Psychological stress and the subsequent appearance of new brain MRI lesions in MS

Objective: To examine the relationship between stressful life events and ps ychological distress, and the subsequent development of gadolinium-enhancin g (Gd+) brain lesions. Background: It has long been speculated that stressf ul life events and psychological distress are associated with disease exace rbation in MS. This is the first prospective longitudinal study of the rela tionship between stressful life events, psychological distress, and disease activity as measured by Gd+ brain MRI. Methods: Thirty-six patients (mean age, 44.4 years; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28 to 100 weeks. Assessments included Gd+ MRI, the Social Readjustment Rating Scale (SRRS), the Hassles Scale, and the Profile of Mood States. The SRRS was altered in the following manner: 1) three ite ms that confounded with MS were eliminated, 2) endorsed items were rated fo r intensity, and 3) the scale was divided into three subscales: major negat ive events, conflict and disruption in routine, and positive life events. D ata were analyzed using mixed-effects logistic regression to account for in trasubject correlations. Stress and distress measures were used to predict concurrent and future MRI activity. Results: For the total sample of patien ts, increased conflict and disruption in routine was followed by increased odds of developing new Gd+ brain lesions 8 weeks later (odds ratio, 1.64; p = 0.00083). There was no strong evidence of a relationship between psychol ogical stress or distress and clinical exacerbation. Conclusions: These dat a provide support for the notion that conflict and disruption in routine ar e related to subsequent disease activity in MS. However, this relationship is not sufficiently robust to predict clinical exacerbations reliably in in dividual patients.