Age-dependent variation of female preponderance across different phenotypes of multiple sclerosis: A retrospective cross-sectional study.

INTRODUCTION: Multiple sclerosis (MS) is an autoimmune disease of the CNS, which predominantly affects women. Studies investigating the sex distribution in MS are sparse. We aim to analyze the female-to-male ratio (F/M ratio) in different MS phenotypes in association with age at diagnosis and year of birth. METHODS: We performed a retrospective cross-sectional analysis by cumulating data (sex, year of birth, age at diagnosis, and MS phenotypes) from unpublished and published studies of the participating centers. RESULTS: Datasets of 945 patients were collected. The overall F/M ratio was 1.9:1.0 and female preponderance was present in all phenotypes except for primary progressive MS (PPMS), in which men were predominantly affected (F/M ratio: 0.5:1.0). Female preponderance declined with increasing age at diagnosis and was no longer present in relapsing-remitting MS (RRMS) patients > 58 years of age. CONCLUSION: Our data demonstrate an age dependency of female preponderance in MS except for PPMS. This could be influenced by the lifecycle of sex hormone secretion in women. In PPMS, a male preponderance was observed in all age-groups, which might point to pathophysiological mechanisms being less influenced by sex hormones.

Intramuscular Testosterone Supplementation Ameliorates Depression in Hypogonadal Men: A Retrospective Study in an Outpatient Department.

INTRODUCTION: Substantial evidence has indicated an association between hypogonadism and depressive symptoms, which led to the conduction of studies that found an ameliorating effect of testosterone (T) supplementation (S) upon depression in men. METHODS: Retrospective analysis of medical records identified 16 depressed, hypogonadal men who have not responded adequately to initial antidepressant therapy and subsequently received intramuscular T injections. Following the proposal of Button et al., a minimal clinically important difference was defined as an 18% reduction of the Beck Depression Inventory-II (BDI-II) score. RESULTS: After TS, the BDI-II score decreased by approximately 31% (p<0.01), from 27.2 (mean; standard deviation [SD] 11.8) to 18.8 (mean; SD 11.3). Patients with baseline BDI-II scores ranging from 29 to 63 (severe depression) showed a significantly higher absolute and relative reduction through TS. Also, men with a shorter depression duration (<2 years) demonstrated a greater benefit. CONCLUSIONS: The depressed, hypogonadal men generally benefited from TS given that the BDI-II score reduction was almost twice as much as needed for a minimal clinically important difference.

Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity.

OBJECTIVES: Low ultraviolet-B (UVB) radiation causes hypovitaminosis D, which is a known risk factor for multiple sclerosis (MS) and associated with MS disease activity. Our objective is to test whether vitamin D supplementation is most effective in lowering disease activity during the period of the year with low UVB radiation and consequently low serum 25-hydroxyvitamin D3 (25(OH)D3) concentration. METHODS: Retrospective analysis of medical records from our outpatient department identified 40 MS patients with available data of at least 6 months before and during oral vitamin D supplementation. Serum 25(OH)D3 concentration was analyzed using immunoassay. UVB radiation data were provided by the local government. Annualized and quarterly relapse rates before and during vitamin D supplementation served as outcome parameters. RESULTS: During vitamin D supplementation (18,950 international units/week (mean, SD 3,397)), serum 25(OH)D3 concentration increased by 51 nmol/L and the UVB-related seasonal variability in 25(OH)D3 levels ceased (rho = -0.13, p > .05). Furthermore, the annualized relapse rate decreased by approximately 50%. This was almost solely driven by the prominent reduction in the quarterly relapse rate in late winter/early spring, when 25(OH)D3 levels of nonsupplemented patients were the lowest. CONCLUSIONS: Our study demonstrated the modulation of seasonal MS disease activity through vitamin D supplementation. Given the prominent reduction in the quarterly relapse rate in late winter/early spring, our data indicate a beneficial effect of supplementing MS patients with vitamin D, especially during this period of the year.