Lower serum vitamin D levels are associated with a higher relapse risk in multiple sclerosis

Runia, Tessel F.; Hop, Wim C. J.; Rijke, Yolanda B. de; Buljevac, D; Hintzen, Rogier Q.

doi:10.1212/wnl.0b013e31825fdec7

Cited by 203 publications

(134 citation statements)

References 30 publications

(18 reference statements)

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“…In our study we found that 65% of patients had abnormal low vitamin D level, also many studies conducted by Smolders J. and his colleagues [15], Correale and his colleagues [16], Van Der Mei and his colleagues [17] and lastly Runia T.F. and his colleagues [18], who all found that hypoviatminosis D highly associated with MS patients.…”

Section: Discussionsupporting

confidence: 85%

Vitamin D Level in Multiple Sclerosis Patients. Could Vitamin D Level Be Routine Investigation for Multiple Sclerosis Patients?

Ibrahim¹,

Alloush²,

Rahim³

2014

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Section: Discussionsupporting

confidence: 85%

Vitamin D Level in Multiple Sclerosis Patients. Could Vitamin D Level Be Routine Investigation for Multiple Sclerosis Patients?

Ibrahim¹,

Alloush²,

Rahim³

2014

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“…In contrast to these inconclusive small controlled studies, several recent association studies found a significant relationship between the vitamin D status and the relapse rate in patients with RRMS [Smolders et al 2008b;Runia et al 2012], with possible variable positive or negative interactions with IFNβ depending upon the vitamin D serum level, higher or lower than 50 nmol/liter respectively [Stewart et al 2012]. In another recent association study, preliminary results provided evidence that low serum 25-OH-D levels are an important risk factor for conversion from CIS to MS, suggesting that vitamin D supplementation in combination with IFNβ-1b may improve outcomes in CIS [Ascherio et al 2012b].…”

Section: Relapsesmentioning

confidence: 89%

“…In patients with MS living in temperate and Nordic countries, as in the general populations of these countries, vitamin D insufficiency is widespread, whatever the cutoff (50 or 75 nmol/ liter) for the lower limit of the 25-OH-D serum level ( Figure 3): indeed, as early as the earliest stages of the disease, that is, in patients with clinically isolated syndrome (CIS) or with RRMS, average serum levels are between 42 and 74 nmol/ liter, depending on the studies and the seasons, with a general mean close to 60 nmol/liter [SoiluHänninen et al 2005[SoiluHänninen et al , 2012Smolders et al 2008b;Hiremath et al 2009;Kragt et al 2009;Mowry et al 2010;Pierrot-Deseilligny andSouberbielle, 2010, 2012;Simpson et al 2010;Banwell et al 2011;Dabbaghmanesh and Yousefipour, 2011;Lonergan et al 2011;Neau et al 2011;Steffensen et al 2011;Yildiz et al 2011; Bäärnhielm Kampman et al 2012;Kirbas et al 2012;Løken-Amsrud et al 2012;Moen et al 2012;Runia et al 2012;SoiluHänninen et al 2012;Šaltyte . Benth et al 2012;Triantafyllou et al 2012] (Table 1).…”

Section: Vitamin D Requirements and Insufficiencymentioning

confidence: 99%

Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis

Pierrot‐Deseilligny

Souberbielle

2013

Ther Adv Neurol Disord

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Abstract:The contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis (MS) is reviewed. Among the multiple recently discovered actions of vitamin D, an immunomodulatory role has been documented in experimental autoimmune encephalomyelitis and in humans. This action in the peripheral immune system is currently the main known mechanism through which vitamin D might influence MS, but other types of actions could be involved within the central nervous system. Furthermore, vitamin D insufficiency is widespread in temperate countries and in patients with MS at the earliest stages of the disease, suggesting that the deleterious effects related to vitamin D insufficiency may be exerted in these patients. In fact, many genetic and environmental risk factors appear to interact and contribute to MS. In genetics, several human leukocyte antigen (HLA) alleles (more particularly HLA-DRB1*1501) could favour the disease whereas some others could be protective. Some of the genes involved in vitamin D metabolism (e.g. CYP27B1) also play a significant role. Furthermore, three environmental risk factors have been identified: past Epstein-Barr virus infection, vitamin D insufficiency and cigarette smoking. Interactions between genetic and environmental risk or protective factors may occur during the mother's pregnancy and could continue during childhood and adolescence and until the disease is triggered in adulthood, therefore possibly modulating the MS risk throughout the first decades of life. Furthermore, some clinical findings already strongly suggest that vitamin D status influences the relapse rate and radiological lesions in patients with MS, although the results of adequately powered randomized clinical trials using vitamin D supplementation have not yet been reported. While awaiting these incontrovertible results, which might be long in coming, patients with MS who are currently in vitamin D insufficiency should be supplemented, at least for their general health status, using moderate doses of the vitamin.

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“…In the recent years, this seasonal relationship is postulated to be associated with serum vitamin D levels (23). Data coming from relevant studies show that lower vitamin D levels are associated with more frequent relapses (24,25). It has been demonstrated that previously accused physical trauma, vaccinations, and epidural anesthesia do not have relapse triggering effects.…”

Section: The Definition and Features Of Relapsementioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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Lower serum vitamin D levels are associated with a higher relapse risk in multiple sclerosis

Cited by 203 publications

References 30 publications

Vitamin D Level in Multiple Sclerosis Patients. Could Vitamin D Level Be Routine Investigation for Multiple Sclerosis Patients?

Vitamin D Level in Multiple Sclerosis Patients. Could Vitamin D Level Be Routine Investigation for Multiple Sclerosis Patients?

Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

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