scholarly journals Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology

2014 ◽  
Vol 72 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Doralina Guimarães Brum ◽  
Elizabeth Regina Comini-Frota ◽  
Claúdia Cristina F. Vasconcelos ◽  
Elza Dias-Tosta
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trial ◽  
Vitamin D ◽  
Environmental Factors ◽  
Scientific Evidence ◽  
Hypovitaminosis D ◽  
Central Nervous System Disease ◽  
Keywords Multiple Sclerosis ◽  
System Disease ◽  
Genetic And Environmental Factors

Multiple sclerosis (MS) is an inflammatory, autoimmune, demyelinating, and degenerative central nervous system disease. Even though the etiology of MS has not yet been fully elucidated, there is evidence that genetic and environmental factors interact to cause the disease. Among the main environmental factors studied, those more likely associated with MS include certain viruses, smoking, and hypovitaminosis D. This review aimed to determine whether there is evidence to recommend the use of vitamin D as monotherapy or as adjunct therapy in patients with MS. We searched PUBMED, EMBASE, COCHRANNE, and LILACS databases for studies published until September 9 th , 2013, using the keywords “multiple sclerosis”, “vitamin D”, and “clinical trial”. There is no scientific evidence up to the production of this consensus for the use of vitamin D as monotherapy for MS in clinical practice.

scholarly journals Role of gene polymorphisms in vitamin D metabolism and in multiple sclerosis

2018 ◽  
Vol 69 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Aylin Elkama ◽  
Bensu Karahalil
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Environmental Factors ◽  
Gene Polymorphisms ◽  
Neurological Impairment ◽  
Vitamin D Metabolism ◽  
Vitamin D Levels ◽  
The Central Nervous System ◽  
Genetic And Environmental Factors

Abstract Multiple sclerosis (MS) is a complex inflammatory disease of the central nervous system (CNS) resulting in neurological impairment and disability. There is evidence that adequate vitamin D levels may lower the risk of MS development. The aetiology of MS is complex and involves both genetic and environmental factors. In fact, not one but several genes are believed to lead to the disease. As for environmental factors, one of the most important risk factors is vitamin D deficiency, which, in turn, is closely related to gene polymorphisms that play a role in vitamin D metabolism and regulation. However, information about these gene polymorphisms is quite contradictory. The aim of this review is to discuss the association between some of the vitamin D-related gene variants and MS.

The effect of supplementation of vitamin D in neurocritical care patients: RandomizEd Clinical TrIal oF hYpovitaminosis D (RECTIFY)

2020 ◽  
Vol 133 (4) ◽  
pp. 1103-1112 ◽  
Author(s):  
Michael Karsy ◽  
Jian Guan ◽  
Ilyas Eli ◽  
Andrea A. Brock ◽  
Sarah T. Menacho ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Clinical Trial ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D3 ◽  
Neurocritical Care ◽  
Hypovitaminosis D ◽  
Mean Difference ◽  
Saps Ii ◽  
Gcs Score

