Multiple sclerosisTreatment

  • There is some evidence to suggest that patients with higher levels of vitamin D have less severe multiple sclerosis.
  • More research is needed in this area.

Low circulating levels of vitamin D have been found in MS patients, especially during relapses, suggesting that vitamin D could be involved in the regulation of the clinical disease activity1

One paper reported greater frequency of exacerbations during instances of upper respiratory tract infection2.  As vitamin D reduces the risk of such infections, this is indirect evidence for a role of vitamin D. 

Several papers reported that severity of lesions were lower in summer than winter34

A study in The Netherlands found that in women for every 10 nmol/L increase of serum 25(OH)D level the odds of MS was reduced by 19% (OR 0.81; 95% CI: 0.69-0.95), suggesting a “protective” effect of higher 25(OH)D serum levels.

In addition, also restricted to women, a negative correlation was found between Expanded Disability Status Scale (EDSS) and 25(OH)D levels (r = -0.29, P = 0.020)56.  Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis: every 10 ng/ml (25 nmol/L) increase in the adjusted 25(OH)D level was associated with a 34% decrease in the rate of subsequent relapses7

A randomized controlled trial in Toronto with MS patients [49 patients (25 treatment, 24 control)] were enrolled [mean age 40.5 years, EDSS 1.34, and 25(OH)D 78 nmol/L] and treated with 10,000 IU/day of vitamin D for a year, with no adverse effects.  However, there were too few people in the study and they may have started with 25(OH)D levels too high to adequately assess changes in clinical disease measures (relapses and Expanded Disability Status Scale scores)8

In a recent review9, it was noted that seasonal variations in disease severity could be due to increased frequency of viral infections in winter rather than a direct beneficial effect of vitamin D.  Thus, more research may be required to determine whether treatment with vitamin D is beneficial to those with MS.

Page last edited: 05 May 2011

References

  1. Sioka, C. Kyritsis, A. P. Fotopoulos, A. Multiple sclerosis, osteoporosis, and vitamin D. J Neurol Sci. 2009 Dec 15; 287 (1-2): 1-6.
  2. Panitch, H. S. Influence of infection on exacerbations of multiple sclerosis. Ann Neurol. 1994; 36 SupplS25-8.
  3. Auer, D. P. Schumann, E. M. Kumpfel, T. Gossl, C. Trenkwalder, C. Seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol. 2000 Feb; 47 (2): 276-7.
  4. Embry, A. F. Snowdon, L. R. Vieth, R. Vitamin D and seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol. 2000 Aug; 48 (2): 271-2.
  5. Kragt, J. van Amerongen, B. Killestein, J. Dijkstra, C. Uitdehaag, B. Polman, Ch Lips, P. Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women. Mult Scler. 2009 Jan; 15 (1): 9-15.
  6. Kragt, J. van Amerongen, B. Killestein, J. Dijkstra, C. Uitdehaag, B. Polman, Ch Lips, P. Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women. Mult Scler. 2009 Jan; 15 (1): 9-15.
  7. Mowry, E. M. Krupp, L. B. Milazzo, M. Chabas, D. Strober, J. B. Belman, A. L. McDonald, J. C. Oksenberg, J. R. Bacchetti, P. Waubant, E. Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann Neurol. 2010 May; 67 (5): 618-24.
  8. Burton, J. M. Kimball, S. Vieth, R. Bar-Or, A. Dosch, H. M. Cheung, R. Gagne, D. D’Souza, C. Ursell, M. O’Connor, P. A phase I/II dose-escalation trial of vitamin D3 and calcium in multiple sclerosis. Neurology. 2010 Jun 8; 74 (23): 1852-9.
  9. Ascherio, A. Munger, K. L. Simon, K. C. Vitamin D and multiple sclerosis. Lancet Neurol. 2010 Jun; 9 (6): 599-612.