Skip to main content
Log in

Historical changes of seasonal differences in the frequency of multiple sclerosis clinical attacks: a multicenter study

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    Article  PubMed  CAS  Google Scholar 

  4. Bamford CR, Sibley WA, Thies C (1983) Seasonal variation of multiple sclerosis exacerbations in Arizona. Neurology 33(6):697–701

    Article  PubMed  CAS  Google Scholar 

  5. Goodkin DE, Hertsgaard D (1989) Seasonal variation of multiple sclerosis exacerbations in North Dakota. Arch Neurol 46(9):1015–1018

    Article  PubMed  CAS  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  7. Bisgård C (1990) Seasonal variation in disseminated sclerosis. Ugeskr Laeger 152(16):1160–1161

    PubMed  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Google Scholar 

  10. 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)

    Article  PubMed  Google Scholar 

  11. Koziol JA, Feng AC (2004) Seasonal variations in exacerbations and MRI parameters in relapsing-remitting multiple sclerosis. Neuroepidemiology 23(5):217–223

    Article  PubMed  Google Scholar 

  12. 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)

    Article  PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. O’Reilly MA, O’Reilly PM (1991) Temporal influences on relapses of multiple sclerosis. Eur Neurol 31(6):391–395

    Article  PubMed  Google Scholar 

  15. 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]

  16. 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

    PubMed  CAS  Google Scholar 

  17. 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)

    Article  PubMed  Google Scholar 

  18. 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)

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. McMichael AJ, Hall AJ (1997) Does immunosuppressive ultraviolet radiation explain the latitude gradient for multiple sclerosis? Epidemiology 8(6):642–645

    PubMed  CAS  Google Scholar 

  21. Hutter CD, Laing P (1996) Multiple sclerosis: sunlight, diet, immunology and aetiology. Med Hypotheses 46(2):67–74

    Article  PubMed  CAS  Google Scholar 

  22. Hutter C (1993) On the causes of multiple sclerosis. Med Hypotheses 41(2):93–96

    Article  PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. 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

    Google Scholar 

  25. 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

  26. Meier DS, Balashov KE, Healy B, Weiner HL, Guttmann CRG (2010) Seasonal prevalence of MS disease activity. Neurology 75:799–806

    Article  PubMed  CAS  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

  29. 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

    Article  PubMed  Google Scholar 

Download references

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).

Ethical standard

All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerardo Iuliano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-012-6785-y

Keywords

Navigation