Muhammed Zülfü Yılmaz1, Murat Gönen1

1Besni State Hospital, Clinic of Neurology, Adiyaman, Türkiye
2Firat University Faculty of Medicine, Department of Neurology, Elazig, Türkiye

Keywords: Multiple Sclerosis, Progression, Heavy metals, Aluminum


Objective: Multiple sclerosis (MS) etiology studies show that the disease is multifactorial. While genetic features are more prominent at the beginning of the disease, the existence of environmental triggers that may cause the progression of the disease is still a subject of research.

Materials and Methods: We evaluated 101 MS patients sharing the same geographical area. We performed heavy metal analysis in the blood and hair tissues of these patients. Of these patients, 67 were in the relapsing remitting MS (RRMS) group and 34 were in the progressive MS (PMS) group.

Results: Samples were analyzed using the X Series 2 model (ICP MS) instrument. In hair samples, aluminum (Al) was found to be 8.98 μg/g in the PMS group and 3.01 μg/g in the RRMS group (P < 0.001). Unlike Al element, magnesium (Mg), calcium (Ca), cobalt (Co), zinc (Zn) and strontium (St) elements were observed to be higher in the RRMS group. RRMS for median Ca: 931 μg/g, PMS: 400 μg/g (P < 0.001); RRMS for Mg: 118 μg/g, PMS: 50 μg/g (P < 0.001); For Co RRMS: 0.0150 μg/g, PMS: 0.0075 μg/g (P = 0.008); RRMS for Zn: 138 μg/g, PMS: 101 μg/g (P = 0.008); For St RRMS: 4.76 μg/g, PMS: 3.70 μg/g (P = 0.008). With these results, we thought that Al excess or Mg, Ca, Co, and Zn deficiencies might be associated with MS progression. The mercury (Hg) blood level was slightly low in PMS. This finding was not correlated with hair samples (P = 0.047). The relationship between blood Hg level and RRMS should be evaluated separately.

Conclusion: We could not find any study comparing PMS forms and RRMS subtypes in terms of heavy metals. In particular, it is necessary to focus on the Al element.

Ethics Committee Approval

The study was initiated after obtaining permission from Firat University’s Neurology Department and approval from the Firat University Clinical Ethics Committee (decision number: 13; project number: TF 18.58).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept: M.Z.Y., M.G., Design: M.Z.Y., M.G., Data Collection or Processing: M.Z.Y., Analysis or Interpretation: M.Z.Y., M.G., Literature Search: M.Z.Y., M.G., Writing: M.Z.Y., M.G.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

This research was supported by Firat University Scientific Research Center (project number: TF18.58).


The contributions of Istanbul University Forensic Toxicology Institute were very helpful in the completion of this study. We would especially like to thank Mr. Murat Yayla and his team for their contributions.