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Jensen SKG, Camposano S, Berens A, Waltz M, Krupp LB, Charvet L, Belman AL, Aaen GS, Benson LA, Candee M, Casper TC, Chitnis T, Graves J, Wheeler YS, Kahn I, Lotze TE, Mar SS, Rensel M, Rodriguez M, Rose JW, Rubin JP, Tillema JM, Waldman AT, Weinstock-Guttman B, Barcellos LF, Waubant E, Gorman MP. Early Adversity and Socioeconomic Factors in Pediatric Multiple Sclerosis: A Case-Control Study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200282. [PMID: 39146511 DOI: 10.1212/nxi.0000000000200282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Psychosocial adversity and stress, known to predispose adults to neurodegenerative and inflammatory immune disorders, are widespread among children who experience socioeconomic disadvantage, and the associated neurotoxicity and proinflammatory profile may predispose these children to multiple sclerosis (MS). We sought to determine associations of socioeconomic disadvantage and psychosocial adversity with odds of pediatric-onset MS (POMS), age at POMS onset, and POMS disease activity. METHODS This case-control study used data collected across 17 sites in the United States by the Environmental and Genetic Risk Factors for Pediatric Multiple Sclerosis Study. Cases (n = 381) were youth aged 3-21 years diagnosed with POMS or a clinically isolated demyelinating syndrome indicating high risk of MS. Frequency-matched controls (n = 611) aged 3-21 years were recruited from the same institutions. Prenatal and postnatal adversity and postnatal socioeconomic factors were assessed using retrospective questionnaires and zip code data. The primary outcome was MS diagnosis. Secondary outcomes were age at onset, relapse rate, and Expanded Disability Status Scale (EDSS). Predictors were maternal education, maternal prenatal stress events, child separation from caregivers during infancy and childhood, parental death during childhood, and childhood neighborhood disadvantage. RESULTS MS cases (64% female, mean age 15.4 years, SD 2.8) were demographically similar to controls (60% female, mean age 14.9 years, SD 3.9). Cases were less likely to have a mother with a bachelor's degree or higher (OR 0.42, 95% CI 0.22-0.80, p = 0.009) and were more likely to experience childhood neighborhood disadvantage (OR 1.04 for each additional point on the neighborhood socioeconomic disadvantage score, 95% CI 1.00-1.07; p = 0.025). There were no associations of the socioeconomic variables with age at onset, relapse rate, or EDSS, or of prenatal or postnatal adverse events with risk of POMS, age at onset, relapse rate, or EDSS. DISCUSSION Low socioeconomic status at the neighborhood level may increase the risk of POMS while high parental education may be protective against POMS. Although we did not find associations of other evaluated prenatal or postnatal adversities with POMS, future research should explore such associations further by assessing a broader range of stressful childhood experiences.
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Affiliation(s)
- Sarah K G Jensen
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Susana Camposano
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Anne Berens
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Michael Waltz
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Lauren B Krupp
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Leigh Charvet
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Anita L Belman
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Gregory S Aaen
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Leslie A Benson
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Meghan Candee
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Theron C Casper
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Tanuja Chitnis
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Jennifer Graves
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Yolanda S Wheeler
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Ilana Kahn
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Timothy E Lotze
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Soe S Mar
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Mary Rensel
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Moses Rodriguez
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - John W Rose
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Jennifer P Rubin
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Jan-Mendelt Tillema
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Amy T Waldman
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Bianca Weinstock-Guttman
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Lisa F Barcellos
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Emmanuelle Waubant
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
| | - Mark P Gorman
- From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco
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von Drathen S, Gold SM, Peper J, Rahn AC, Ramien C, Magyari M, Hansen HC, Friede T, Heesen C. Stress and Multiple Sclerosis - Systematic review and meta-analysis of the association with disease onset, relapse risk and disability progression. Brain Behav Immun 2024; 120:620-629. [PMID: 38906489 DOI: 10.1016/j.bbi.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/25/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVE This systematic review and meta-analysis address the evidence on the association of psychological stressors with onset of multiple sclerosis, inflammatory disease activity (relapses or new disease activity on magnetic resonance imaging, MRI) and disability progression. METHODS PubMed was searched from 1946 to 15 July 2022. Studies and certain stressors were selected when they assessed stressors independent from stress elicited by the disease process itself. Risk of bias was assessed by the CASP Case Control Study Checklist and the CASP Cohort Study Checklist. Normal-Normal Hierarchical Model (NNHM) for random-effects meta-analysis was used in the Bayesian framework. RESULTS 30 studies reporting data from 26 cohorts reporting on 24.781 cases could be identified. Ten studies addressed stressors and MS disease onset showing a weak to modest effect of psychological stressors. A meta-analysis of three studies investigating diagnosed stress disorders and MS risk showed a 1.87-fold (CI 1.061 to 3.429) increased MS risk. Stress and MS relapse risk were addressed in 19 heterogeneous studies. Meta-analyses from two independent cohorts investigating the same military threat of a population showed a threefold increased risk for relapses in association with war (relapse rate: 3.0, CI 1.56 to 5.81). In addition, two studies confirmed an association of stressful life events and MRI activity. Three studies of stressors and disease progression were included indicating some effect on disease progression. CONCLUSIONS Taken together studies indicate a minor to modest impact of psychological stressors on disease onset, inflammatory activity and progression of MS. Possible case-selection bias and lack of confounder analysis were present in many studies.
