Document Type : Original Article
Authors
- Ehsan Sharifipour 1
- Mohamad Hussein Assi 2
- Sama Aghamohamadpour 3
- Mostafa Vahedian 4
- Mohamad Hussein Atarod 5
- Zeinab Alshavi 6
1 Department of Neurology, School of Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Neurology, School of Medicine, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
3 Department of Neurology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
4 Department of Family and Community Medicine, School of Medicine, Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
5 Student Research Committee, School of Medicine, Qom University of Medical Sciences, Qom, Iran
6 Department of Neurology, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
Abstract
Background: Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (CNS). Environmental factors such as seasonal changes and air pollution play a significant role in the progression and relapse of this disease. This study aimed to investigate the impact of seasonal changes and air pollution on the frequency and severity of MS attacks in patients from Qom province.
Methods: This cross-sectional analytical study included 491 patients with relapsing-remitting MS (RRMS) registered with the MS Association of Qom province from 2016 to 2021. Data on temperature, humidity, and air pollutants (PM2.5, PM10, and O3) were collected from the Meteorological Organization and the Environmental Protection Agency of Qom province. Missing data were estimated using the Multiple Imputation method. Data were analyzed using the Generalized Additive Model (GAM) and R software.
Results: The mean number of relapses was 0.68 ± 5.21. The results showed that increased temperature was directly correlated with a higher number of relapses (r = 0.46, P < 0.001), while increased relative humidity was associated with a decrease in relapses (r = -0.35, P = 0.006). Additionally, PM10 and PM2.5 pollutants were directly related to an increase in relapses. Comorbid autoimmune diseases and family history of MS were also significantly associated with the number of relapses (P = 0.000).
Conclusion: This study emphasizes the complexity of relationships between environmental factors, demographic characteristics, and the onset of MS relapses, underscoring the need for integrated strategies in managing MS patients.
Keywords
Main Subjects
- Jeanjean M, Bind MA, Roux J, Ongagna JC, de Sèze J, Bard D, et al. Ozone, NO2 and PM10 are associated with the occurrence of multiple sclerosis relapses. Evidence from seasonal multi-pollutant analyses. Environ Res. 2018;163:43- 52. doi: 10.1016/j.envres.2018.01.040.
- Farez MF, Mascanfroni ID, Méndez-Huergo SP, Yeste A, Murugaiyan G, Garo LP, et al. Melatonin contributes to the seasonality of multiple sclerosis relapses. Cell. 2015;162(6):1338-52. doi: 10.1016/j.cell.2015.08.025.
- World Health Organization (WHO). Atlas: Multiple Sclerosis Resources in the World 2008. Geneva: WHO; 2008.
- Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, et al. Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology. 2014;83(11):1022-4. doi: 10.1212/wnl.0000000000000768.
- Sahebi R, Amiri M, Jami MS. Multiple sclerosis in Iran. Int J Epidemiol Res. 2018;5(1):30-3. doi: 10.15171/ijer.2018.07.
- Simpson S Jr, der Mei IV, Taylor B. The role of vitamin D in multiple sclerosis: biology and biochemistry, epidemiology and potential roles in treatment. Med Chem. 2018;14(2):129- 43. doi: 10.2174/1573406413666170921143600.
- Serafini B, Zandee S, Rosicarelli B, Scorsi E, Veroni C, Larochelle C, et al. Epstein-Barr virus-associated immune reconstitution inflammatory syndrome as possible cause of fulminant multiple sclerosis relapse after natalizumab interruption. J Neuroimmunol. 2018;319:9-12. doi: 10.1016/j. jneuroim.2018.03.011.
- Alonso R, Fernández-Fernández AM, Pisa D, Carrasco L. Multiple sclerosis and mixed microbial infections. Direct identification of fungi and bacteria in nervous tissue. Neurobiol Dis. 2018;117:42-61. doi: 10.1016/j.nbd.2018.05.022.
- Patsopoulos NA. Genetics of multiple sclerosis: an overview and new directions. Cold Spring Harb Perspect Med. 2018;8(7):a028951. doi: 10.1101/cshperspect.a028951.
- Olberg HK, Eide GE, Cox RJ, Jul-Larsen Å, Lartey SL, Vedeler CA, et al. Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy. Eur J Neurol. 2018;25(3):527-34. doi: 10.1111/ene.13537.
- Zhang W, Yi X, An Y, Guo S, Li S, Song P, et al. MicroRNA-17-92 cluster promotes the proliferation and the chemokine production of keratinocytes: implication for the pathogenesis of psoriasis. Cell Death Dis. 2018;9(5):567. doi: 10.1038/ s41419-018-0621-y.
- Wingerchuk DM. Environmental factors in multiple sclerosis: Epstein-Barr virus, vitamin D, and cigarette smoking. Mt Sinai J Med. 2011;78(2):221-30. doi: 10.1002/msj.20240.
- Sibley WA, Bamford CR, Clark K. Clinical viral infections and multiple sclerosis. Lancet. 1985;1(8441):1313-5. doi: 10.1016/s0140-6736(85)92801-6.
- Blatt NL, Khaiboullin TI, Lombardi VC, Rizvanov AA, Khaiboullina SF. The skin-brain connection hypothesis, bringing together CCL27-mediated T-cell activation in the skin and neural cell damage in the adult brain. Front Immunol. 2016;7:683. doi: 10.3389/fimmu.2016.00683.
- Templer DI, Trent NH, Spencer DA, Trent A, Corgiat MD, Mortensen PB, et al. Season of birth in multiple sclerosis. Acta Neurol Scand 1992;85(2):107-9. doi: 10.1111/j.1600- 0404.1992.tb04007.x.
- Tataru N, Vidal C, Decavel P, Berger E, Rumbach L. Limited impact of the summer heat wave in France (2003) on hospital admissions and relapses for multiple sclerosis. Neuroepidemiology. 2006;27(1):28-32. doi: 10.1159/000094233.
)