The relationship of MS to physical trauma and psychological stress [RETIRED]

Abstract

Despite the long history of the idea that physical trauma or psychological stress might be involved in the causality or exacerbation of multiple sclerosis (MS), the proposed causal link between these factors and MS has yet to be established or refuted conclusively. Much of this uncertainty and debate occurs because many reports that propose such a causal link are either uncontrolled series or reports using very small sample sizes (studies that today would be regarded as examples of Class III evidence). For this review, only Class II studies (i.e., studies with a defined control population) were considered in detail. On the basis of Class II evidence, any posited association of trauma, especially head trauma, with more than a small effect on either MS onset or exacerbation is excluded. Moreover, the preponderance of the Class II evidence supports no association between physical trauma and either MS onset or exacerbation. On the basis of several Class II studies, the relationship between antecedent psychological stress and either MS onset or exacerbation is considered possible. Nevertheless, prospective data are insufficient to establish any such relationship with reasonable medical certainty. (PsycINFO Database Record (c) 2012 APA, all rights reserved)