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Affiliation(s)
- Sönke von Drathen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Friedrich-Ebert-Krankenhaus, Friesenstraße 11, D-24534 Neumünster, Germany.
| | - Stefan Michael Gold
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg; Charité Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, D-12203 Berlin, Germany; Charité Universitätsmedizin Berlin, Medical Department, Section Psychosomatic Medicine, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, D-12203 Berlin, Germany
| | - Julia Peper
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Anne Christin Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Caren Ramien
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg
| | - Melinda Magyari
- Danish Multiple Sclerosis Center and The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Hans-Christian Hansen
- Department of Neurology, Friedrich-Ebert-Krankenhaus, Friesenstraße 11, D-24534 Neumünster, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg
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Fauver M, Clark EM, Schwartz CE. A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis. Front Integr Neurosci 2024; 18:1365672. [PMID: 38957213 PMCID: PMC11218666 DOI: 10.3389/fnint.2024.1365672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.
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Affiliation(s)
- Michelle Fauver
- Integral Health Program, California Institute for Human Science, Encinitas, CA, United States
| | - Eva M. Clark
- MIND based Healing, Santa Cruz, CA, United States
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Department of Medicine and Departments of Orthopaedic Surgery, Tufts University Medical School, Boston, MA, United States
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Reece JC, Neate SL, Davenport RA, Milanzi E, Nag N, Bevens W, Yu M, Jelinek GA, Simpson-Yap S. Stressful life events and depression and fatigue in people with multiple sclerosis: a cross-sectional analysis of an international cohort. Acta Neurol Belg 2024; 124:457-466. [PMID: 37770791 DOI: 10.1007/s13760-023-02390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Relationships between stressful life events (SLEs) and health outcomes in people living with multiple sclerosis (plwMS), beyond relapse, are not well-established. We examined associations between SLEs and fatigue and symptoms of depression in plwMS. METHODS 948 participants were queried whether they had experienced any of the 16 SLEs (Holmes-Rahe Social Readjustment Rating Scale) in the preceding 12 months. SLEs were summated to estimate SLE number and SLE load (weighted for the degree of associated stress). Cross-sectional associations between SLE (number, load and individual) and fatigue, and depressive symptoms were examined using log-binomial or log-multinomial regression adjusted for age, sex, relapse symptoms, education, MS type at baseline, disability, fatigue, comorbidity, depression, and antidepressant/antifatigue medications, as appropriate. Sub-analyses restricted to SLEs with a negative emotional impact were performed. RESULTS Median SLE number and load were 2 (IQR 1-2) and 57 (IQR 28-97), respectively. SLE number and load were not associated with a higher prevalence of fatigue, or depressive symptoms, even when restricting analyses to SLEs with a perceived negative emotional impact. A new relationship or family member with a negative impact was associated with a threefold and 2.5-fold higher prevalence of depressive symptoms, respectively. Serious illness was associated with a 28% higher prevalence of depressive symptoms. CONCLUSION Psychological support for SLEs, and/or intervention targeted to SLE appraisal, may be beneficial in mitigating the adverse effects of SLEs with a perceived negative emotional impact on depressive symptoms in plwMS. Potential associations between serious illness and increased prevalence of depressive symptoms may warrant further investigation.
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Affiliation(s)
- Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia
| | - Sandra L Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia
| | - Rebekah A Davenport
- Mood, Anxiety and Eating Disorders Laboratory, School of Psychological Sciences, The University of Melbourne, Australia
| | - Elasma Milanzi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia
| | - Maggie Yu
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie St, The University of Melbourne, VIC, 3010, Australia.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Gammoh O, Ennab W. Depression, anxiety, insomnia and dysmenorrhea in stressed fingolimod-treated women with multiple sclerosis. Int J Psychiatry Med 2024; 59:50-64. [PMID: 37465938 DOI: 10.1177/00912174231190455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study examined the prevalence and correlates of depression, anxiety, insomnia, and dysmenorrhea in stressed fingolimod-treated women with multiple sclerosis. METHODS This cross-sectional study recruited female patients diagnosed with multiple sclerosis and high stress scores from Al-Bashir Hospital in Jordan. Depression was assessed by the Patient Health Questionnaire (PHQ-9); anxiety by the Generalized Anxiety Disorder (GAD-7) scale; insomnia by the Insomnia Severity Index (ISI-A) scale; and dysmenorrhea severity by a measure assessing working ability, location, intensity, days of pain, and miscellaneous dysmenorrhea symptoms (WaLIDD). RESULTS A total of 129 patients were recruited for the study. Severe depression was reported in 55.8%, severe anxiety in 62.0%, severe insomnia in 36.4%, and severe dysmenorrhea in 23.3%. Multivariate analyses revealed that depressive symptoms were associated with dysmenorrhea (OR = 3.55, 95% CI = 1.56-8.12, p = 0.003); anxiety symptoms with "not using dysmenorrhea analgesics" (OR = 2.74, 95% CI = 1.16-6.46, p = 0.02) and dysmenorrhea symptoms (OR = 4.74, 95% CI = 1.94-11.59, p = 0.001); insomnia symptoms with age above 30 years (OR = 4.34, 95% CI = 1.64-11.51, p = 0.003); and dysmenorrhea symptoms with the presence of chronic diseases (OR = 4.21, 95% CI = 1.28-13.92, p = 0.02), anxiety symptoms (OR = 3.03, 95% CI = 1.18-7.73, p = 0.02), and insomnia symptoms (OR = 3.00, 95% CI = 1.18-7.64, p = 0.02). CONCLUSION Stressed women with multiple sclerosis in Jordan experience high rates of depression, anxiety, insomnia, and dysmenorrhea. Characteristics related to these conditions may help clinicians to identify those at risk. Longitudinal studies are needed to determine the causal nature of these associations.
