Migraine and frequent tension-type headache are not associated with multiple sclerosis in a Norwegian case-control study.

BACKGROUND: Inconsistent results have been obtained with regard to headache comorbidity in multiple sclerosis (MS). OBJECTIVE: Investigate the one-year prevalence of migraine and tension-type headache (TTH) in Norwegian MS patients and relate this to clinical parameters. METHODS: A questionnaire concerning headache was administered to 756 MS patients and 1090 controls and used to determine the one-year prevalence of migraine and frequent TTH. RESULTS: No significant differences were seen between patients and controls or between patients with different disease course. Less migraine was observed in patients with Expanded Disability Status Scale score (EDSS) ≥4.0. CONCLUSIONS: This case-control study does not support an association between migraine or TTH and MS.

No association between multiple sclerosis and periodontitis after adjusting for smoking habits.

BACKGROUND AND PURPOSE: Periodontitis has been reported to be associated with several systemic disorders, and recently a possible relationship with multiple sclerosis (MS) was suggested. The aim of the present study was to investigate the association between periodontitis and MS in a Norwegian cohort. METHODS: A case-control study in 756 MS patients and 1090 controls was conducted, and logistic regression analysis, adjusting for age, gender, place of residence, mononucleosis and smoking, was performed to investigate the association between MS and periodontitis. RESULTS: In the unadjusted analysis a higher prevalence of periodontitis was seen in MS patients, but this difference was not statistically significant after adjusting for the covariates. CONCLUSIONS: The previously suggested association between MS and periodontitis is not supported in this study. Our results underline the importance of adjusting for relevant covariates in epidemiological research.

High prevalence and no latitude gradient of multiple sclerosis in Norway.

The prevalence of multiple sclerosis (MS) is increasing, and the presence of a latitude gradient for MS risk is still discussed. We present the first nationwide prevalence estimates for Norway, spanning the latitudes from 58-71 degrees North, in order to identify a possible latitude gradient. Information from the Oslo MS Registry and the Norwegian MS Registry and Biobank was combined with data from the Norwegian Patient Registry, the Norwegian Prescription Database and Statistics Norway. We estimated a crude prevalence of 203/100,000 on 1 January 2012. The prevalence in the Northern and Southern regions were not significantly different. MS prevalence in Norway is among the highest reported worldwide. We found no evidence of a latitude gradient.

Intrathecal levels of vitamin D and IgG in multiple sclerosis.

BACKGROUND: Intrathecal synthesis of IgG is a hallmark of multiple sclerosis (MS). Vitamin D may modulate B-cell function and dampen the synthesis of IgG. OBJECTIVE: To investigate the relation between vitamin D levels in cerebrospinal fluid and serum and intrathecal synthesis of IgG. METHODS: 25-hydroxyvitamin D (25(OH)D) and IgG were assessed in cerebrospinal fluid and serum in 40 patients with MS. RESULTS: There was no significant correlation between the IgG index and 25(OH)D levels in cerebrospinal fluid or serum. The levels of 25(OH)D in cerebrospinal fluid and serum did not differ between patients with and without intrathecal synthesis of IgG. There was a non-significant trend towards a positive correlation between the concentrations of 25(OH)D and IgG in the cerebrospinal fluid, but not in serum. CONCLUSION: Physiological variation in vitamin D does not exert a major impact on intrathecal synthesis of IgG in MS.

Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome.

OBJECTIVE: Osteoporosis is common in patients with multiple sclerosis (MS) with long-standing disease. Hypovitaminosis D is a candidate risk factor for MS, and vitamin D also mediates bone mineralization. If vitamin D exerts a major effect on MS risk, skeletal consequences of hypovitaminosis D could be apparent shortly after the onset of MS. In order to test this hypothesis, we assessed bone mineral density (BMD) at early stages of disease in patients with no or minor disability. METHODS: A population-based case-control study was conducted on 99 consecutive and newly diagnosed patients with clinically isolated syndrome or MS, and on 159 age-, sex-, and ethnicity-matched controls. BMD was measured by dual-energy x-ray absorptiometry of the femoral neck, total hip, anterior-posterior lumbar spine, total body, and nondominant ultradistal radius. RESULTS: A total of 50.5% of the patients exhibited either osteopenia (-2.5 < T score < -1.0) or osteoporosis (T score ≤-2.5) in at least one skeletal site, compared to 37.1% of controls (p = 0.034). After adjusting for possible confounders, left femoral total hip T score and lumbar spine BMD and T score were significantly lower in patients than in controls (p = 0.023, 0.039, and 0.026, respectively). CONCLUSIONS: Low bone mass appears to occur early in MS. This is compatible with shared etiologic or pathogenic factors in MS and osteoporosis, and calls for an active approach to optimize bone health in early stages of MS.

Fractures and falls in patients with newly diagnosed clinically isolated syndrome and multiple sclerosis.

