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Area of Science:

  • Neurology
  • Clinical Medicine
  • Public Health

Background:

  • Ramadan fasting presents unique challenges for multiple sclerosis (MS) patients in Muslim-majority countries.
  • Physicians require practical knowledge regarding the implications of fasting on MS management.
  • This study synthesizes evidence from literature searches and expert symposiums to address these challenges.

Purpose of the Study:

  • To review the effects of Ramadan fasting on multiple sclerosis (MS).
  • To provide practical management guidelines for MS patients who observe Ramadan fasting.
  • To inform healthcare providers about the safety and considerations of fasting in MS.

Main Methods:

  • Database searches of Cochrane Database of Systematic Reviews and PubMed.
  • A mini-symposium involving experts to discuss Ramadan fasting and MS.
  • Review of existing evidence and expert consensus on management strategies.

Main Results:

  • Fasting is generally feasible for most stable MS patients, particularly those with mild disability (Expanded Disability Status Scale [EDSS] score ≤3).
  • Some MS symptoms like fatigue, dizziness, and spasticity may temporarily worsen during fasting but typically resolve during non-fasting periods.
  • Experimental evidence suggests calorie restriction may reduce inflammation and disease severity in MS.

Conclusions:

  • Tailored care is essential for MS patients considering fasting.
  • Fasting is contraindicated for patients with active disease, high disability (EDSS score ≥7), on high-dose medications (corticosteroids, anti-convulsants, anti-spastics), or with coagulopathy.
  • Patient spiritual beliefs are a key factor in managing fasting decisions for MS patients.