Stress as a Risk Factor for Multiple Sclerosis Onset or Relapse: A Systematic Review

Background: Stress has been considered a triggering factor for multiple sclerosis (MS) since the description of the disease by Jean-Martin Charcot. Until our times, many published studies have supported that both MS onset and relapse could be predisposed by psychological stress. This review aims to synthesize existing knowledge of the relationship between psychological stress and MS onset and relapse, focusing mainly on the quality of observational studies. Methods: We hand-searched MEDLINE with the terms ‘stress and multiple sclerosis’, using English language restrictions, from January 1980 to November 2010. We included only observational longitudinal studies. The NewcastleOttawa scale proposed by the Cochrane Collaboration was used for assessing the quality of the observational studies. Results: Seventeen publications were analyzed, 5 for MS onset (1 cohort and 4 case-control studies) and 12 for MS relapse (9 cohort and 3 case-control studies). We found a marked heterogeneity in stress measurement that mostly targeted the environmental approach to stress. Only 2 publications used radiological criteria for MS relapse. Quality issues were identified mainly for comparability, meaning that studies failed to control adequately for various triggering Received: November 16, 2010 Accepted: December 31, 2010 Published online: February 17, 2011 Artemios K. Artemiadis, MD, MSc Immunogenetic Laboratory, Department of Neurology, Aeginition Hospital National and Kapodistrian University Medical School Vassilisis Sofias Avenue 72–74, GR–115-28 Athens (Greece) Tel. +30 210 728 9165, E-Mail artemiad @ med.uoa.gr © 2011 S. Karger AG, Basel 0251–5350/11/0362–0109$38.00/0 Accessible online at: www.karger.com/ned A.K.A. and E.C.A. contributed equally to reviewing all the publications and analyzing the data. All authors contributed equally to the interpretation of the results. All the work was coordinated by E.C.A. and M.C.A. The article was written initially by A.K.A. and revised by