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Affiliation(s)
- Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
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Briones-Buixassa L, Montañés-Masias B, Milà-Villaroel R, Arrufat FX, Aragonès JM, Norton S, Bort-Roig J, Moss-Morris R. The bidirectional effect of stress and functionality in multiple sclerosis and the interaction role of anxiety, coping and social support. J Psychosom Res 2023; 170:111375. [PMID: 37196585 DOI: 10.1016/j.jpsychores.2023.111375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/27/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The present study aims to analyse the bidirectional hypothesis between stress and multiple sclerosis with several measures of stress, impairment and functionality, considering also the interaction role of stress-related psychosocial factors such as anxiety, coping and social support. METHODS A one-year follow-up was conducted with 26 people with multiple sclerosis. Participants reported i) at baseline, anxiety (State-Trait Anxiety Inventory), and social support (Multidimensional Scale of Perceived Social Support); ii) daily, Ecological Momentary Assessment through self-reported diaries of stressful events and coping strategies; iii) monthly, the perceived stress (Perceived Stress Scale), iv) trimonthly, the self-reported functionality (Functionality Assessment in multiple sclerosis) and v) at baseline and at the end, neurologist rated impairment (Expanded Disability Status Scale). Mixed-effect regression models were conducted. RESULTS The bidirectional hypothesis was confirmed with perceived stress and self-reported functionality, which were negatively related in both directions. Coping and anxiety showed an interaction effect: active coping increased functionality only with high levels of stress, and high-trait anxiety showed lower functionality whereas low-trait anxiety showed higher functionality but only with low stress levels. CONCLUSION People with multiple sclerosis may benefit from different types of psychological therapies, from gold-standard therapies like Cognitive Behavioural Therapy to third-waves therapies like Dialectical Behaviour Therapy or mindfulness, that focus on dealing with stress and affective symptoms, adjusting to the disease, and to improving their overall quality of life. More research is needed in this field under the biopsychosocial model.
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Affiliation(s)
- Laia Briones-Buixassa
- Department of basic health sciences, Innovation in Mental Health and Social Wellbeing Research Group (ISaMBeS), Centre for Health and Social Care Research (CESS), Universitat de Vic - Universitat Central de Catalunya, C/ Sagrada Familia, 7, Vic 08500 - Spain; Department of Health Sciences, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain.
| | - Brenda Montañés-Masias
- Department of basic health sciences, Innovation in Mental Health and Social Wellbeing Research Group (ISaMBeS), Centre for Health and Social Care Research (CESS), Universitat de Vic - Universitat Central de Catalunya, C/ Sagrada Familia, 7, Vic 08500 - Spain
| | - Raimon Milà-Villaroel
- Global Research on Wellbeing (GRoW), Blanquerna School of Health Sciences-Ramon Llull University, Barcelona, Spain
| | | | - Josep Mª Aragonès
- Neurology Department, Consorci Hospitalari de Vic, Vic, Catalonia, Spain
| | - Sam Norton
- Psychology Department, Health Psychology Section, Institute for Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Judit Bort-Roig
- Sport and Physical Activity Research Group, Centre for Health and Social Care Research, Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Rona Moss-Morris
- Psychology Department, Health Psychology Section, Institute for Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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7
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Novak AM, Lev-Ari S. Resilience, Stress, Well-Being, and Sleep Quality in Multiple Sclerosis. J Clin Med 2023; 12:jcm12020716. [PMID: 36675644 PMCID: PMC9864697 DOI: 10.3390/jcm12020716] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, and fatigue in Israeli people with MS (PwMS), and to examine the associations between these factors and the sociodemographic and clinical characteristics. These factors had never before been studied in conjunction in PwMS, nor had they been systematically addressed in Israel, the unique geopolitical situation of which may pose unique challenges. (2) Methods: This was a survey-based, cross-sectional study conducted through an Internet platform. (3) Results: Israeli PwMS who participated in the study were experiencing relatively high levels of stress and low resilience, poor sleep quality, and severe fatigue. The analysis revealed significant associations between resilience and stress, well-being, and anxiety, as well as stress and well-being, resilience, sleep quality, fatigue, and Clinically Isolated Syndrome (CIS). (4) Conclusions: the Israeli PwMS who participated in the study were experiencing higher levels of stress, lower resilience and worse sleep quality than PwMS in other countries, as compared to results previously reported in literature. The findings of this study ought to serve as a call to action for the MS care providers in Israel and warrant further research into the possible causes of the phenomenon and strategies to address it.
