Do positive or negative stressful events predict the development of new brain lesions in people with multiple sclerosis?

Abstract

Background Stressful life events have long been suspected to contribute to multiple sclerosis (MS) disease activity. The few studies examining the relationship between stressful events and neuroimaging markers have been small and inconsistent. This study examined whether different types of stressful events and perceived stress could predict development of brain lesions. Methods This was a secondary analysis of 121 patients with MS followed for 48 weeks during a randomized controlled trial comparing Stress Management Therapy for MS to a waitlist control. Patients underwent MRI’s every 8 weeks. Monthly, patients completed an interview measure assessing stressful life events, and self-report measures of perceived stress, anxiety, and depressive symptoms, which were used to predict the presence of gadolinium enhancing (Gd+) and T2 lesions on MRI’s 29–62 days later. Participants classified stressful events as positive or negative. Negative events were considered “major” if they involved physical threat or threat to the patient’s family structure, and “moderate” otherwise. Results Positive stressful events predicted decreased risk for subsequent Gd+ lesions in the control group (OR=.53 for each additional positive stressful event, 95% CI=.30–.91) and less risk for new or enlarging T2 lesions regardless of group assignment (OR=.74, 95% CI=.55–.99). Across groups, major negative stressful events predicted Gd+ lesions (OR=1.77, 95% CI=1.18–2.64) and new or enlarging T2 lesions (OR=1.57, 95% CI=1.11–2.23), while moderate negative stressful events, perceived stress, anxiety, and depressive symptoms did not. Conclusions Major negative stressful events predict increased risk for Gd+ and T2 lesions, while positive stressful events predict decreased risk.

Antivirus immune activity in multiple sclerosis correlates with MRI activity

“…Multiple prospective studies of cytokine secretion in patients with MS found increased production of tumor necrosis factor-a or IFNc 2-4 weeks before a clinical relapse (24)(25)(26)(27)(28). And psychologic stress is associated with relapses or MRI activity 2-8 weeks later (32)(33)(34)(35). And psychologic stress is associated with relapses or MRI activity 2-8 weeks later (32)(33)(34)(35).…”

Ambulatory Assessment in Neuropsychology

“…A recent randomised trial of stress management in MS patients provided evidence for a reduction of new gadolinium-enhancing (Gd+) and T2 lesions in magnetic resonance imaging (MRI) scans during the intervention, although these effects did not remain stable after treatment was finished ). An additional analysis of data from this study suggested that major negative stressful events, but not moderate negative stressful events and perceived stress, predicted Gd+ lesions on MRI scans carried out 1-2 months later (Burns, Nawacki, Kwasny, Pelletier, & Mohr, 2014). It is therefore unclear which type of stressor is typically relevant for MS progression, and why stress management generates clear positive effects that are nevertheless time-limited.…”

Managing psychological stress in the multiple sclerosis medical visit: Patient perspectives and unmet needs

“…Objective evidence continues to demonstrate that psychological stress can worsen MS symptoms (Burns et al, 2013; Mohr et al, 2000, 2004, 2012), and thus we assert that stress should, in some way, be addressed in the medical context. This study explored how stress is handled in the MS medical visit from the patient perspective and is the first we are aware of to address this question directly.…”

“…Stressful life events have been found to predict increased MS lesions in the brain (Burns et al, 2013; Mohr et al, 2000; Yamout et al, 2010; see Lovera & Reza, 2013 for review), and a stress-management intervention has been shown to reduce the appearance of new brain lesions on MRI (Mohr et al, 2012). …”