A medical, legal, and
informational resource
for persons dealing with
traumatic brain injury.

MULTIPLE SCLEROSIS AGGRAVATION
BY STRESS AND TRAUMA

Relationship Between Acute Stress and Aggravation of Multiple Sclerosis:

The relationship between acute stress and aggravation of quiet or asymptomatic MS is well established by medical literature especially that which has come out since the year 2000.

1. The study published in the distinguished Journal of Neurology in 2000 by Mohr et al entitled "Psychological Stress and the Subsequent Appearance of New Brain MRI Lesions in MS" examine the relationship between stressful life events and the subsequent development of brain lesions on MRI. The results state "for a total sample of patients, increase conflict and disruption in routine was followed by increased odds of developing new Gd + brain lesions eight weeks later."
   
   
2. An article (Esposito, et al) in the "Journal of Pharmacology and Experimental Therapeutics" looked at the cellular mechanism involved in stress on a microscopic level. Their findings, published December 2002, state "these results demonstrate that CRH and the mast cells are involved in regulating BBB permeability and possibly, brain inflammatory disorders exacerbated by acute stress."
   
   
3. An article from a distinguished British Medical Journal(BMJ) was published in 2003. The paper entitled "Self Reported Stressful Life Events and Exacerbations in Multiple Sclerosis: Prospective Study" (Buljevac D. et al, 2003) sought to study the relationship between stressful life events not related to MS and the occurrence of exacerbations in relapsing remitting MS. Patients used in the study were ones with the ability to walk, such as the Plaintiff. It noted in the introduction into the paper that "psychological stress is an additional factor that has been implicated repeatedly as a determinate of disease activity ever since Charcot first described the disease." In the conclusion to the study it was noted "stressful events were associated with increased exacerbations in relapsing-remitting multiple sclerosis. This association was independent of the triggering effect of infections on exacerbations of multiple sclerosis." They noted that this study fulfilled an earlier need by the American Academy of Neurology to obtain tightly defined prospective study on stress and aggravation of MS. They noted that their study adds "that patients with multiple sclerosis who experience a stressful event are subsequently at increased risk of an exacerbation of their disease."
4. A Harvard Medical School (2002) study "The Role of Stress in Neuro - degeneration Diseases and Mental Disorders" noted the relationship between stress and disease like MS.
   
   
5. A 2002 University of California study (Mohr D.C. et al) entitled "Moderating Effects of Coping on the Relationship Between Stress and the Development of New Brain Lesions in Multiple Sclerosis" stated "considerable research has supported a relationship between stress and both clinical exacerbation and the development of new brain lesions".
   
   
6. The Journal "Neuroendocrinology Letters" in 2004 published a supportive article.
   
   
7. The Journal of Neuroimmunology in 2004 confirmed again that stress can affect the mast cells leading to worsening of inflammatory diseases.

Multiple Sclerosis and Physical Trauma:

For over a century, patients and physicians have dealt with the phenomena that suggests that trauma may proceed the onset of MS or may aggravate ongoing MS. Because of the variability of the course of MS, there is some controversy regarding the causation between physical trauma and onset or aggravation of MS. However, more recent studies have shown that trauma to the head and neck does indeed bear a relationship to the aggravation of or creation of MS.

A 2001 article in the European Journal of Neurology (A. Chaudhuri and Behan). In the conclusion of the paper it is noted:

Like infection, which will trigger MS symptoms only in a portion of a patients [10% (McAlpine et al, 1965) - 48% (Sibley and Foley, 1965)], cervical cord hyperextension - hyperflexion injury is likely to unmask or worsen the natural course of MS in a sub group of affected patients with an underlying diathesis. This may be important because of the prevalence of asymptomatic ("silent") MS has been estimated to be about 25% of that diagnosed invivo (Engell, 1989). We make it clear that we do not propose physical trauma in any form causes MS per se. Physiologically, CNS - specific trauma produces focal reaches in the BBB [brain-blood barrier] and induces metabolic changes by activating the stress response. In addition, focal trauma also enhances the expression of nitric oxide synthase in the CNS microvasculature. In susceptible individuals, these effects might unleash critical changes in the level of pro-inflammatory cytokines and nitro oxide, this triggering MS symptoms ab initio or aggravating symptoms of pre-existing latent disease.

Dr. Charles Poser of Harvard Medical School has long been a proponent of the link between trauma and MS. As he notes in his enclosed paper entitled "Trauma to the Central Nervous System May Result in Formation or Enlargement of Multiple Sclerosis Plaques," "In some patients with MS certain types of trauma may act as a trigger at sometime for the appearance of new or recurrent symptoms. Only trauma affecting the head, neck or upper back, that is, to the brain and/or spine cord can be considered significant." (Published in the Archives of Neurology, July 2000). Dr. Poser goes on to talk about the effects of whiplash on the central nervous system and outlines the existing extensive medical research that back up the correlation.