Background: Elevated homocysteine levels are associated with various neurodegenerative diseases and have even been identified as a risk factor for some of these. Homocysteine levels may be elevated in multiple sclerosis (MS) patients, but large studies are lacking and the relation with disease progression remains to be determined.
Our aim was to study homocysteine levels in MS patients and controls, and the relation of homocysteine levels with clinical progression in MS.
Methods: Serum homocysteine levels were compared between MS subtypes (n=219) and controls (n=152). Homocysteine levels were associated with baseline and follow-up clinical severity scores.
Results: The results showed that serum homocysteine values were similar in MS patients and controls. Baseline scores on the Expanded Disability Status Scale were higher in patients with secondary progressive (SP) MS in the top compared to the bottom quartile of homocysteine levels (p=0.02). The baseline scores on the Multiple Sclerosis Functional Composite (MSFC) and Paced Auditory Serial Addition Test (PASAT), which measures cognitive functioning, were lower in SPMS patients in the top compared to the bottom quartile of homocysteine levels (MSFC: p=0.02, PASAT: p=0.02). High homocysteine levels were associated with a decline in PASAT scores during follow-up in primary progressive (PP) MS patients (p=0.009).
Conclusions: Serum total homocysteine levels are associated with several measures of disease progression in MS, but are not elevated in MS patients compared to controls. The association of homocysteine levels with cognition in progressive MS patients raises the question whether homocysteine directly impacts MS or reflects a more general neurodegenerative process.
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