Annual incidence rates of multiple sclerosis (MS) in the Shetland Islands have been updated from 1938 to 1986. These reveal a significant decline in MS incidence beginning between 1951 and 1968. No significant change in prevalence, age-specific prevalence, duration of MS, or mean age of the MS population in Shetland has been found since the last survey in 1974, although a trend towards an older MS population was noted.