Abstract
Multiple sclerosis (MS) is becoming a global subject of study in which some demographic variations are thought to be correlated with its activity. Relapsing-remitting multiple sclerosis (RRMS) is the most common demyelinating disorder, characterized by periods of exacerbating attacks, followed by partial or complete remission. Several factors might play a role in disease progression and relapse frequency, such as vitamin D, ultraviolet B radiation, estrogen levels, smoking, obesity, and unhealthy lifestyles. In this study, we identified the relationship between seasonal variation and relapse rate and correlated the latter with sex, age, and vitamin D levels in patients with RRMS in Jeddah, Saudi Arabia. We retrospectively collected data from 182 RRMS patients between 2016 and 2021. A total of 219 relapses were documented in 106 patients (58.2 %). The relapse per patient ratio showed a sinusoidal pattern, peaking in January at a rate of 0.49 and troughed in June at a rate of 0.18. There was no difference in relapse rates between men and women (p =0.280). There was a significant negative correlation between vitamin D levels and relapse rate (r = −0.312, p =0.024). Therefore, the relapse rate was higher during the winter and was correlated with low vitamin D levels. However, relapses are likely multifactorial, and more population-based studies are needed to understand the role of environmental variables in MS exacerbation. A better understanding of this relationship will allow for improved treatment and possibly better prevention of relapse.
Highlights
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) characterized by autoimmune inflammation and neurodegeneration [1]
This study aimed to evaluate the impact of seasonal variation in different climate variables and vitamin D levels on patients with Relapsing-remitting multiple sclerosis (RRMS) in a tertiary hospital in Jeddah, Saudi Arabia
Because vitamin D analysis were randomly taking between follow ups, each relapse date was linked to the nearest vitamin D analysis date to assess the correlation between vitamin D levels and the relapse rate
Summary
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) characterized by autoimmune inflammation and neurodegeneration [1]. MS is characterized by recurrent episodes of acute inflammation and focal demyelination in the CNS, better known as relapse. Relapse is defined as episodic exacerbation of neurological impairment, which can be both reversible and irreversible [4]. Relapse episodes commonly occur in patients with relapsing-remitting MS, the most common phenotype of MS [4]. A relapse is marked by periods of exacerbations that last for 24 h or more, Seasonal Variation of MS Relapse during which the symptoms typically worsen, followed by periods of remission and resolution of inflammation [5]. It is estimated that the number patients with MS increased from 2.1 million in 2008 to 2.3 million in 2013 worldwide [6]. In Saudi Arabia, the prevalence of MS cases has significantly increased from 25/1,00,000 in 1998 to 40/1,00,000 in 2008 [7, 8]
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