title: Iranian consensus on use of vitamin D in patients with multiple sclerosis.
abstract: BACKGROUND
  Accumulating evidences from experimental, epidemiologic and clinical studies support the potential linkage between poor vitamin D status and the risk of developing Multiple Sclerosis (MS), as well as, an adverse disease course. However, the results of the trials on the clinical outcomes of vitamin D supplementation in MS patients are less consistent which brought many discrepancies in routine practice. In this article we presented a summary of a symposium on vitamin D and MS. In this symposium we aim to review the current data about the relationship between vitamin D and MS, and suggest management guides for practicing neurologists.
  
  
  CONCLUSIONS
  Generally, supplementation seems to be reasonable for all MS and clinically isolated syndrome (Rinaldi et al., Toxins 7:129-37, 2015) patients with serum 25(OH)D level below 40 ng/ml. In patients with vitamin D insufficiency or deficiency, a large replacing dose (e.g. 50,000 IU capsules of D per week for 8-12 week) is recommended. Panel also suggested: the checking of the serum vitamin D, and calcium level, as well as, patients' compliance after the initial phase; a maintenance treatment of 1500-2000 IU daily or equivalent intermittent (weekly, biweekly or monthly) Dose, considering the patient's compliance; routine check of serum vitamin D level at least two times a year especially at the beginning of spring and autumn; Serum vitamin D evaluation for first degree relatives of MS patients at high risk age and supplementation in case of insufficiency (25(OH)D less than 40 ng/ml); correction of vitamin D deficiency and insufficiency before pregnancy, as well as, a daily dose of 1500-2000 IU or equivalent biweekly intake in 2nd and 3rd trimesters; stopping supplementation if 25(OH)D serum level exceeds 100 ng/ml. Although the results of high power studies are not available, correcting vitamin D status seems plausible in all MS and CIS patients. Maintaining the serum 25(OH)D level between 40 and 100 ng/ml is not known to exert adverse effect. More ever, it might be associated with lower disease activity.
authors.affiliation: MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.|Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Soodeh Razeghi
authors.initials: SR
authors.lastname: Jahromi
authors.affiliation: MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. msahrai@sina.tums.ac.ir.|Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. msahrai@sina.tums.ac.ir.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Sahraian
authors.affiliation: Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mansoureh
authors.initials: M
authors.lastname: Togha
authors.affiliation: Shafa Hospital, Medical Sciences University of Kerman, Kerman, Iran.
authors.forename: Behnaz
authors.initials: B
authors.lastname: Sedighi
authors.affiliation: Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Shayegannejad
authors.affiliation: Department of Neurology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Nickseresht
authors.affiliation: Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Nafissi
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Niayesh
authors.initials: N
authors.lastname: Mohebbi
authors.affiliation: Department of Neurology, Golestan Hospital, Ahvaz University of Medical Sciences, Ahvaz, Iran.
authors.forename: Nastran
authors.initials: N
authors.lastname: Majdinasab
authors.affiliation: Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Foroughipour
authors.affiliation: Department of Neurology, Azahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Etemadifar
authors.affiliation: Department of Neurology, Imam Hossein Hospital, Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Nahid Beladi
authors.initials: NB
authors.lastname: Moghadam
authors.affiliation: Department of Neurology, Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hormoz
authors.initials: H
authors.lastname: Ayramlou
authors.affiliation: Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Ashtari
authors.affiliation: MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shekoofe
authors.initials: S
authors.lastname: Alaie
mesh_terms: D005260:Female; D006801:Humans; D007492:Iran; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use*
chemical_list: D014807:Vitamin D
keywords: Assessment; Etiology; Multiple sclerosis; Pathogenesis; Treatment; Vitamin D