A 21-year-old patient was diagnosed last year with encephalomyelitis disseminata... Her MS counsellor advised her to check her vitamin D level and possibly to substitute this vitamin. The counsellor also told her that for patients with MS this is covered by the statutory health insurance. Is there any evidence that vitamin D treatment is of benefit in the treatment of multiple sclerosis?

Dr. med. T. NEUGEBAUER (internist)
D-75433 Maulbronn
Conflict of interest: none

A possible correlation between vitamin D and multiple sclerosis (MS) has been the subject of discussion for a long time. It is true that the MS risk in countries in higher latitudes, and thus with less sunlight, is higher than in countries near the equator. The reason for this could possibly be the direct effects of solar radiation, but indirect vitamin D-mediated effects could also play a role. In various observational studies, an inverse correlation between the vitamin D levels in the blood and the relapse rate or the degree of disability in MS has also been demonstrated (1). However, this kind of finding does not allow to draw conclusions regarding the benefits of vitamin D supplementation for MS patients. For example, a so-called reversed causality is also a reasonable explanation for this correlation; namely, that with the increased severity of the disease, activities in the open air, and thus exposure to the sun, are reduced. Randomised controlled studies are indispensable for proving evidence of benefits. However, to date, there have been very few studies into the effect of vitamin D in MS patients, and with a maximum of 60 to 70 patients, they have been very small. With the exception of an open study with a high bias potential, they have shown no significant effect of vitamin D either upon the relapse rate or upon the progression of the disease (1, 2).

  For this reason, it is our opinion that the treatment of multiple sclerosis with vitamin D is unsubstantiated at the present time.

1

PIERROT-DESEILLIGNY, C. et al.: Ther. Adv. Neurol. Disord. 2013; 6: 81-116

2

POZUELO-MOYANO, B. et al.: Neuroepidemiol. 2013; 40: 147-53