Abstract
Previous papers show discordant patterns of monthly and seasonal differences in the frequency of multiple sclerosis relapses. Attacks are more often reported in spring and summer, but there are many variations, mainly as to summer peaks. This paper, an MSBase collaboration substudy, reports multiple series of relapses from 1980 to 2010, comparing ultradecennal trends of seasonal frequency of attacks in different countries. The MSBase international database was searched for relapses in series recording patient histories from 1980 up to 2010. The number of relapses by month was stratified by decade (1981–1990, 1991–2000, 2001–2010). Positive spring versus summer peaks were compared by odds ratios; different series were compared by weighted odds ratio (Peto OR). Decade comparison of the 1990s versus 2000s shows inversion of spring–summer peak (2000s = March; 1990s = July), significant in the whole group (Peto odds ratio = 1.31, CI = 1.10–1.56, p = 0.003) and in Salerno series (OR = 1.97, CI = 1.14–1.40). The global significance persisted also excluding Salerno series (Peto odds ratio = 1.25, CI = 1.04–1.50, p = 0.002). Multicentric data confirm a summer peak of relapses in the 1991–2000 decade, significantly different from the spring peak of 2001–2010. Seasonal frequency of relapses shows long-term variations, so that other factors such as viral epidemics might have more relevance than ultraviolet exposure.
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Jin YP, de Pedro-Cuesta J, Soderstrom M, Link H (1999) Incidence of optic neuritis in Stockholm, Sweden, 1990–1995: II. Time and space patterns. Arch Neurol 56(8):975–980
Salvi F, Bartolomei I, Smolensky MH, Lorusso A, Barbarossa E, Malagoni AM, Zamboni P, Manfredini R (2010) A seasonal periodicity in relapses of multiple sclerosis? A single-center, population-based, preliminary study conducted in Bologna, Italy. BMC Neurol 1(10):105
Jin Y, de Pedro-Cuesta J, Soderstrom M, Stawiarz L, Link H (2000) Seasonal patterns in optic neuritis and multiple sclerosis: a meta-analysis. J Neurol Sci 181(1–2):56–64
Bamford CR, Sibley WA, Thies C (1983) Seasonal variation of multiple sclerosis exacerbations in Arizona. Neurology 33(6):697–701
Goodkin DE, Hertsgaard D (1989) Seasonal variation of multiple sclerosis exacerbations in North Dakota. Arch Neurol 46(9):1015–1018
Abella-Corral J, Prieto JM, Dapena-Bolaño D, Iglesias-Gómez S, Noya-García M, Lema M (2005) Seasonal variations in the outbreaks in patients with multiple sclerosis. Rev Neurol 40(7):394–396
Bisgård C (1990) Seasonal variation in disseminated sclerosis. Ugeskr Laeger 152(16):1160–1161
Ogawa G, Mochizuki H, Kanzaki M, Kaida K, Motoyoshi K, Kamakura K (2004) Seasonal variation of multiple sclerosis exacerbations in Japan. Neurol Sci 24(6):417–419
Iuliano G, Napoletano R, Esposito A (2005) Seasonal differences in the frequency of relapse in multiple sclerosis. (article in italian, abstract in english) Riv. It. Neurobiologia II(4):209–212
Tremlett H, van der Mei IA, Pittas F, Blizzard L, Paley G, Mesaros D, Woodbaker R, Nunez M, Dwyer T, Taylor BV, Ponsonby AL (2008) Monthly ambient sunlight, infections and relapse rates in multiple sclerosis. Neuroepidemiology 31(4):271–279 (published online first: 30 October 2008)
Koziol JA, Feng AC (2004) Seasonal variations in exacerbations and MRI parameters in relapsing-remitting multiple sclerosis. Neuroepidemiology 23(5):217–223
Fonseca AC, Costa J, Cordeiro C, Geraldes R, de Sá J (2009) Influence of climatic factors in the incidence of multiple sclerosis relapses in a Portuguese population. Eur J Neurol 16:537–539. doi:10.1111/j.1468-1331.2008.02528.x (Published online first: Jan 27)
Saaroni H, Sigal A, Lejbkowicz I, Miller A (2010) Mediterranean weather conditions and exacerbations of multiple sclerosis. Neuroepidemiology 35(2):142–151 Epub 2010 Jun 23
