1.Stress differentially predicts multiple sclerosis relapses
Shahram Oveisgharan ; S Simindokht Hosseini ; Mohammad Arbabi ; Shahriar Nafissi
Neurology Asia 2014;19(1):53-58
Background and Objective: For decades, stress has been postulated as a risk factor for multiple sclerosis
(MS) relapses. Because of conflicting results in previous studies we conducted a prospective study to
investigate this relationship in a less studied, Middle Eastern population. Methods: In this prospective
study, 57 Iranian MS patients were followed trimonthly for 12 months. Possible stressful events (measured
with validated Persian version of Paykel’s questionnaire) and quality of life (measured with validated
Persian version of the Multiple Sclerosis Impact Scale questionnaire) were assessed in successive visits
in addition to other variables. Relapses were enquired and confirmed clinically by a Neurologist. Main
analysis was done by use of Mixed Generalized Linear Model. Results: Mean age of the participants
was 33.5±7.4 years, 81% were females, and all were receiving interferons. Number of stressors, not
the stress severity measures, reached near significance in predicting relapses (p=0.054), and showed a
trend towards significance in predicting severe relapses (p=0.082). Education and number of previous
relapses were the only variables that had a near significance interaction with number of stressors in
its association with MS relapse. This association was only significant among subjects with less than
college education (P=0.008) and subjects with more than 2 relapses (p=0.038).
Conclusion: Number of stressors, not their severity, was associated with MS relapses among Iranian
patients. This association had interaction with education and history of previous relapses; it was
significant only among lower educated patients or patients with more prior relapses.