Helmut H.Leitner, MD, AUVA Rehabilitation Center Meidling AustriaHelmut.Leitner@auva.at
Submitted December 20, 2011
Stein et al. compared high dose versus low dose Vitamin D2 treatment in multiple sclerosis without benefit in the high-dose treatment group. [1] Sunlight exposure and reduced Vitamin D 3 levels independently contribute to MS risk. The effect of sunlight exposure is supported by decreased signs of actinic skin damage found in MS patients compared to controls. [2] It is difficult to decide which of these two environmental factors is of primary importance as higher levels of sunlight exposure will enhance Vitamin D levels.
The incidence of Vitamin D-related rickets disease decreased in the United States and Europe during the last century following the discovery that vitamin D possessed antirachitic properties, whereas the incidence of MS seems to increase in the same population. In the United States most of the patients affected with rickets are black, whereas the majority of MS patients are European.[3] It seems improbable that the same environmental factor should be centrally involved in the etiology of both diseases, which differ clinically and occur in different populations living in the same geographical area.
These findings together with those of Stein et al. do not provide a reason for Vitamin D supplementation in MS aside from correcting a proven Vitamin D deficiency. Other factors associated with increased sunlight exposure may more effectively prevent MS.
1. Stein MS, Liu Y, Gray OM, Baker JE, Kolbe SC, Ditchfield MR, Egan GF, Mitchell PJ, Harriison LC, Butzkueven H, Kilpatrick TJ. A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis. Neurology 2011; 77:1611-1618.
2. Lucas RM, Ponsonby AL, Dear K, et al. Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology 2011;76:540-548.
3. Nield LS, Mahajan P, Joshi A, Kamat D. Rickets: not a disease of the past. Am Fam Physician 2006;74:619-626.
For disclosures, contact editorial office at journal@neurology.org.
Stein et al. compared high dose versus low dose Vitamin D2 treatment in multiple sclerosis without benefit in the high-dose treatment group. [1] Sunlight exposure and reduced Vitamin D 3 levels independently contribute to MS risk. The effect of sunlight exposure is supported by decreased signs of actinic skin damage found in MS patients compared to controls. [2] It is difficult to decide which of these two environmental factors is of primary importance as higher levels of sunlight exposure will enhance Vitamin D levels.
The incidence of Vitamin D-related rickets disease decreased in the United States and Europe during the last century following the discovery that vitamin D possessed antirachitic properties, whereas the incidence of MS seems to increase in the same population. In the United States most of the patients affected with rickets are black, whereas the majority of MS patients are European.[3] It seems improbable that the same environmental factor should be centrally involved in the etiology of both diseases, which differ clinically and occur in different populations living in the same geographical area. These findings together with those of Stein et al. do not provide a reason for Vitamin D supplementation in MS aside from correcting a proven Vitamin D deficiency. Other factors associated with increased sunlight exposure may more effectively prevent MS. 1. Stein MS, Liu Y, Gray OM, Baker JE, Kolbe SC, Ditchfield MR, Egan GF, Mitchell PJ, Harriison LC, Butzkueven H, Kilpatrick TJ. A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis. Neurology 2011; 77:1611-1618. 2. Lucas RM, Ponsonby AL, Dear K, et al. Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology 2011;76:540-548. 3. Nield LS, Mahajan P, Joshi A, Kamat D. Rickets: not a disease of the past. Am Fam Physician 2006;74:619-626. For disclosures, contact editorial office at journal@neurology.org.