Impact of Ramadan fasting on disease activity in patients with multiple sclerosis: a multicenter study

ABSTRACT

Background

The safety of Ramadan fasting for Muslim patients suffering from multiple sclerosis (MS) is still a matter of debate. This work aimed to study the clinical course of MS during Ramadan fasting and to clarify the predictors of relapses and symptoms exacerbation.

Methods

This retrospective study included 153 Muslim patients with MS. Data related to the disease course before Ramadan were obtained from patients' files, whereas data related to the disease activity during Ramadan, were collected from patients over the two months following Ramadan.

Results

Patients with MS who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant longer disease duration compared to those who did not experience (P < 0.001, <0.001, 0.01 respectively). Also, patients who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant higher expanded disability status scale (EDSS) compared to those who did not experience (P <0.001, <0.001,0.01, respectively). The occurrence of relapses, exacerbation of symptoms and development of new symptoms during Ramadan, were significantly higher in patients who experienced relapses in the preceding year compared to those who did not (P= 0.002, 0.002, 0.01, respectively). Binary logistic regression revealed that each score elevation of EDSS increased the odds of relapse during Ramadan by 1.02 (P-value = 0.04). Also, each month's increase in disease duration increased the odds of relapse during Ramadan by 1.87 (P-value = 0.046).

Conclusion

High EDSS and long disease duration are independent predictors of relapse during Ramadan.

KEYWORDS:

• Multiple sclerosis
• Ramadan fasting
• relapse
• symptom worsening
• EDSS
• DMT
• Muslim patients with MS
• Treatment rescheduling

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contribution

AH participated in study design and helped to draft the manuscript. NM participated in the collection of data and helped to draft the manuscript. FO participated in the collection of data and helped to draft the manuscript. WR participated in the collection of data and helped to draft the manuscript. HK participated in the collection of data and helped to draft the manuscript. SH participated in the revision of the manuscript. MA participated in the revision of the manuscript. HS participated in study design and helped to draft the manuscript. NS participated in study design and helped to draft the manuscript. NK participated in study design and helped to draft the manuscript. MN participated in study design and helped to draft the manuscript. MH participated in study design and helped to draft the manuscript. MF participated in study design and helped to draft the manuscript. SA participated in study design and helped to draft the manuscript. MH participated in the analysis of data and helped to draft the manuscript. All authors read and approved the final manuscript.

Additional information

Notes on contributors

Amr Hassan

Amr Hassan earned his M.B.B.ch. (Medicine and Surgery) at Cairo University in 2001, and worked as a resident at Neurology department, Cairo University for 3 years where he earned his Master degree in Neuropsychiatry. He started his career as an assistant lecturer in 2006 then he completed his Doctoral degree in 2010 and now he is a Consultant and Professor of Neurology, at Kasr Al Ainy, Faculty of Medicine, Cairo University At 2016, he became Fellow of European Board of Neurology after passing through the required exams. He is the former director of Kasr AlAiny Multiple sclerosis Unit (KAMSU) and the main trainer in the Neurology Egyptian fellowship program and Pediatric Neurology master degree at Cairo university. He published many international papers and has remarkable scientific research activities especially in the field of headache and multiple sclerosis.

Nahla Merghany

Nahla Merghany is currently a Neurology Associate Lecturer at Cairo University (since 12/2018). Prior to that, she worked as a Tropical Medicine, Internal Medicine, and Neurology Resident for 4 years at Theodor Bilharz Research Institute and Kasr Al-Ainy University hospitals (2014-2018). She earned her Master degree in Neuropsychiatry and her Bachelor degree in Medicine and Surgery (MBBCh) at Kasr Al- Ainy Faculty of Medicine, Cairo University, Egypt, in 2018 and 2013, respectively. She was awarded by the European Academy of Neurology for being the best case presenter during her Spring School 2021 training. Her broad research interests include neuroimmunology and headache disorders

Fatima Ouchkat

Fatima Ouchkat is a neurologist in Rabat, she had her residency training at the department of neurology B and neurogenetics in the hospital of specialities in Rabat for 4 years. Her fields of interest are movement disorders and neuropsychology.

