Seasonal variation of relapse rate in multiple sclerosis is latitude dependent

Spelman, Tim; Gray, Orla; Trojano, María; Petersen, Thor; Izquierdo, Guillermo; Lugaresi, Alessandra; Hupperts, Raymond; Bergamaschi, Roberto; Duquette, Pierre; Grammond, Pierre; Giuliani, G.; Boz, Cavit; Verheul, Freek; Oreja‐Guevara, Celia; Barnett, Michael; Grand’Maison, François; Rio, Maria Edite; Lechner‐Scott, Jeannette; Pesch, Vincent Van; Bolanos, R. Fernandez; Flechter, Shlomo; Braber-Moerland, Leontien Den; Iuliano, Gerardo; Amato, Maria Pia; Slee, Mark; Cristiano, Edgardo; Saladino, Maria Luisa; Paine, Mark; Vella, Norbert; Kasa, Krisztian; Deri, Norma; Herbert, Joseph; Moore, Fraser; Petkovska‐Boskova, Tatjana; Alroughani, Raed; Savino, Aldo; Shaw, Cameron; Vucic, Steve; Santiago, Vetere; Bacile, Elizabeth Alejandra Bacile; Skromne, Eli; Poehlau, Dieter; Cabrera-Gómez, José Antonio; Lucas, Robyn; Butzkueven, Helmut

doi:10.1002/ana.24287

Cited by 76 publications

(61 citation statements)

References 59 publications

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“…This observation was confirmed and extended by a large multicentric observational study from the MSBase cohort, which showed consistent trends in both northern and southern hemispheres [25] . Interestingly, the lag between seasonal ultraviolet radiation trough levels in midwinter and subsequent peak in relapse probability was inversely associated with the latitude (mean of 28.5 days per 10° of latitude).…”

Section: Epidemiology Of Ms Relapsessupporting

confidence: 70%

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Kalinčík

2015

Neuroepidemiology

135

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Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies.

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Section: Epidemiology Of Ms Relapsessupporting

confidence: 70%

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Kalinčík

2015

Neuroepidemiology

135

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“…Furthermore, an analysis of the international MSBase registry data demonstrated that increasing latitudes away from the equator are associated with a shorter lag between seasonal UV radiation trough and relapse peak (Spelman et al, 2014). The relapse peak was recorded in early spring (March) and the relapse trough in autumn (October), which indicate an annual cyclical pattern of MS disease activity (Spelman et al, 2014). As UVB radiation is lowest during the winter months (Webb et al, 1988) and 25(OH)D 3 has a half-life of approximately 15 days (Jones, 2008), VD deficiency increases during winter.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity

Miclea

Miclea²,

Pistor

et al. 2017

Brain and Behavior

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“…This risk seems to be environmentally related, as it may decrease or increase if the person moves after birth [4] . In recent times, it has also been observed that there is a latitude-dependent relationship between seasonal ultraviolet radiation and disease relapse, showing that increasing latitudes away from the equator are associated with shorter lag [31] . The more likely environmental candidate accounting for this latitude-related phenomenon is sun exposure (ultraviolet radiation), acting either directly or through the generation of vitamin D.…”

Section: Discussionmentioning

confidence: 98%

Analysis of the Relationship between the Month of Birth and Risk of Multiple Sclerosis in a Spanish Population

Villar-Quiles¹,

Matías‐Guiu²,

Ortega³

et al. 2016

Eur Neurol

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Background: Some studies have suggested an association between the month of birth and risk of multiple sclerosis (MS), related to environmental factors, mainly sun exposure and maternal vitamin D levels. Few studies have been conducted in Southern Europe countries. Madrid has a continental climate with considerable variation of sun hours between winter and summer, so it may be relevant to study this relationship. Methods: MS patients, born between 1932 and 2003, 1,335 of them from our database between 2004 and 2015, were analysed. The weighted average number of births per month in Madrid from 1996 and 2012 (n = 1,098,774) was considered the control population. The month and season of birth were analysed using chi-square, Hewitt's and Roberson's seasonality tests. Results: Birth rate increased in June, July, and September, and decreased in November, January, and February. Births were 29% more frequent in summer (July-September) than in winter (January-March), with a ratio of 0.79. Hewitt's test for seasonality gave a rank sum of 53 between May and October (p = 0.12). Rogerson's variation was applied to 3-, 4-, and 5-month periods. Substantial differences were noted in the 5-month periods (k = 5), although the largest rank sum (June-October) was not significant (p = 0.09). Conclusion: Our analysis seemed to suggest that pre-natal sun exposure may have an influence on the incidence of MS, most likely in combination with other environmental or genetic factors.

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Seasonal variation of relapse rate in multiple sclerosis is latitude dependent

Cited by 76 publications

References 59 publications

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity

Analysis of the Relationship between the Month of Birth and Risk of Multiple Sclerosis in a Spanish Population

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