A new study that combined results of previously published research findings suggests that acute attacks of multiple sclerosis may be associated with stressful life events. The study, appearing in the British Medical Journal and funded in part through National MS Society postdoctoral fellowships, is a “meta-analysis” (which statistically combines findings) of previously published studies of the topic of stress and MS.
Background:Multiple sclerosis is thought to be an autoimmune disease that targets the brain and spinal cord. In its most common form (“relapsing-remitting MS”), neurological symptoms of the disease come and go in the form of acute attacks followed by periods of partial or complete recovery. It is still not known what causes MS, or what triggers relapses, although upper respiratory infections have been linked to relapses in some individuals. Although there have been many studies examining a possible link between stress and MS, conclusions have been controversial. This is because stress has many different meanings and has been defined and studied in many different ways that are hard to compare. Moreover, studies of stress and the long-term course of MS are lacking.
The Study: David Mohr, PhD, and colleagues (University of California at San Francisco) searched the medical literature for studies from 1965 to February 2003 that contained the terms “stress,” “trauma,” and “multiple sclerosis.” The investigators independently reviewed the papers, analyzing methods, statistics, and outcomes. They excluded studies that focused solely on physical trauma or medical conditions, and also excluded studies that did not provide adequate details of methods and outcomes. National MS Society-funded postdoctoral fellows Laura Julian, PhD, and Darcy Cox, PsyD, contributed to the analysis.
The authors included 14 studies that met their screening criteria, including studies that looked at MS relapses after diagnosis as well as initial MS attacks. In 13 out of 14 studies, the authors noted a significant increase in the likelihood of MS relapse following stressful life events, such as marital problems or financial difficulties. In one study however, stress was followed by a reduction in relapses.
The authors conclude that these studies indicate a modest association between stressful events and MS relapses, but also note the limitations of their study. The quality of the studies they reviewed varied, and the authors of those studies did not always consider or report other factors (such as upper respiratory infections) that might have triggered relapses. Furthermore, the association between stress and relapse was not consistent among patients, or even in one individual over time.