandes
Overview
No disease-specific medication, supplement, vaccine, dietary regimen, or other intervention currently has adequate evidence to prevent multiple sclerosis (MS) in an otherwise unaffected person. Current international consensus therefore emphasizes reduction of potentially modifiable risk factors while acknowledging that these measures cannot guarantee prevention and that their direct effect on an individual's MS risk has not been established in randomized primary-prevention trials.[1][2]
The most consistently supported potentially modifiable factors relevant to primary prevention are cigarette smoking, childhood or adolescent obesity, low sunlight exposure, vitamin D insufficiency or deficiency, and Epstein–Barr virus (EBV) infection. Because MS results from interactions among genetic, environmental, and biological factors, exposure to one or more of these factors does not mean that an individual will develop MS.[1][3]
Primary Prevention
Avoidance of tobacco smoke
Avoiding initiation of smoking and supporting smoking cessation are the most directly actionable current MS risk-reduction measures. Exposure to secondhand tobacco smoke should also be minimized, particularly among children and adolescents.[1][3]
Cigarette smoking is consistently associated with an increased risk of developing MS. A large population-based study estimated that a clinically important proportion of MS cases may be attributable to tobacco smoking; however, population-attributable estimates should not be interpreted as an individual's absolute risk.[4]
Maintenance of a healthy body weight
Childhood and adolescent obesity is consistently associated with increased MS risk, and these life stages may represent an important period of susceptibility.[1][2]
Healthy growth and weight should be supported through an age-appropriate balanced diet, regular physical activity, adequate sleep, and established obesity-prevention measures. These measures provide broad health benefits and may reduce MS risk by preventing obesity, but no particular diet or exercise program has independently been proven to prevent MS.[1][3]
Vitamin D sufficiency
Low serum vitamin D levels are associated with increased MS risk. Avoidance and correction of documented vitamin D deficiency according to age-, pregnancy-, and country-specific public-health guidance is reasonable.[1][3]
No MS-specific prophylactic vitamin D dose has been established, and vitamin D supplementation has not been proven to prevent MS in the general population. Supplementation and laboratory testing should therefore follow usual clinical indications rather than an unvalidated MS-prevention regimen. High-dose or megadose vitamin D should not be used solely in an attempt to prevent MS.[2]
Low sunlight exposure is also associated with MS risk, but this association does not justify intentional unprotected ultraviolet radiation exposure or the use of tanning devices as an MS-prevention intervention.
Epstein–Barr virus
Epstein–Barr virus infection is strongly associated with MS and is considered a leading causal candidate. In a large longitudinal cohort, MS risk increased markedly following EBV infection. Infectious mononucleosis, a symptomatic manifestation of EBV infection, is also associated with increased subsequent MS risk.[5]
Deliberately exposing children or adults to EBV or other infections is not a recommended primary-prevention strategy. The fact that childhood EBV infection is frequently asymptomatic does not establish that intentionally acquiring the infection early prevents MS.
No licensed vaccine is currently available to prevent EBV infection, and no EBV-directed intervention has been shown to prevent MS. Therefore, an EBV-specific MS primary-prevention intervention cannot currently be recommended.[6][1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Marrie RA, Dobson R, Baranzini SE, et al. (February 2026). "Toward a global research agenda for preventing multiple sclerosis". Multiple Sclerosis Journal. 32 (2): 151–162. doi:10.1177/13524585251398381. PMC 12916883 Check
|pmc=value (help). PMID 41454472 Check|pmid=value (help). - ↑ 2.0 2.1 2.2 Dobson R, Kreft KL, Jacobs BM, et al. (March 2026). "Towards primary prevention of multiple sclerosis". Nature Reviews Neurology. 22 (3): 182–195. doi:10.1038/s41582-025-01164-w. PMID 41310024 Check
|pmid=value (help). - ↑ 3.0 3.1 3.2 3.3 Amato MP, Derfuss T, Hemmer B, et al. (April 2018). "Environmental modifiable risk factors for multiple sclerosis: Report from the 2016 ECTRIMS focused workshop". Multiple Sclerosis. 24 (5): 590–603. doi:10.1177/1352458516686847. PMID 28671487.
- ↑ Manouchehrinia A, Huang J, Hillert J, et al. (March 2022). "Smoking attributable risk in multiple sclerosis". Frontiers in Immunology. 13: 840158. doi:10.3389/fimmu.2022.840158. PMC 8927036 Check
|pmc=value (help). PMID 35309300 Check|pmid=value (help). - ↑ Bjornevik K, Cortese M, Healy BC, et al. (January 2022). "Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis". Science. 375 (6578): 296–301. doi:10.1126/science.abj8222. PMID 35025605 Check
|pmid=value (help). - ↑ Centers for Disease Control and Prevention (9 May 2024). "About Epstein-Barr Virus (EBV)". Retrieved 31 August 2026.