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Hosseini Z, Homayuni A, Ghanbarnejad A. Determinants of stress coping behaviors in patients with Multiple Sclerosis (MS-DSCB): development and psychometrics of a PRECEDE model-based questionnaire. BMC Psychiatry 2022; 22:578. [PMID: 36042451 PMCID: PMC9426368 DOI: 10.1186/s12888-022-04217-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Stress management delays the onset or exacerbation of symptoms of multiple sclerosis. The present study aimed to develop and psychometrically evaluate a questionnaire to measure the determinants of stress coping behaviors in patients with multiple sclerosis. METHODS This was a methodological study that was conducted in two stages: qualitative and quantitative phases. Participants in this study were patients with multiple sclerosis who referred to the MS Association and Charity Foundations for Special Diseases in Isfahan in 2021. Preliminary item pool was developed by qualitative part of the study. The validity of the questionnaire was determined with item impact, content validity ratio (CVR), content validity index (CVI), face validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). RESULTS In the first stage, an item pool containing 97 items were generated and after removing duplicate items and merging some of them, a questionnaire containing 51 items was developed. Ten items were removed based on the results of face validity and content validity. The EFA revealed 11 factors containing 41 items that explained 64% of the total variance of test. In CFA, 9 other items were deleted, and the questionnaire was reduced to 32 phrases in general. The results of the CFA determined the 9-factor structure of the questionnaire including awareness, attitude, self-efficacy, access to resources, skills of using resources, social support, important others, behavioral consequences and social comparison. The Cronbach's alpha coefficient of the questionnaire was 0.726. CONCLUSION The results showed that the designed questionnaire is a valid and reliable tool for assessing the determinants of stress coping behaviors in patients with multiple sclerosis. Identifying these factors and designing interventions based on them, in order to control or reduce stress in these patients, can help to improve the quality of life in these patients.
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Affiliation(s)
- Zahra Hosseini
- grid.412237.10000 0004 0385 452XHealth Education and Health Promotion, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Atefeh Homayuni
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Amin Ghanbarnejad
- grid.412237.10000 0004 0385 452XDepartment of Public Health, School of Health, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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9
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Beyond the neuron: Role of non-neuronal cells in stress disorders. Neuron 2022; 110:1116-1138. [PMID: 35182484 PMCID: PMC8989648 DOI: 10.1016/j.neuron.2022.01.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 12/11/2022]
Abstract
Stress disorders are leading causes of disease burden in the U.S. and worldwide, yet available therapies are fully effective in less than half of all individuals with these disorders. Although to date, much of the focus has been on neuron-intrinsic mechanisms, emerging evidence suggests that chronic stress can affect a wide range of cell types in the brain and periphery, which are linked to maladaptive behavioral outcomes. Here, we synthesize emerging literature and discuss mechanisms of how non-neuronal cells in limbic regions of brain interface at synapses, the neurovascular unit, and other sites of intercellular communication to mediate the deleterious, or adaptive (i.e., pro-resilient), effects of chronic stress in rodent models and in human stress-related disorders. We believe that such an approach may one day allow us to adopt a holistic "whole body" approach to stress disorder research, which could lead to more precise diagnostic tests and personalized treatment strategies. Stress is a major risk factor for many psychiatric disorders. Cathomas et al. review new insight into how non-neuronal cells mediate the deleterious effects, as well as the adaptive, protective effects, of stress in rodent models and human stress-related disorders.
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10
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Homayuni A, Hosseini Z, Abedini S. Explaining stress coping behaviors in patients with multiple sclerosis based on the PRECEDE model: a qualitative directed content analysis. BMC Psychiatry 2021; 21:631. [PMID: 34930184 PMCID: PMC8686275 DOI: 10.1186/s12888-021-03643-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Stress can be regarded as one of the consequences of Multiple Sclerosis (MS) and a factor in exacerbating or recurring the symptoms resulting from the disease. This study aimed to explain the stress coping behaviors in patients with MS based on the PRECEDE model. METHODS This study is a qualitative directed content analysis research based on the PRECEDE model. Data were obtained through in-depth semi-structured interviews with 26 patients with MS, who were selected using a purposive sampling and maximum diversity in terms of gender, age, education, marital status, and employment. Data collection continued until the saturation occurred. Simultaneously, collected data were analyzed using a qualitative directed content analysis method. RESULTS Data analysis led to the identification of 11 sub-categories. Of these, 10 sub-categories were assigned to three categories of predisposing factors (awareness, attitude, self-efficacy, and perceived severity), enabling factors (existence of resources, access to resources, skills of using resources, and educational preferences), and reinforcing factors (social support, important others and behavioral consequences). The social comparison category was a new category identified from the analysis of interviews. CONCLUSIONS Based on the results, individual, environmental and social factors play a role in the stress of these patients. Designing programs that lead to their empowerment and improvements in the environmental and social conditions can be effective in controlling stress in these patients. Based on the results, planners can adopt the most appropriate strategies to change these determinants, help reduce stress, and promote the psychological standard of living in these patients.
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Affiliation(s)
- Atefeh Homayuni
- grid.412237.10000 0004 0385 452XStudent Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Health Promotion and Education, Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Sedigheh Abedini
- grid.412237.10000 0004 0385 452XHealth Promotion and Education, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Palukuru S, Patil SS, Nagarathna R, Singh A, Nibedita KS. Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing-Remitting Multiple Sclerosis Patients. Ann Neurosci 2021; 28:29-38. [PMID: 34733052 PMCID: PMC8558981 DOI: 10.1177/09727531211023754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Some investigations point to the beneficial effects of yoga in alleviating
the motor and cognitive dysfunctions in multiple sclerosis (MS) patients by
using varying combinations of physical, breathing, and meditative practices
of yoga. There is a need for a validated yoga module with a holistic
approach that can be used as a standardized protocol by researchers and
therapists. Purpose: To develop and validate an integrated yoga module for practice in
relapsing–remitting MS patients to improve their quality of life. Methods: We did a thorough review of the literature for the development of the yoga
module. We formed an expert group with 24 experts and a neurologist and used
two rounds of interactive Delphi method to combine their opinion to obtain
content validity of the module through online structured questionnaire
prepared for the purpose on a Google Form. We incorporated all suggestions
obtained by the experts. The final module (60 min per session, twice a day,
five days per week) included warm-up exercises, customized asanas,
relaxation techniques, and OM meditation. Advice on yogic diet and
discussion using yogic concepts for stress management also form a part of
the holistic approach to yoga lifestyle modification. Results: Analysis divulged that 30 out of 39 practices exhibited a content validity
ratio value greater than or equal to 0.42. Conclusion: The study has shown good content validity of the integrated yoga module.
