Vitamin D Deficiency Found Highly Prevalent Across the Board in MS, Neuromuscular Disease

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by Charles Moore |

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A study presented at the 61st annual meeting of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) held October 29 to November 1 in Savannah, Georgia, further corroborates growing awareness of a high prevalence of vitamin D deficiency in neuromuscular disease.’

sbandyopadhyayThe study, entitled “Surprising Prevalence of Significant Vitamin D Deficiency in Neuro-muscular Disease Clinic in Central Pennsylvania,”Ā was conducted by Sankar Bandyopadhyay, MD of Penn State Hershey Neurology in Hershey, Pennsylvania, and Sol Dejesus, MD., a Neurology Fellow at The University of Florida Health Center for Movement Disorders & Neurorestoration in Gainesville, Florida, and a physician at Penn State Hershey Center. The AANEM Annual Meeting is the premier event focusing on diagnosis and treatment of neuromuscular diseases and electrodiagnostic (EDX) medicine.

ā€œPrevious work has shown vitamin D deficiency to be quite common in other neurological disorders such as multiple sclerosis, myasthenia gravis, and Parkinsonā€™s disease. This study suggests this concern may be more prevalent in other neuromuscular conditions as well,ā€ says AANEM News Science Editorial Board member Ileana Howard, MD, in a release.

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Drs. Bandyopadhyay and Dejesus note that despite reports — albeit scattered — of vitamin D deficiency in various conditions of fatigue and pain such as Crohnā€™s disease, fibromyalgia, Parkinsonā€™s disease, pregnant women, and myasthenia gravis, a search for vitamin-D deficiency is still not a routine or standard clinical practice, and while effective treatment exists, it is often missed.

shutterstock_144494866The objective of this study was to determine the prevalence of vitamin D deficiency among patients seen in the neuromuscular clinics in a central Pennsylvania academic institution in fall and winter months. The Harvard biomarker study published in October 2013 in Neurology journal showed a deficiency in 17.6% Parkinsonā€™s disease patients compared to 9.3 %controls.

Retrospective data analysis from the neuromuscular data pool was done for patients randomly seen in fall and winter by the first author, with Vitamin D routinely ordered for weakness, ache, or pain. The coauthors report that all of these patients had a clinical neuromuscular diagnosis, with Vitamin D deficiency defined as 25 (OH) D3 level of <30ng/ml. The researchers found that of 50 blood levels, 24 were below 30 (Deficient: 48%), 3 at 30 (borderline: 6%), 16 were between 30 and 40 (low normal: 32%), and only 7 were above 40 (Clear normal: 14%). A severe deficiency level below 20 ng/ml was seen in 11 blood test (22%). The prevalence of vitamin D deficiency was significantly above the Harvard biomarker control values considering similar climatic and ethnic influences. Drs. Bandyopadhyay and Dejesus conclude that although 25-hydroxy-D3, which are produced in liver and skin stimulated by exposure to sunlight, can be low in fall and winter, significantly lower levels were seen (p>000.1) among the patients seen randomly in their neuromuscular clinic, and suggest that widespread case-control studies with seasonal influences are worth studying.

Vitamin D supplementation has been suggested to improve function in frail elderly patients at risk for falls, as well as individuals with myasthenia gravis and Parkinsonā€™s. The impact of vitamin D deficiency and supplementation on function in other neurologic conditions has yet to be explored.

ā€œWhile the connection between vitamin D deficiency and neurologic disease is likely complex and not yet fully understood, this study may prompt physicians to consider checking vitamin D levels in their patients with neurologic conditions and supplementing when necessary,ā€ says Dr. Howard.

A 2012 Czech study entitled “Vitamin D and neurological diseases” (Vnitr Lek. 2012 May;58(5):393-5.) coauthored by J. PolĆ­vka of NeurologickĆ” klinika LĆ©karskĆ© fakulty UK a FN Plzen, J. PolĆ­vka Jr, M. Peterka,V. Rohan, P. SevcĆ­k, and O Topolcan, also provides an overview of the association between vitamin D and some neurological diseases. The researchers say the majority of literature refers to cerebrovascular diseases, followed by multiple sclerosis and cognitive disorders. They conclude that Vitamin D hypovitaminosis might be associated with the diseases directly or alternatively might contribute to the disease risk factors (typically in cerebrovascular events). They also observe that Vitamin D hypovitaminosis may also play a role in patients with residual functional involvement due to a neurological disorder (movement disorders, lack of self-sufficiency) and worsen functional status owing to muscle weakness, instability and falls.

Sources:
American Association of Neuromuscular & Electrodiagnostic Medicine
MedLine