EPMA Journal

, Volume 10, Issue 4, pp 437–444 | Cite as

Flammer syndrome in multiple sclerosis: diagnostics, prediction, and personalization of treatments

  • Cihat UzunköprüEmail author
  • Yeşim Beckmann



Flammer syndrome (FS) occurs from well-described signs and symptoms. The syndrome itself is not a disease, but it may be a directive marker for advancing therapeutic approaches by predictive and preventive measures as well as for personalization of treatments. The syndrome is related to many diseases, but FS has been rarely studied in multiple sclerosis (MS). The study aimed to determine whether FS signs and symptoms occur more often in people with MS than in healthy controls, and in order to personalize the treatment, we investigated the possible effect of current therapies on FS signs and symptoms.


Two hundred twenty-two MS patients and 203 healthy controls answered the questionnaire consisting of 15 signs and symptoms of FS.


MS patients had significantly more complaints in 9 items of FS signs and symptoms (cold hands or/and feet, the reduced feeling of thirst, dizziness, drug side effects, other headaches (tension-type, medication overuse), weight loss, feeling cold, long sleep-onset time, and skin blotches) compared to healthy controls. Six items (low blood pressure, tinnitus, increased odor sensitivity, low pain threshold, and perfectionism) were similar between the two groups. The treatment agents currently used did not have any effect on the signs and symptoms of FS.


This study showed that FS might be associated with MS. Injectable or oral agents are not related to the signs and symptoms of FS. Further studies are needed to validate this association.

Relevance of the article for predictive, preventive, and personalized medicine

FS is common among MS patients. Being aware of this incidence that might impair the life quality of MS patients is useful to predict the comorbidity and develop preventive strategies and applying personalized treatment options and procedures.


Multiple sclerosis Primary vascular dysregulation Flammer syndrome 


Compliance with ethical standards

All the patient investigations conformed to the principles outlined in the Declaration of Helsinki and have been performed with the permission of the Ethics Committee of İzmir Katip Çelebi University. The study was approved by the Ethics Committee of İzmir Katip Çelebi University. All the patients were informed about the purposes of the study and have signed their “consent of the patient.” This article does not contain any studies with animals performed by any of the authors.

Competing interests

The authors declare that they have no competing interests.


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Copyright information

© European Association for Predictive, Preventive and Personalised Medicine (EPMA) 2019

Authors and Affiliations

  1. 1.Department of Neurologyİzmir Katip Çelebi UniversityİzmirTurkey

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