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Seasonal and monthly variation in multiple sclerosis relapses: a systematic review and meta-analysis

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Abstract

Background

Multiple Sclerosis (MS) relapses are episodes of transient disease exacerbation. There are contradictory findings regarding seasonal variation in MS relapses. In this systematic review and meta-analysis, we aimed to investigate the seasonal and monthly variation in relapse rates among patients with MS.

Methods

We systematically queried PubMed, Scopus, and Web of Science for published papers until February 30, 2022.

Results

A total of 24 studies were included in this systematic review and meta-analysis with a total of 29,106 patients with MS. We found that the relapse rate was significantly lower in fall compared to the average relapse rate in other seasons with a risk ratio (RR) of 0.97 (95% CI 0.95–0.98). Furthermore, patients with MS experienced a higher number of relapses in April (RR: 1.06, 95% CI 1.01–1.11) and March (RR: 1.08, 95% CI 1.00–1.16) compared to other months. Also, the risk of relapse was lower in August (RR: 0.92, 95% CI.85–0.98), September (RR: 0.97, 95% CI.94–0.99), October (RR: 0.92, 95% CI.89–0.96), and November (RR: 0.93, 95% CI.89–0.97).

Conclusion

Our systematic review and meta-analysis confirm the temporal fluctuations in the relapse of MS through a comprehensive review of the existing literature, with a lower relapse rate during late summer and fall and a higher relapse rate during early spring.

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Authors and Affiliations

  1. Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Fardin Nabizadeh

  2. School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Fardin Nabizadeh

  3. School of Medicine, Tehran University of Medical Science, Tehran, Iran

    Parya Valizadeh

  4. Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maryam Yazdani Tabrizi

  5. Tehran University of Medical Science, Tehran, Iran

    Kimia Moayyed

  6. School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Niousha ghomashi

  7. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Omid Mirmosayyeb

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  1. Fardin Nabizadeh
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Nabizadeh, F., Valizadeh, P., Yazdani Tabrizi, M. et al. Seasonal and monthly variation in multiple sclerosis relapses: a systematic review and meta-analysis. Acta Neurol Belg 122, 1447–1456 (2022). https://doi.org/10.1007/s13760-022-02103-y

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