Future clinical studies are being planned to rule the feasibility and
reliability of this module.
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Affiliation(s)
- Sreedhar Palukuru
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Suchitra S Patil
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - R Nagarathna
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Amit Singh
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - K S Nibedita
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
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Pokryszko-Dragan A, Chojdak-Łukasiewicz J, Gruszka E, Pawłowski M, Pawłowski T, Rudkowska-Mytych A, Rymaszewska J, Budrewicz S. Burden of COVID-19 Pandemic Perceived by Polish Patients with Multiple Sclerosis. J Clin Med 2021; 10:jcm10184215. [PMID: 34575327 PMCID: PMC8468201 DOI: 10.3390/jcm10184215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
People with multiple sclerosis (MS) were expected to be particularly affected by the COVID-19 pandemic. The purpose of the study was to evaluate the burden of pandemic, perceived by Polish MS patients, with regard to major contributing factors. The survey, conducted in August/September 2020, included: Perceived Stress Scale (PSS-10), Coping Orientations to Problems Experienced (Brief–COPE), questions on demographic data, MS characteristics, and health-related and social aspects of pandemic burden. Relationships were searched between PSS-10 and Mini-COPE results and other analyzed items, using U Mann–Whitney test, Kruskal–Wallis ANOVA rank test and Spearman rank correlation. The survey was answered by 287 MS patients (208 female, 79 male, aged 21–69 years). Since March 2020, 2.4% of respondents had been positive for COVID-19 and 5.2% had undergone a quarantine. Mean PSS-10 score was 19.99, with moderate or high level of stress in 83.3% of respondents. Problem-focused strategies were more frequently used than emotion-focused strategies (1.76 vs. 1.16). Higher PSS-10 score was associated with comorbidities (H = 4.28), increase in major MS symptoms during the pandemic (21.92 vs. 18.06), experience of healthcare limitations (21.12 vs. 17.98), work-related (22.58 vs. 18.69), financial (22.70 vs. 18.83) and family-related problems (22.54 vs. 17.73) due to pandemic restrictions. A coping model was associated with functional disability and limitations to daily activities (H = 7.81). During the first stage of the pandemic, MS patients reported increased level of stress and preferred problem-focused coping. The level of stress and coping showed more relationships with pandemic impact upon social issues than with MS-related variables.
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Affiliation(s)
- Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Justyna Chojdak-Łukasiewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
- Correspondence: ; Tel.: +48-71-734-3100; Fax: +48-71-734-3109
| | - Ewa Gruszka
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Marcin Pawłowski
- Department of Psychiatry, Wroclaw Medical University, Wybrzeże Pasteura 10, 50-367 Wroclaw, Poland; (M.P.); (T.P.); (A.R.-M.); (J.R.)
| | - Tomasz Pawłowski
- Department of Psychiatry, Wroclaw Medical University, Wybrzeże Pasteura 10, 50-367 Wroclaw, Poland; (M.P.); (T.P.); (A.R.-M.); (J.R.)
| | - Anna Rudkowska-Mytych
- Department of Psychiatry, Wroclaw Medical University, Wybrzeże Pasteura 10, 50-367 Wroclaw, Poland; (M.P.); (T.P.); (A.R.-M.); (J.R.)
| | - Joanna Rymaszewska
- Department of Psychiatry, Wroclaw Medical University, Wybrzeże Pasteura 10, 50-367 Wroclaw, Poland; (M.P.); (T.P.); (A.R.-M.); (J.R.)
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
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Kotas R, Nowakowska-Kotas M, Budrewicz S, Pokryszko-Dragan A. The Level of Stress and Coping Strategies in Patients with Multiple Sclerosis and Their Relationships with the Disease Course. J Clin Med 2021; 10:jcm10173916. [PMID: 34501362 PMCID: PMC8432053 DOI: 10.3390/jcm10173916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: Stress is supposed to be linked with a background of multiple sclerosis (MS) and the disease course. Design: The study aimed to assess the level of stress and coping strategies in MS patients within a year of follow-up and to investigate the relationships between these aspects and factors related—or not—to MS. Methods: In 65 patients with MS, the Perceived Stress Scale (PSS-10), Type D Scale (DS14) and Coping Orientations to Problems Experienced (COPE) were performed at baseline and after a year. Baseline PSS-10, DS-14 and COPE scores were analyzed with regard to demographics, MS duration, treatment, indices of disability and self-reported stressful events (SEs). Final PSS-10 and COPE results were analyzed with reference to MS activity and SE within a year of follow-up. Results: Initially, 67% of patients reported a moderate or high level of stress and 31% met Type-D personality criteria. Diverse coping strategies were preferred, most of which were problem-focused. The negative affectivity DS-14 subscore (NEG) was correlated with disability level. Non-health-related SEs were associated with higher PSS-10 and NEG scores. After a year, the mean PSS-10 score decreased, while COPE results did not change significantly. Non-health-related SEs were associated with a higher PSS-10 score and less frequent use of acceptance and humor strategies. Those with an active vs. stable MS course during the follow-up did not differ in terms of PSS-10 and COPE results. Conclusions: MS patients experienced an increased level of stress. No significant relationships were found between stress or coping and MS course within a year. Non-health-related factors affected measures of stress more than MS-related factors.
