24Jun 2017

A POTENTIAL BENEFICIAL EFFECT OF ULTRAVIOLET PHOTOTHERAPY ON RELAPSING REMITTING MULTIPLE SCLEROSIS.

  • Neurology Department, Faculty of Medicine, Cairo University, Egypt.
  • Neurophysiology unit, Faculty of Medicine, Cairo University, Egypt.
  • Medical biochemistry and molecular biology Department, Faculty of Medicine, Cairo University, Egypt.
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Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. Ultraviolet radiation (UVR) exposure has an influence on immune system regulation. Aim of work: The current study was designed to elicit the effect of ultraviolet B (UVB) phototherapy on the clinical and neurophysiological outcomes in a group of relapsing remitting MS patients. A secondary aim was to clarify if vitamin D had a contributing effect in any expected change in the studied parameters. Patients and methods: In this prospective study, 20 patients with clinically definite relapsing remitting multiple sclerosis underwent UVB phototherapy sessions for one month. Patients were initially assessed clinically and electrophysiologicallybefore and after phototherapy, using the Expanded Disability Status Scale (EDSS), the International Prostate Symptom Score (IPSS), the Brief Ataxia Rating Scale (BARS), Modified Ashworth Scale for grading Spasticity (MAS), visual evoked potential (VEP) and H-reflex. Moreover, serum 25 hydroxy-cholecalcifirol (25(OH) D) levels (pre, post -1 month and post- 3 months UVR therapy sessions) were detected. Results: After UVB phototherapy, the percentage of patients with sensory symptoms, unlike patients with sphincteric complains, reduced significantly (P=0.021). A statistically significant improvement was elicited in EDSS (P=0.01), IPSS (P=0.02) and BARS (P=0.02).Furthermore, the latencies of right sided VEP (P=0.019) and H-reflex (P=0.001) were significantly reduced. Parallel to the documented improvement, follow up serum 25(OH)D levels were significantly increased. Also, a statistically significant inverse correlation between IPSS score (after one month) and the amount of elevation in 25(OH)D was found(P=0.028). Conclusion: There was a beneficial effect of UVB phototherapy on clinical and neurophysiological features of MS patients, in which vitamin D improvement had a considerable contribution.