OBJECTIVEHypovitaminosis D is prevalent in neurocritical care patients, but the potential to improve patient outcome by replenishing vitamin D has not been investigated. This single-center, double-blinded, placebo-controlled, randomized (1:1) clinical trial was designed to assess the effect on patient outcome of vitamin D supplementation in neurocritical care patients with hypovitaminosis D.METHODSFrom October 2016 until April 2018, emergently admitted neurocritical care patients with vitamin D deficiency (≤ 20 ng/ml) were randomized to receive vitamin D3 (cholecalciferol, 540,000 IU) (n = 134) or placebo (n = 133). Hospital length of stay (LOS) was the primary outcome; secondary outcomes included intensive care unit (ICU) LOS, repeat vitamin D levels, patient complications, and patient disposition. Exploratory analysis evaluated specific subgroups of patients by LOS, Glasgow Coma Scale (GCS) score, and Simplified Acute Physiology Score (SAPS II).RESULTSTwo-hundred seventy-four patients were randomized (intent-to-treat) and 267 were administered treatment within 48 hours of admission (as-treated; 61.2% of planned recruitment) and monitored. The mean age of as-treated patients was 54.0 ± 17.2 years (56.9% male, 77.2% white). After interim analysis suggested a low conditional power for outcome difference (predictive power 0.12), the trial was halted. For as-treated patients, no significant difference in hospital LOS (10.4 ± 14.5 days vs 9.1 ± 7.9 days, p = 0.4; mean difference 1.3, 95% CI −1.5 to 4.1) or ICU LOS (5.8 ± 7.5 days vs 5.4 ± 6.4 days, p = 0.4; mean difference 0.4, 95% CI −1.3 to 2.1) was seen between vitamin D3 and placebo groups, respectively. Vitamin D3 supplementation significantly improved repeat serum levels compared with placebo (20.8 ± 9.3 ng/ml vs 12.8 ± 4.8 ng/ml, p < 0.001) without adverse side effects. No subgroups were identified by exclusion of LOS outliers or segregation by GCS score, SAPS II, or severe vitamin D deficiency (≤ 10 ng/ml).CONCLUSIONSDespite studies showing that vitamin D can predict prognosis, supplementation in vitamin D–deficient neurocritical care patients did not result in appreciable improvement in outcomes and likely does not play a role in acute clinical recovery.Clinical trial registration no.: NCT02881957 (clinicaltrials.gov)

Genetic and environmental factors and the distribution of multiple sclerosis in Europe

2010 ◽  
Vol 17 (9) ◽  
pp. 1210-1214 ◽  
Author(s):  
A. E. Handel ◽  
L. Handunnetthi ◽  
G. Giovannoni ◽  
G. C. Ebers ◽  
S. V. Ramagopalan
Keyword(s):  
Multiple Sclerosis ◽  
Environmental Factors ◽  
Genetic And Environmental Factors

scholarly journals What Can We Learn from Sex Differences in MS?

2021 ◽  
Vol 11 (10) ◽  
pp. 1006
Author(s):  
Patricia K. Coyle
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Young Adults ◽  
Sex Differences ◽  
Central Nervous System Disease ◽  
Nervous System Disease ◽  
System Disease ◽  
The Impact

Multiple sclerosis (MS) is the major acquired central nervous system disease of young adults. It is a female predominant disease. Multiple aspects of MS are influenced by sex-based differences. This has become an important area of research and study. It teaches us how the impact of sex on a disease can lead to new insights, guidelines, management, and treatments.

The Epidemiology of Multiple Sclerosis: An Historical Perspective

2017 ◽  
Author(s):  
Kassandra L. Munger
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Environmental Factors ◽  
Sex Ratio ◽  
Cigarette Smoking ◽  
Historical Perspective ◽  
Current Evidence ◽  
Descriptive Epidemiology ◽  
Ebv Infection ◽  
Over Time

The descriptive epidemiology has proved to be dynamic with attenuation of the latitude gradient, increase in incidence among women, and changes in the sex ratio over time, indicating that recent changes in environmental factors are responsible. Although we still do not know the causes of MS, or how to prevent it, the current evidence supports causal roles for EBV infection, vitamin D, and cigarette smoking.

Sharp increase in the incidence and prevalence of multiple sclerosis in Isfahan, Iran

2011 ◽  
Vol 17 (8) ◽  
pp. 1022-1027 ◽  
Author(s):  
Masoud Etemadifar ◽  
Amir-Hadi Maghzi
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Environmental Factors ◽  
Sex Ratio ◽  
Vitamin D Deficiency ◽  
Sharp Increase ◽  
Isfahan Province ◽  
Study Population ◽  
Male Sex ◽  
Prevalence Figure