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Affiliation(s)
- Roman Kotas
- Department of Psychiatry, Regional Specialist Hospital, ul. Iwaszkiewicza 5, 59-220 Legnica, Poland;
| | - Marta Nowakowska-Kotas
- Department of Neurology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (S.B.); (A.P.-D.)
- Correspondence: ; Tel.: +48-717343100; Fax: +48-717343109
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (S.B.); (A.P.-D.)
| | - Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (S.B.); (A.P.-D.)
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Lee B, Tansey TN, Chan F, Bishop M, Hoyt WT, Hancock LM. Exploration of the Effects of Protective Person–Environment Factors Between Functional Impairments and Stress in Individuals With Multiple Sclerosis: Mediation and Moderation Analyses. REHABILITATION COUNSELING BULLETIN 2021. [DOI: 10.1177/00343552211025534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional impairments can lead to stress in individuals with multiple sclerosis (MS). The study examined protective person and environment factors (i.e., positive cognitive stress appraisal, core self-evaluations [CSE], resilience, hope, spirituality, social support, and environmental supports) as both mediators and moderators of this association to guide understanding of the experience of stress in this population. The sample consisted of 373 participants with MS. In simple mediation analyses, positive cognitive stress appraisal, CSE, resilience, hope, social support, and environmental supports served as a partial mediator between functional impairments and stress. In a parallel mediation analysis, significant unique indirect effects were observed for two of the seven hypothesized mediator variables (CSE and environmental supports). Separate moderator tests provided support for the CSE variable as a protective factor. The positive association between functional impairments and stress was weaker for persons reporting high CSE compared with those reporting low CSE. The findings provide implications for rehabilitation counseling practices by promoting CSE and environmental supports in improving rehabilitation and psychosocial outcomes for individuals with MS.
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Affiliation(s)
| | | | - Fong Chan
- University of Wisconsin–Madison, USA
| | | | | | - Laura M. Hancock
- University of Wisconsin School of Medicine and Public Health, Madison, USA
- William S. Middleton VA Medical Center, USA
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15
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't Hart BA, Luchicchi A, Schenk GJ, Stys PK, Geurts JJG. Mechanistic underpinning of an inside-out concept for autoimmunity in multiple sclerosis. Ann Clin Transl Neurol 2021; 8:1709-1719. [PMID: 34156169 PMCID: PMC8351380 DOI: 10.1002/acn3.51401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/27/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
The neuroinflammatory disease multiple sclerosis is driven by autoimmune pathology in the central nervous system. However, the trigger of the autoimmune pathogenic process is unknown. MS models in immunologically naïve, specific‐pathogen‐free bred rodents support an exogenous trigger, such as an infection. The validity of this outside–in pathogenic concept for MS has been frequently challenged by the difficulty to translate pathogenic concepts developed in these models into effective therapies for the MS patient. Studies in well‐validated non‐human primate multiple sclerosis models where, just like in humans, the autoimmune pathogenic process develops from an experienced immune system trained by prior infections, rather support an endogenous trigger. Data reviewed here corroborate the validity of this inside–out pathogenic concept for multiple sclerosis. They also provide a plausible sequence of events reminiscent of Wilkin’s primary lesion theory: (i) that autoimmunity is a physiological response of the immune system against excess antigen turnover in diseased tissue (the primary lesion) and (ii) that individuals developing autoimmune disease are (genetically predisposed) high responders against critical antigens. Data obtained in multiple sclerosis brains reveal the presence in normally appearing white matter of myelinated axons where myelin sheaths have locally dissociated from their enwrapped axon (i.e., blistering). The ensuing disintegration of axon–myelin units potentially causes the excess systemic release of post‐translationally modified myelin. Data obtained in a unique primate multiple sclerosis model revealed a core pathogenic role of T cells present in the normal repertoire, which hyper‐react to post‐translationally modified (citrullinated) myelin–oligodendrocyte glycoprotein and evoke clinical and pathological aspects of multiple sclerosis.