Wafa Regragui

Wafa Regragui is a Professor of neurology at the university of Mohammed V of Rabat since 2009. She is the head of department of neurology B and neurogenetics in the hospital des spécialités of Rabat. She is an expert on movement disorders, a member of the Movement Disorder society MDS and the general secretary of “Amis du Mouvement Anormale”.

Hanaa Kedah

Hanaa Kedah has earned her M.B.B.ch. (Medicine and Surgery) from king Abdulaziz University Jeddah in 1996. She has saudibourd program of internal medicine in 2001 then earned Saudibourd program of neurology in 2006. Worked as a neurology consultant and saudibourd program director at Alnoor specialist hospital from 2006 - till 2013. Then move to Hera hospital and work as head of internal medicine departments and neurology department from 2013 till date. She had subspecialty in multiple sclerosis and headache. She is a member of saudibourd exam of internal medicine as well neurology program since 2008 till date. She is a head of neurology commette of MOH Makkah region since 2015 till date.

Sherif M. Hamdy

Sherif M. Hamdy is a Professor of Neurology at Cairo University, Egypt. He received his Master in Neuropsychiatry in 1985, and after receiving Medical Degree in Neurology from Cairo University, Egypt in 1991; he has completed several internships in UK and USA. He is appointed to the board of directors of MScare-Egypt, a member of MSIF since 2006, and he has actively participated in all patients education forums since 2007. He is also officially appointed to Treasurer of Egyptian Society of Neurology Psychiatry and Neurosurgery. His current research is focused on epilepsies, multiple sclerosis and related epidemiological studies and headache research surveys. Dr. Hamdy is author or co-author of many articles published on peer-reviewed journals and he is also reviewer of several international scientific journals. He participated, as a ‘speaker' / ‘poster presenter’ to international congresses including WCN, AAN, ECTRIMS, and he shared as speaker/poster presenter/chairman in all CNC meetings held in Egypt since 2001 till now.

Maged Abdel-Naseer

Maged Abdel-Naseer is a Professor of Neurology at Cairo University, Egypt. He received his Master in Neuropsychiatry in 1988, and after receiving Medical Degree in Neurology from Cairo University, Egypt in 1994; he has completed several internships in UK and USA. He is also officially appointed to Treasurer of Egyptian Society of Neurology Psychiatry and Neurosurgery since 2009. He is also officially appointed to Secretary General of Egyptian Society of Neurology Psychiatry and Neurosurgery since 2011. He is also nominated as a president of Egyptian Society of Neurology Psychiatry and Neurosurgery in 2019, and head of Pan Arab Union of Neurological Societies 2020 - present. His current research is focused on epilepsies, multiple sclerosis and related epidemiological studies and headache research surveys. Dr. Abdelnaseer is author or co-author of many articles published on peer-reviewed journals and he is also reviewer of several international scientific journals. He participated, as a ‘speaker' / ‘poster presenter’ to international congresses including WCN, AAN, ECTRIMS, and he shared as speaker/poster presenter/chairman in all CNC meetings held in Egypt since 2001 till now.

Hatem S. Shehata

Hatem S. Shehata is a Professor of Neurology at Cairo University, Egypt. He received his Master in Neuropsychiatry in 1997, and after receiving Medical Degree in Neurology from Cairo University, Egypt in 2001; he has completed several internships in neurorehab in Milan-Italy, Heywood hospital Stoke-On-Trent, Staffordshire-UK and Danish headache center, Glostrup Hospital- Denmark. He is officially appointed to the board of directors of MScare- Egypt, a member of MSIF since 2016, and he has actively participated in all patients education forums since 2007. His current research focused on multiple sclerosis related epidemiological measures, integrative rehab program of different neurological disabilities and headache research surveys. Dr. Shehata is author or co-author of many articles published on peer-reviewed journals and he is also reviewer of several international scientific journals. He participated, as a ‘speaker’ to international congresses including WCN, AAN, ECTRIMS, and he shared as speaker/poster presenter/chairman in all CNC meetings held in Egypt since 2002 till now.