BACKGROUND: Increased risk of falls and reduced bone strength may both contribute to enhanced fracture risk in patients with multiple sclerosis (MS). Fall tendency and fractures have not been investigated in newly diagnosed patients. OBJECTIVES: The aim was to compare the fall tendency and fracture risk in a cohort of newly diagnosed clinically isolated syndrome (CIS) and MS patients with that in the general population. METHODS: We performed a population-based case-control study in Oslo of self-reported fall tendency and fracture history in consecutive patients diagnosed with either a CIS suggestive of demyelinating disease or MS between January 2005 and January 2008. Two age-, sex-, and ethnicity-matched control groups were included; one group from the population registry and one group recruited by the patients. RESULTS: Ninety-nine patients (mean time since the first symptom 1.6 ± 1.3 years, mean expanded disability status scale [EDSS] score 1.4 ± 1.1) and 159 controls were included. Whereas no difference in the number of fractures was reported, 20% of the patients and 3% of the controls reported a tendency to fall (P<0.001). Fall tendency was associated with degree of disability (mean EDSS score among patients with and without self-reported fall tendency was 2.4 ± 1.4 and 1.1 ± 0.9, respectively; P=0.001). Fall tendency was also reported in two of 22 patients with EDSS 0. CONCLUSIONS: Fall tendency may occur early in the disease course of MS, before impairment of locomotion and balance becomes evident on clinical examination.

Assessing vitamin D in the central nervous system.

Epidemiological and experimental evidence suggest that vitamin D deficiency is a risk factor for multiple sclerosis and other autoimmune diseases. The activated form of vitamin D exerts several immunomodulating properties in vitro and in vivo, that could contribute to explain the association with multiple sclerosis. Hypovitaminosis D is also associated with several other neurological diseases that is less likely mediated by dysregulated immune responses, including Parkinson's disease and Alzheimer's disease, schizophrenia and affective disorders, suggesting a more diverse role for vitamin D in the maintenance of brain health. Accordingly, both the vitamin D receptor and the enzymes necessary to synthesize bioactive 1,25-dihydroxyvitamin D are expressed in the brain, and hypovitaminosis D is associated with abnormal development and function of the brain. We here review current knowledge on the intrathecal vitamin D homeostasis in heath and disease, highlighting the need to assess vitamin D in the intrathecal compartment.

Lumbar bone mineral density in adolescent female runners.

BACKGROUND: The purpose of this study was to determine if there were significant differences in lumbar bone mineral density (L2-L4, g/cm2) or several hormones among 3 groups of adolescent females: 10 amenorrheic runners, 10 eumenorrheic runners, and 10 eumenorrheic controls. EXPERIMENTAL DESIGN: comparative. SETTING: Cooper Clinic, Aerobics Center, Dallas, Texas. PATIENTS OR PARTICIPANTS: The subjects were white, non-smokers, aged 15.1-18.8 years, who were not taking birth control pills. All amenorrheic runners had less than 5 menstrual period in the past year, averaging 2,4 periods. The runners averaged approximately 36 miles/week (58.1 km) during the last 9 months of their training season and had been running for 1-5 years. INTERVENTIONS: None. MEASURES: Lumbar bone mineral density (BMD), 10 hormones, percentage of body fat, and dietary intake were measured. RESULTS: Mean lumbar BMD (g/cm2) did not differ significantly among groups (amenorrheic runners = 1.134, eumenorrheic runners = 1.165, controls = 1.148). However, expected trends were observed. Compared to the controls, the amenorrheic runners tended to have lower lumbar BMD and the eumenorrheic runners, higher. Although there were significant differences in concentrations of five serum hormones measured, all mean hormonal values were within normal ranges. Calcium intakes were low for all groups. CONCLUSIONS: In this study, with its small number of subjects and great variability within each group, it was concluded that there is no significant difference among amenorrheic runners, eumenorrheic runners, and controls in lumbar BMD. However, a longer period of amenorrhea might result in significantly lower BMD for the amenorrheic runners.

Right and left proximal femur analyses: is there a need to do both?

The purpose of this study was to determine if differences existed between right and left proximal femur bone mineral density (BMD) in a group of women. Participants for the study were 198 women ranging in age from 16 to 73 years. Bone mineral densities of both proximal femurs (femoral neck, Ward's area, and trochanter) were assessed using dual energy X-ray absorptiometry (Lunar DPX). Mean (+/-SD) age, height, and weight of the participants were 32.9 +/- 18 years, 164 +/- 7.4 cm, and 64.9 +/- 12.1 kg, respectively. Significant differences between right and left femoral BMDs were found only in the trochanter. Overall, mean differences in BMD were low (neck = 0. 7%, Ward's = 0.2%, and trochanter = 1.9%) but individual variations were as high as 22%. Based on BMD z-scores of <-1.0, 84 women were classified as "at risk" for osteoporosis. When right and left z-scores were compared, misclassifications of at risk women were 4, 15, and 11 for neck, Ward's area, and trochanter, respectively. In conclusion, analyses of both right and left proximal femurs may not be necessary for either the researcher or the clinician.