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Affiliation(s)
- Bert A 't Hart
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands.,Department Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Antonio Luchicchi
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Geert J Schenk
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Peter K Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Jeroen J G Geurts
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands
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16
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Kołtuniuk A, Kazimierska-Zając M, Cisek K, Chojdak-Łukasiewicz J. The Role of Stress Perception and Coping with Stress and the Quality of Life Among Multiple Sclerosis Patients. Psychol Res Behav Manag 2021; 14:805-815. [PMID: 34177278 PMCID: PMC8219305 DOI: 10.2147/prbm.s310664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Multiple sclerosis (MS) is one of the most common neurological disorders and a cause of disability in young adults. Adequate stress management in MS patients may merit the benefits of both physical and psychological well-being. This study aimed to evaluate the quality of life in MS patients and its correlation with stress levels and coping strategies. Methods This descriptive and correlational study was conducted among 109 patients diagnosed with relapsing-remitting MS (RRMS). The study was based on a questionnaire designed by the authors and the following standardized questionnaires: the Perceived Stress Scale (PSS-10), the Inventory for Measuring Coping with Stress (Mini-COPE), and the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL). Results Data analysis showed that 47.71% of the patients experienced a high level of stress, and the most often used strategies under challenging situations included seeking emotional support (2.11) and active coping (1.96). Also, it showed that when the level of stress is higher, the QOL in all domains is lower. Coping strategies such as sense of humor, turning to religion, self-distraction, denial, venting, substance use, behavioral disengagement, and self-blame are negatively correlated with the quality of life of MS. Conclusion Quality of life in MS patients is negatively affected by a higher level of perceived stress. The use of coping strategies such as active coping, positive reframing, acceptance, and seeking emotional and instrumental support is positively correlated with the quality of life of MS patients.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Kazimierska-Zając
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Cisek
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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17
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Coping strategies in relapsing-remitting multiple sclerosis non-depressed patients and their associations with disease activity. Acta Neurol Belg 2021; 121:465-471. [PMID: 31571134 DOI: 10.1007/s13760-019-01212-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
Few studies evaluated coping strategies in people with multiple sclerosis (pwMS) in relation to annualized relapse rate (ARR) and lesion load (LL). Overall, results might have been influenced by the inclusion of depressed patients. To investigate the coping strategies and their association to disease activity, we studied relapsing-remitting pwMS accurately selected to avoid the confounding effect of depression. Sixty-seven relapsing-remitting pwMS and 67 healthy subjects (HS) underwent to Coping Orientation to Problems Experienced (I-COPE) and Coping Inventory for Stressful Situation (CISS) and Beck Depression Inventory-II. Cognitive performances, ARR, physical disability and magnetic resonance imaging T2-LL were assessed for correlation with coping and depression scores. pwMS showed lower scores than HSs on social support and turning to religion subscales of I-COPE and on emotion dimension of CISS. In pwMS, higher ARR was related to higher positive attitude and lower score on the turning to religion subscale of I-COPE. The present study revealed a less employment of emotion-based coping strategies in pwMS. A scarce use of faith for support and a frequent adoption of a positive attitude were associated with an increase of MS activity in terms of ARR.
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18
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Anagnostouli M, Markoglou N, Chrousos G. Psycho-neuro-endocrino-immunologic issues in multiple sclerosis: a critical review of clinical and therapeutic implications. Hormones (Athens) 2020; 19:485-496. [PMID: 32488815 DOI: 10.1007/s42000-020-00197-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) is a multifactorial, chronic, immune-mediated, and neurodegenerative disease, having a well-known hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Several hormones have a great impact in the immune dysregulation, psychology, and cognitive status of patients with MS, as also in the fertility and response to treatment. In this comprehensive review, as an introduction, we mention basic data concerning MS: epidemiology, genetics, immunogenetics, epigenetics, pathophysiology, and neuroimmunology. Hormonal components of the disease cascade, mainly glucocorticoids (stress-related hormone), estrogens, prolactin and dehydroepiandrosterone (sex-related hormones), melatonin, and vitamin D, are discussed, aiming at focusing on core data regarding the impact of these hormones in MS pathophysiology, severity of the disease, correlation with comorbid mental disorders, and fertility. A great focus is given in the pre- and post-pregnancy period of MS patients, in the context of the disease-modifying treatments (DMTs) and HPA status, having in mind that there are only very limited knowledge and few papers on this specific life period of these women, having MS. All this data are presented in the main text and also in the workable tables, for the first time, suggesting targeted topics that need to be addressed in the near future.
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Affiliation(s)
- Maria Anagnostouli
- Demyelinating Diseases Clinic, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vasilissis Sofias 72-74, 115 28, Athens, Greece.
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vasilissis Sofias 72-74, 115 28, Athens, Greece.
| | - Nikolaos Markoglou
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vasilissis Sofias 72-74, 115 28, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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19
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Shaygannejad V, Afshari-Safavi A, Hatef B. Assessment of mental health, knowledge, and attitude of patients with multiple sclerosis and neuromyelitis optica spectrum disorder in response to 2019 novel coronavirus. Neurol Sci 2020; 42:2891-2901. [PMID: 33219424 PMCID: PMC7678583 DOI: 10.1007/s10072-020-04905-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
Background With the recent pandemic of the novel coronavirus disease (COVID-19), multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients for their compromised immune system have been in significant concern. Awareness and attitude about this virus have an important impact on infection prevention and coping with stress and anxiety. So we conducted this study to assess knowledge, attitude, and mental health status in MS and NMOSD patients within the COVID-19 pandemic. Method In this cross-sectional study, the link of Depression Anxiety Stress Scales-21 (DASS-21) and a self-administered structured questionnaire were sent through social media to MS and NMOSD patients and two control groups consisting of healthy and migraine individuals. Results A total of 223 MS patients, 41 NMOSD, 29 migraine, and 245 healthy subjects participated in this study. MS patients had higher total DASS scores compared to healthy participants (p = 0.012). There were no significant differences among the study groups regarding knowledge and attitude. In MS patients, physical comorbidity was associated with a total score of attitude (OR 1.59, 95% CI 0.53, 2.66, p = 0.004). We did not find association between other demographic and clinical variables with DASS scores, attitude, and knowledge in MS patients. Conclusion The current data highlight the necessity of attitude, knowledge, and mental health assessment among MS and NMOSD patients. Further studies in other countries need to be carried to assess these points among MS and NMOSD patients.
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Affiliation(s)
- Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Vanak, Mollasadra, Tehran, Iran.
