Seasonal characteristics of debut of illness and complications in relapsing-remitting multiple sclerosis

doi:10.26565/2312-5675-2022-19-04

Olga V. Somilo Dnipro State Medical University http://orcid.org/0000-0003-4429-8884
Natalia P. Shastun Dnipro State Medical University http://orcid.org/0000-0002-5206-2065

DOI: https://doi.org/10.26565/2312-5675-2022-19-04

Keywords: multiple sclerosis, exacerbations, disease-modifying therapy, debut, complications

Abstract

Relapsing-remitting multiple sclerosis (RRMS) is the most common demyelinating disease characterized by periods of disease
exacerbation followed by partial or complete remission. Environmental risk factors in the occurrence of MS are widely studied. However,
temporal, especially seasonal, fluctuations of multiple sclerosis (MS) and its relapses require clarification.
The aim of the study was to assess the impact of seasonal factors on the debut of the disease and complications of RRMS.
105 patients diagnosed with RRMS, aged 18 to 49 years, were examined, including 74 women (70.5%) and 31 men (29.5%). Patients
underwent comprehensive clinical-anamnestic and neurological examinations. It was found that the debut of the disease in the majority
of examined patients occurred in the spring months, and there was also an associative connection between the month of diagnosis
establishment and the number of exacerbations in the past year. The highest number of exacerbations throughout the year was observed
among patients diagnosed with MS in the spring months.
It was confirmed that the lowest frequency of exacerbations throughout the year was observed among patients receiving diseasemodifying therapy (DMT), while in patients without DMT, the indicator was the highest and exceeded (p<0.001) the indicator among
patients receiving DMT by 72.5%.
It was also established that the level of comorbid pathology in the group of patients not receiving DMT was higher compared to those
examined who received therapy by 2.4 times (p<0.001). Correlation analysis showed that the number of comorbidities correlated with the
season of the last exacerbation, the number of exacerbations in the past year (p<0.001), the number of symptoms of MS debut (p<0.001),
and the use of DMT (p<0.001).

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References

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Damasceno A., Von Glehn F., de Deus-Silva L., Damasceno B.P. (2012) Monthly variation of multiple sclerosis activity in the southern hemisphere: analysis from 996 relapses in Brazil. Eur. J. Neurol., 19(4): 660–662.

Hartl C., Obermeier V., Gerdes L.A. et al. (2017) Seasonal variations of 25-OH vitamin D serum levels are associated with clinical disease activity in multiple sclerosis patients. J. Neurol. Sci., 375: 160–164.

Lakin L., Davis B.E., Binns C.C. et al. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms – A Narrative Review. Neurol Ther. 2021. No. 10, pp. 75–98. https://www.doi.org/10.1007/s40120-021-00239-2

Brochet B., Ruet A. Cognitive Impairment in Multiple Sclerosis With Regards to Disease Duration and Clinical Phenotypes. Front Neurol. 2019. No. 20(10), p. 261. https://www.doi.org/10.3389/fneur.2019.00261

Kobelt, G., Thompson, A., Berg, J., Gannedahl, M., & Eriksson, J. New insights into the burden and costs of multiple sclerosis in Europe. Multiple Sclerosis Journal. 2017, vol. 23, no. 8, pp. 1123–1136. DOI: 10.1177/1352458517694432

Elshebawy, H., Fahmy, E.M., Elfayoumy, N.M. et al. Clinical predictors to cognitive impairment in multiple sclerosis patients. Egypt J Neurol Psychiatry Neurosurg. 2021. No. 57, p. 38. https://doi.org/10.1186/s41983-021-00292-6

Bass, A. D., Van Wijmeersch, B., Mayer, L., Mäurer, M., Boster, A., Mandel, M., Mitchell, C., Sharrock, K., & Singer, B. Effect of Multiple Sclerosis on Daily Activities, Emotional Well-being, and Relationships: The Global vs MS Survey. International journal of MS care. 2020. No. 22(4), pp. 158–164. https://www.doi.org/10.7224/1537- 2073.2018-087

Walton V., King R., Rechtman L., Kaye W., Leray E., Marrie R.A., Robertson N., La Rocca N., Uitdehaag B., van der Mei I., Wallin M., Helme A., Napier C.A., Rijke N., Baneke P. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Multiple Sclerosis Journal. 2020. No. 14, pp. 1816-1821. https:// www.doi.org/10.1177/1352458520970841

Thompson A.J., Banwell B.L., Barkhof F., Carroll W.M., Coetzee T., Comi G., Correale J., Fazekas F., Filippi M., Freedman M.S., Fujihara K., Galetta S.L., Hartung H.P., Kappos L., Lublin F.D., Marrie R.A., Miller A.E., Miller D.H., Montalban X., Mowry E.M., Sorensen P.S., Tintoré M., Traboulsee L., Trojano M., Uitdehaag B.M.J., Vukusic S., Waubant E., Weinshenker B.G., Reingold S.C., Cohen J.A. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology. 2018. No. 17, pp. 162-173. https://doi.org/10.1016/S1474-4422(17)30470-2

Salvi F., Bartolomei I., Smolensky M.H. et al. (2010) A seasonal periodicity in relapses of multiple sclerosis? A single-center, population-based, preliminary study conducted in Bologna, Italy. BMC Neurol., 10: 105.