Background: The epidemiology of multiple sclerosis (MS) has changed in recent decades. Objectives: This study aimed to give an update on the prevalence and incidence of MS in Isfahan, Iran. Methods: The study population was all residents of Isfahan province during the period from April 2003 to July 2010. In April 2003, a registry of MS patients was created at the Isfahan MS Society (IMSS), which is the only referral center for MS patients in the province. Nearly all MS patients in Isfahan province are now registered with IMSS and were included in the analysis. Results: Among the 3522 registered patients, 2716 were female and 806 were male (sex ratio: 3.37 : 1), and 431 were diagnosed in 2009. This results in a prevalence figure of 73.3 (95% CI: 70.9–75.8) and an incidence of 9.1 (95% CI: 8.3–10.0) per 100,000. Conclusion: The reported prevalence and incidence figures in our study were higher than in our previous report of 2007, in which the prevalence and incidence of MS were reported to be 43.8 and 3.64 per 100,000, respectively. This dramatic increase in the prevalence of MS puts Isfahan amongst the regions with the highest prevalence of MS in Asia and Oceania and is mostly due to changing environmental factors, amongst which vitamin D deficiency seems an important factor in our population.

scholarly journals Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Tim Sinnecker ◽  
Jalal Othman ◽  
Marc Kühl ◽  
Imke Metz ◽  
Thoralf Niendorf ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Milky Way ◽  
Jc Virus ◽  
Brain Biopsy ◽  
Central Nervous System Disease ◽  
Mri Findings ◽  
Diagnostic Biomarkers ◽  
System Disease ◽  
Inflammatory Syndrome

Background. Natalizumab- (NTZ-) associated progressive multifocal leukoencephalopathy (PML) is a severe and often disabling infectious central nervous system disease that can become evident in multiple sclerosis (MS) patients after NTZ discontinuation. Recently, novel diagnostic biomarkers for the assessment of PML risk in NTZ treated MS patients such as the anti-JC virus antibody index have been reported, and the clinical relevance of milky-way lesions detectable by MRI has been discussed. Case Presentation and Conclusion. We report a MS patient in whom PML was highly suspected solely based on MRI findings after switching from NTZ to fingolimod despite repeatedly negative (ultrasensitive) polymerase chain reaction (PCR) testing for JC virus DNA in cerebrospinal fluid. The PML diagnosis was histopathologically confirmed by brain biopsy. The occurrence of an immune reconstitution inflammatory syndrome (IRIS) during fingolimod therapy, elevated measures of JCV antibody indices, and the relevance of milky-way-like lesions detectable by (7 T) MRI are discussed.

Genetic and environmental determinants of 25-hydroxyvitamin D levels in multiple sclerosis

2014 ◽  
Vol 21 (11) ◽  
pp. 1414-1422 ◽  
Author(s):  
Julie H Laursen ◽  
Helle Bach Søndergaard ◽  
Anders Albrechtsen ◽  
Ruth Frikke-Schmidt ◽  
Nils Koch-Henriksen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Environmental Factors ◽  
Association Studies ◽  
Genome Wide Association Studies ◽  
Protective Effects ◽  
Allelic Discrimination ◽  
Vitamin D Metabolism ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Background: Evidence is accumulating supporting a beneficial effect of vitamin D in multiple sclerosis (MS). Genome-wide association studies (GWAS) have shown significant associations between 25-hydroxyvitamin D (25(OH)D) and single nucleotide polymorphisms (SNPs) in key genes in the vitamin D metabolism. Objective: To examine the association between 25(OH)D and six GWAS SNPs and environmental factors in 1497 MS patients. Methods: Blood samples and lifestyle questionnaires were collected between 2009 and 2012. Genotyping of GC-, CYP2R1- and NADSYN1-SNPs was performed by TaqMan allelic discrimination (Life Technologies). Results: We found significant associations between 25(OH)D and SNPs in GC (rs7041, p = 0.01 and rs2282679, p = 0.03) and CYP2R1 (rs10741657, p =1.8 × 10−4). Season of blood sampling (p = 2.8 × 10−31), sex ( p = 1.9 × 10−5), BMI ( p = 2.3 × 10−5), vitamin supplements ( p = 7.0 × 10−22), and fish intake ( p = 0.02) also had significant effects on 25(OH)D. Conclusion: In this cross-sectional study, we found significant effects of environmental factors and SNPs in GC and CYP2R1 on 25(OH)D in MS patients. Since 25(OH)D might have protective effects in MS, and vitamin D supply is a modifiable factor, it may be important to include this in the MS treatment regimen.

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