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Stress may increase the risk of an exacerbation in people with relapsing remitting multiple sclerosis

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Neurologists and patients have long suspected that stress can trigger exacerbations of multiple sclerosis. Circumstantial evidence has suggested it since Charcot first described the disease. New, more robust, prospective data from the Netherlands now confirm a clear link between stressful life events and clinically defined exacerbations. The risk of an exacerbation seems to double in the four weeks following a stressful life event including a death in family, marriage problems, holiday stress, or even the death of pet. The researchers, who recruited a cohort of 73 patients from a single Dutch outpatient clinic, found that the link between stress and worsening disease is independent of any reported infections, ruling out confounding by this well known trigger.

Patients, who were all between 15 and 55 with relapsing remitting multiple sclerosis, kept weekly diaries recording stressful events for an average of 1.4 years. They were all examined regularly by a neurologist, and had extra appointments after self reported neurological deterioration, or an infection. Compliance with the diaries was good, covering 84 of follow up. Patients were considered high risk for an exacerbation for four weeks after a stressful event. At the end of follow up, the researchers compared the rate of clinically proven exacerbations in high risk weeks, with the rate in low risk weeks. The rate was 2.2 times higher in high risk weeks, a significant increase. The next step, they say, is to find out why. Measuring the neuroendocrine response to stress in these patients might be a good place to start.

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