MOOD DISORDERS AND DYSFUNCTION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN MULTIPLE-SCLEROSIS - ASSOCIATION WITH CEREBRAL INFLAMMATION

Objective: To investigate the association between affective and neuroe ndocrine abnormalities, commonly observed in multiple sclerosis, with inflammatory disease activity. Design: Cross-sectional design. Twenty- three patients with definite relapsing-remitting multiple sclerosis an d age-and sex-matched control subjects were investigated. Depression a nd anxiety were assessed using structured interviews, self-report meas ures, and Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria. Neurologic impairment was assessed by the Kurtzke Expanded Disability Status Scale and function of hypothalamic- adrenal-pituitary axis was analyzed using a corticotropin-releasing ho rmone stimulation test after dexamethasone suppression. Inflammatory d isease activity was evaluated first by routine and experimental labora tory tests, and second by magnetic resonance assessment of gadolinium uptake of multiple sclerotic plaques. Setting: University hospital, a major provider of acute neurologic care. Results: Compared with contro ls, patients with multiple sclerosis had higher scores on depression a nd anxiety scales and exhibited a failure of suppression of cortisol r elease after dexamethasone pretreatment. Both affective symptoms and n euroendocrine abnormalities were correlated with cerebrospinal fluid w hite blood cell counts and presence of gadolinium-enhancing lesions on magnetic resonance images; however, no association with the degree of neurologic impairment was observed. Conclusion: Affective and neuroen docrine disorders were related to inflammatory disease activity but no t to degree of disability, supporting the hypothesis that these sympto ms are causally associated with brain injury.