Nevin M. Shalaby

Nevin M. Shalaby is a Professor of Neurology, Cairo University, Egypt. Former director of Kasr Al-Ainy MS clinic and currently research director of the clinic, Cairo University. General secretary of the Egyptian MS Chapter of the Egyptian society of neurology, psychiatry and neurosurgery (ESNPN). Published nationally and internationally over 70 articles, with special interest in neuroimmunology and symptomatic MS management. PI and coordinator of some phase IV MS studies. Speaker and Chairperson in national, regional and international meetings and conferences

Nirmeen A. Kishk

Nirmeen A. Kishk is currently a full Professor of Neurology at Cairo University (since 2014). After completing his residency training at the Neurology department Cairo university hospitals, she has multiple fields of interest. She focused on epilepsy clinic science 2004 after that at 2010 she became the moderator of the Epilepsy clinic and share in the upgrading into Epilepsy Unit, she joined many internationally educational EEG & Epilepsy courses and schools. She is Vice Secretary-General of the Egyptian Society Against Epilepsy (ESAE), Chapter of the International League Against Epilepsy (ILAE), and Join ILAE COVID Task Force as a representative Eastern Mediterranean. She is the principal investigator for ongioing national researchs in her university focused on drug-resistant Epilepsy.

Mona A. F. Nada

Mona A. F. Nada currently works as professor of Neurology, in Cairo University. Mona conducted research in Neurology especially in multiple sclerosis and headache. She is interested in neuroimmunology and pathogenesis of migraine. Her most recent publication is “The MuSC-19 Study: The Egyptian Cohor” published in Multiple Sclerosis and Related Disorders journal, 2021. Mona has more than 25 published articles in both national and international journals. Mona is a peer-reviewer in national and international scientific Journals e.g. Egyptian Journai of Neurology, Psychiatry and Neurosurgery, E Neurological Science (Official Journal of World Federation of Neurology), Clinical Case Reports, Indian Journal of Medical Research, Current Medicinal Chemistry, Austin Journal of Multiple sclerosis, Annals of Medical and Health Sciences Research, Kasr Ai Ainy Medical Journal and American Journal of Case Reports.

Mohamed I. Hegazy

Mohamed I. Hegazy is an Associate Professor of Neurology at Cairo University, Egypt. He is the current director of Kasralainy Multiple Sclerosis Unit (KAMSU). His current research focused on multiple sclerosis and its management. He is an author or co-author of many articles published on peer-reviewed journals and he is also a reviewer of several international scientific journals. He participated as a speaker and chairperson in national, regional and international meetings and conferences.

Marwa Farghaly

Marwa Farghaly is a Professor of Neurology at Cairo University, Egypt. Her current research work focused on cognition. She is an author or co-author of many articles published on peer-reviewed journals and she is also a reviewer of several international scientific journals. She participated as speaker and chairperson in national, regional and international meetings and conferences.

Sandra M. Ahmed

Sandra M. Ahmed She is a Professor of Neurology at Cairo University. Active member of MS unit and Stroke unit team at Cairo University Hospitals. Current director of Kasralainy Multiple Sclerosis Unit (KAMSU), current director of Cairo University Neurosonoly unit (CUNU), active member of Stroke unit team at Cairo University.

Mona Hussein

Mona Hussein is currently an Associate professor of Neurology, Beni-Suef University, Egypt. She is the moderator of the stroke unit in Beni-Suef University. She is the academic counselor in Neurology department, Beni-Suef University. She has more than 30 international publications in the field of epilepsy, Parkinson's disease, multiple sclerosis and cognition. She is a reviewer in multiple highly ranked international journals. She has more than 126 citations. She presented her research work in many international conferences such as American academy of neurology, European academy of neurology and International Congress of Parkinson's Disease and Movement Disorders.