  1. Bhargava, P., Steele, S.U., Waubant, E., Revirajan, N.R., Marcus, J., Dembele, M. and et al. (2016): Multiple sclerosis patients have a diminished serologic response to vitamin D supplementation compared to healthy controls. MultScler., 22:753?60.
  2. Bohannon, R.W., Smith, M.B. (1997): Inter rater reliability of a modified Ashworth scale of muscle spasticity. PhysTher., 67(2):206-7
  3. Breuer, J., Schwab, N., Schneider-Hohendorf, T., Marziniak, M., Mohan, H., Bhatia, U. and et al. (2014): Ultraviolet B light attenuates the systemic immune response in central nervous system autoimmunity. Ann Neurol., 75:739?58.
  4. Cantorna, M.T., Hayes, C.E. and DeLuca, H.F. (1996): 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. ProcNatlAcadSci U S A., 93(15): 7861?7864.
  5. El‑Ghoneimy ,A.T., Gad, A.H., Samir, H., Shalaby, N.M., Ramzy, G.H., Farghaly, M. and Hegazy, M.I. (2009): Contribution of vitamin D to the pathogenesis of multiple sclerosis and its effect on bone. Egypt J Neurol .PsychiatNeurosurg., 46:209?222.
  6. Esmael, A., El‑Sherifa, M. and Elazzounyb, A.A. (2016): Effects of vitamin D deficiency on the relapse, severity, and disability of multiple sclerosis. Egypt J NeurolPsychiatNeurosurg., 53(3):174?178.
  7. Essa, S.A.,?Mostafa, Y.M.,?Fathi, S.M.,?Elhafez, H.M.,? Ahmed, A.F. and? El Fayoumy, N.M. (2015): Could Phototherapy Reverse Visual Deficits in Patients with Relapsing Remitting Multiple Sclerosis?. JMSCR., 3(5): 5479-5494.
  8. Essa, S.A.?,?Mostafa,M.,?Fathi, S.M.,?Elhafez, H.M.,? Ahmed, A.F. and? El Fayoumy, N.M. (2016): Spasticity is modifiable through phototherapy in patients with relapsing remitting multiple sclerosis: A randomized controlled study. Kasr AL Ainy medical journal., 22(3)?: 81-90.
  9. Goldberg, P. (1974): Multiple sclerosis: vitamin D and calcium as environmental determinants of prevalence. Part 1: sunlight, dietary factors and epidemiology. Int J Environ Stud., 6: 19?27.
  10. Hart, P. H., Townley, S. L., Grimbaldeston, M. A., Khalil, Z. and Finlay-Jones, J. J. (2002): Mast cells, neuropeptides, histamine and prostaglandins in UV‑induced systemic immunosuppression. Methods., 28: 79?89.
  11. Holick, M. F.?(1994):?McCollum Award Lecture, 1994: vitamin D7? new horizons for the 21st century.?Am. J ClinNutr.,?60:?619?630.
  12. Kurtzke, J.F.(1983): Rating neurologic impairment in multiple sclerosis: an ExpandedDisability Status Scale (EDSS)". Neurology., 33:1444?1452.
  13. Langer-Gould, A., Chen, L., Lucas, R., Xiang, A. and Barcellos, L. (2015): Hypovitaminosis D and the risk of multiple sclerosis in blacks and Hispanics. Neurology., 84(14): 2?207.
  14. L?pez-M?ndeza, p., Sosa-Henr?quezb, M. and Ruiz-P?rezd, ?. (2016): Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis. archsocespoftalmol., 91 (5):217?222.
  15. McDonald, W.I., Compston, ,? Edan, G., Goodkin, D., Hartung, H.P., Lublin, F.D., and et al. (2001): Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol., 50: 121?27.
  16. Mehta, B. K. (2010): New hypotheses on sunlight and the geographic variability of multiple sclerosis prevalence. J Neurol , 192: 5?10.
  17. Munger, K.L., Levin, L.I., Hollis, B.W., Howard, N.S. and Ascherio, A. (2006): Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA.,?296?:2832-2838.
  18. Norval, M.(2006): The mechanisms and consequences of ultraviolet-induced immunosuppression. ProgBiophysMol , 92:108?118.
  19. Polman CH, Reingold SC, Banwell B, Clanet M,Cohen JA,?Filippi M and et al. (2011): Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.?Ann Neurol.; 69(2):292-302.
  20. Schmahmann, D., MacMore, J. and Vangel, M.(2009):? Ceerebeller stroke without motor deficit: clinical evidence for motor and non-motor domains within the human cerebellum. Neuroscience., 162(3):852-861.
  21. Schwarz, A. and Schwarz, T. (2010): UVR-induced regulatory T cells switch antigen-presenting cells from a stimulatory to a regulatory phenotype. J Invest Dermatol.,130:1914?1921.
  22. Smolders, J., Damoiseaux, J., Menheere, P. and Hupperts, R. (2008): Vitamin D as an immune modulator in multiple sclerosis, a review. J Neuroimmunol., 194(1):7?17.
  23. Solarc/SolRx Vitamin-D User?s Manual, 2012.
  24. Sreevidya, C. S. ,Fukunaga, A.,?Khaskhely, N.M.,?Masaki, T.,?Ono, R.,?Nishigori, C.and?Ullrich, S.E. (2010): Agents that reverse UV‑induced immune suppression and photocarcinogenesis affect DNA repair. J Invest Dermatol.,130, 1428?1437.
  25. Staples, J., Ponsonby, A. L. and Lim, L. (2010): Low maternal exposure to ultraviolet radiation in pregnancy, month of birth, and risk of multiple sclerosis in offspring: longitudinal analysis. BMJ., 340. c1640.
  26. Ullrich, S. E. (2005): Mechanisms underlying UV‑induced immune suppression. Mutat. Res., 571: 185?205.
  27. van der Mei, I. A., Simpson, S., Stankovich, J. and Taylor, B. V. (2011): Individual and joint action of environmental factors and risk of MS. NeurolClin., 29: 233?255.
  28. Wang, Y., Marling, S.J., Mcknight, S.M., Danielson, A.L., Severson, K.S. and Deluca, H.F. (2013): Suppression of experimental autoimmune encephalomyelitis by 300?315?nm ultraviolet light.?Arch BiochemBiophys., 536:81?86.
  29. Woolmore, J.A., Stone, M., Pye, E.M. and et al. (2007): Studies of associations between disability in multiple sclerosis, skin type, gender and ultraviolet radiation. Mult. Scler., 13: 369?75.
  30. Zamzam,A.,?Fouad, M.M.,?Elaidy, D.A.,?Abd-Elaziz, D.M.andAbd-Elaziz, A.A. (2016): Vitamin D levels in a sample of Egyptian patients with multiple sclerosis. Egypt J NeurolPsychiatNeurosurg., 53 (2) :107-110.

[Shereen M. Fathi ,Asmaa M. Ebraheim, Dalia M. Labib, Neveen M ElFayoumy Amal S Ashour, AbdAlazim M Reda, Wael Ezzat andFatma Mohamed Taha. (2017); A POTENTIAL BENEFICIAL EFFECT OF ULTRAVIOLET PHOTOTHERAPY ON RELAPSING REMITTING MULTIPLE SCLEROSIS. Int. J. of Adv. Res. 5 (Jun). 1419-1425] (ISSN 2320-5407). www.journalijar.com

Dalia M. Labib
Assistant Prof. of Neurology, Faculty of Medicine, Cairo University, Egypt

DOI:

Article DOI: 10.21474/IJAR01/4553      
DOI URL: https://dx.doi.org/10.21474/IJAR01/4553

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