The previously reported prevalence of multiple sclerosis in Bulgaria is considerably lower than that reported for neighbouring countries. The aim of this study was to perform a detailed epidemiological investigation in well-defined populations in this country to obtain an accurate estimate of the frequency of multiple sclerosis. An epidemiological study was conducted in two small areas of the country. All patients with clinically or laboratory-supported, definite multiple sclerosis according to Poser''s criteria were personally interviewed. The study was begun in January, 1993 and December 31,1995 was selected as prevalence day. The prevalence ratio of multiple sclerosis per 100,000 population was 39.3 in the first community and 39.1 in the second. Thus, the prevalence ratio of multiple sclerosis in Bulgaria is not significantly different from that reported in bordering countries.

Despite some publications on Parkinson’s disease prevalence in Bulgaria, its frequency in the country still remains uncertain. Earlier studies in Bulgaria were carried out on large population groups and were based on medical records without further diagnostic confirmation. The aim of the present study was to perform an epidemiological investigation on Parkinson’s disease in Bulgaria, using strict diagnostic criteria in an attempt to obtain a more accurate estimate of its frequency in this country. We studied the prevalence of Parkinson’s disease in two small regions of Bulgaria. Cases were ascertained by the medical records and confirmed by personal examination. The prevalence of Parkinson’s disease was found to be 164.2 per 100,000 with 47 cases in the first region and 169.8 per 100,000 with 155 cases in the second region. Based on two small population studies, the prevalence ratio in different parts of Bulgaria is not significantly different and is similar to other European countries.

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The present case-control study includes 50 patients with multiple sclerosis, diagnosed according to McDonald criteria, 35 women and 15 men, median age 40.8 years (21-61). Twenty of them had familial history with disease transmitted from the mother. Relapsing-remitting course was noted in 42 of them, relapsing-progressive in 4 and secondary progressive in 4. Statistically significant association with multiple sclerosis was found only for the highest serum levels of EBVCA IgG > 750 U/ml (17 vs. 8, p<0.05) and EBVNA IgG > 1.000 U/ml (23 vs. 3, p<0.05). The subgroup analysis by gender and family history did not reveal significant difference between cases and controls. Two of the sporadic cases were EBVCA IgG and EBVNA IgG negative. In both groups there was identical age-depended increase of the serum levels. The analysis of HLA-G 14bp ins/del polymorphism did not reveal a significant difference between the patients with the EBVCA >750 U/ml и EBVNA > 1.000 U/ml, the entire cohort and controls. In contrast to the literature, we found no convincing evidence for the role of EBV in MS. Except a true association, the highest serum levels may reflect a synergistic influence of other genetic or enviromental factors or may be just a secondary phenomenon. However, the possible role of EBV at the early stages of MS pathogenesis could not be excluded and future and larger studies with a proper design are justified.