O’Reilly MA, O’Reilly PM (1991) Temporal influences on relapses of multiple sclerosis. Eur Neurol 31(6):391–395
Mealy MA, Newsome S, Greenberg BM, Wingerchuk D, Calabresi P, Levy M (2011) Low serum vitamin D levels and recurrent inflammatory spinal cord disease. Arch Neurol Nov 14. [Epub ahead of print]
Simpson S Jr, Taylor B, Blizzard L, Ponsonby AL, Pittas F, Tremlett H, Dwyer T, Gies P, van der Mei I (2010) Higher 25-hydroxyvitamin D is associated with lower relapse risk in multiple sclerosis. Ann Neurol 68(2):193–203
Van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, Butzkueven H, McMichael AJ (2007) Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol 254(5):581–590 (published online first: 11 April 2007)
Davis GE Jr, Lowell WE (2006) Solar cycles and their relationship to human disease and adaptability. Med Hypotheses 67(3):447–461 (published online first: 15 May 2006)
Freedman DM, Dosemeci M, Alavanja MC (2000) Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates. Occup Environ Med 57(6):418–421
McMichael AJ, Hall AJ (1997) Does immunosuppressive ultraviolet radiation explain the latitude gradient for multiple sclerosis? Epidemiology 8(6):642–645
Hutter CD, Laing P (1996) Multiple sclerosis: sunlight, diet, immunology and aetiology. Med Hypotheses 46(2):67–74
Hutter C (1993) On the causes of multiple sclerosis. Med Hypotheses 41(2):93–96
Lauer K (1994) The risk of multiple sclerosis in the USA in relation to sociogeographic features: a factor-analytic study. J Clin Epidemiol 47(1):43–48
Gray OM, Jolley D, Zwanikken C, Trojano M, Grand-Maison F, Duquette P et al (2009) Temporal variation of onset of relapses in multiple sclerosis: results from the Northern and Southern Hemispheres in the Msbase registry (abstract). Neurology 72(suppl 3):8–27
O. Gray, D. Jolley, K. Gibson, M. Trojano, C. Zwanikken, F. Grand’Maison, P. Duquette, G. Izquierdo, P. et al (2009) Onset of relapses in multiple sclerosis: the effect of seasonal change in both the northern and southern hemisphere (abstract). Multiple Sclerosis 15 (suppl 2): p532, s158
Meier DS, Balashov KE, Healy B, Weiner HL, Guttmann CRG (2010) Seasonal prevalence of MS disease activity. Neurology 75:799–806
Iuliano G (2011) Multiple sclerosis: long time modifications of seasonal differences in the frequency of clinical attacks. Neurol Sci 33(5):999–1003. doi:10.1007/s10072-011-0873-0
Butzkueven H, Boz C, Chapman J et al (2010) MSBase, an international platform dedicated to linking multiple sclerosis researchers—observational plan, 6th edition. The MSBase Foundation Ltd, Parkville
Polman CH, Reingold SC, Edan C et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria”. Ann Neurol 58(6):840–846
Conflicts of interest
Gerardo Iuliano has had travel/accommodation/meeting expenses funded by Bayer Schering, Sanofi Aventis, Merck Serono, Novartis, and Biogen Idec, Cavit Boz, Edgardo Cristiano, and Pierre Duquette declare no conflicts of interest. Alessandra Lugaresi has received honoraria or grants from Bayer Schering, Biogen Idec, Merck Serono, Sanofi Aventis, Novartis, and Teva. Dr. Oreja-Guevara has participated in clinical trials and other research projects promoted by Biogen Idec, GSK, Merck-Serono, Teva, and Novartis. Vincent Van Pesch has received compensation for serving on an advisory board for Biogen Idec (2010–11), travel/accommodations/meeting expenses funded by Bayer Schering, Sanofi Aventis, Merck Serono, Novartis, and Biogen Idec, and honoraria for speaking engagement funded by Biogen Idec (2011).
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Iuliano, G., Boz, C., Cristiano, E. et al. Historical changes of seasonal differences in the frequency of multiple sclerosis clinical attacks: a multicenter study. J Neurol 260, 1258–1262 (2013). https://doi.org/10.1007/s00415-012-6785-y
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DOI: https://doi.org/10.1007/s00415-012-6785-y