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20
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N'diaye M, Brauner S, Flytzani S, Kular L, Warnecke A, Adzemovic MZ, Piket E, Min JH, Edwards W, Mela F, Choi HY, Magg V, James T, Linden M, Reichardt HM, Daws MR, van Horssen J, Kockum I, Harris RA, Olsson T, Guerreiro-Cacais AO, Jagodic M. C-type lectin receptors Mcl and Mincle control development of multiple sclerosis-like neuroinflammation. J Clin Invest 2020; 130:838-852. [PMID: 31725411 PMCID: PMC6994148 DOI: 10.1172/jci125857] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
Pattern recognition receptors (PRRs) are crucial for responses to infections and tissue damage; however, their role in autoimmunity is less clear. Herein we demonstrate that 2 C-type lectin receptors (CLRs) Mcl and Mincle play an important role in the pathogenesis of experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS). Congenic rats expressing lower levels of Mcl and Mincle on myeloid cells exhibited a drastic reduction in EAE incidence. In vivo silencing of Mcl and Mincle or blockade of their endogenous ligand SAP130 revealed that these receptors’ expression in the central nervous system is crucial for T cell recruitment and reactivation into a pathogenic Th17/GM-CSF phenotype. Consistent with this, we uncovered MCL- and MINCLE-expressing cells in brain lesions of MS patients and we further found an upregulation of the MCL/MINCLE signaling pathway and an increased response following MCL/MINCLE stimulation in peripheral blood mononuclear cells from MS patients. Together, these data support a role for CLRs in autoimmunity and implicate the MCL/MINCLE pathway as a potential therapeutic target in MS.
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Affiliation(s)
- Marie N'diaye
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Brauner
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sevasti Flytzani
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lara Kular
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Warnecke
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Milena Z Adzemovic
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eliane Piket
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jin-Hong Min
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Will Edwards
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filia Mela
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hoi Ying Choi
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Vera Magg
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tojo James
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Linden
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Holger M Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Jack van Horssen
- Department of Molecular Cell Biology and Immunology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Robert A Harris
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andre O Guerreiro-Cacais
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maja Jagodic
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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21
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Lee B, Pfaller J, Iwanaga K, Chen X, Wu JR, Chan F. Core self-evaluations as a mediator of the relationship between stress and quality of life in women with multiple sclerosis. JOURNAL OF VOCATIONAL REHABILITATION 2020. [DOI: 10.3233/jvr-191066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Beatrice Lee
- University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Xiangli Chen
- University of Wisconsin-Madison, Madison, WI, USA
| | - Jia-Rung Wu
- Northeastern Illinois University, Chicago, IL, USA
| | - Fong Chan
- University of Wisconsin-Madison, Madison, WI, USA
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22
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Asadollahpour F, Mehri A, Khatoonabadi A, Mohammadzaheri F, Ebadi A. Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:52. [PMID: 31333731 PMCID: PMC6611185 DOI: 10.4103/jrms.jrms_248_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/10/2018] [Accepted: 03/10/2019] [Indexed: 11/22/2022]
Abstract
Background This study is to evaluate swallowing problems (dysphasia) in multiple sclerosis (MS) patients; the importance of using tools that are durable and appropriate is well understood. One of the most trusted tools is the dysphagia in multiple sclerosis (DYMUS) test. The aim of this study was to prepare a Persian version and to evaluate the validity and reliability of the test. Materials and Methods This methodological study was conducted on 236 MS patients in Southeast of Iran from August 2015 to February 2016. After translation and cultural adaptation of the test in Persian, the validity of this test was determined using expert opinions accordance with the International Quality of Life Assessment Project. In addition, exploratory factor analysis (EFA) was performed with varimax rotation. The confirmatory factor analysis (CFA) was conducted and the goodness of fit indices was calculated. Moreover, to test the reliability, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used. Results: In total, 236 MS patients were included in the study (81 males and 155 females). All the questions in the test's Persian version obtained an acceptable face and content validity (content validity ratio = 1, Scale content validity index/Ave = 1). EFA revealed that the scale has two factors (solid–liquid) with 67.5% cumulative variance. CFA indicated a good fit to the intended two-factor structure, and the ratio of Chi-square to the degree of freedom was 1.79, and the root mean square error of approximation was 0.058. The internal consistency of total test indicated the appropriate level (Cronbach's alpha coefficient = 0.775), and test–retest reliability total questionnaire was found to be ICC = 0.985, indicating its high reliability. Conclusion: The results of this study indicated that the Persian version of the DYMUS questionnaire had good reliability and validity for patients with MS.
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Affiliation(s)
- Faezeh Asadollahpour
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Mehri
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Khatoonabadi
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Mohammadzaheri
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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23
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Picariello F, Chilcot J, Hudson JL. Re: Bakkum et al. "Effects of psychological stress on proteinuria in childhood steroid-sensitive nephrotic syndrome". J Psychosom Res 2019; 121:3-5. [PMID: 30987810 DOI: 10.1016/j.jpsychores.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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24
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Abdollahpour I, Nedjat S, Mansournia MA, Eckert S, Weinstock-Guttman B. Stress-full life events and multiple sclerosis: A population-based incident case-control study. Mult Scler Relat Disord 2018; 26:168-172. [PMID: 30268037 DOI: 10.1016/j.msard.2018.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 01/09/2023]
Abstract
AIM While sizeable evidence regarding the association between stressful-life events and multiple sclerosis (MS) disease activity (clinical and/or radiological) was previously documented, their relation to MS risk is controversial. We aimed to investigate the possible association of stressful-life events and multiple sclerosis risk after adjustment for relevant confounders in an Iranian population. METHOD This was a population-based incident case-control study that recruited 547 MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran. The patients were identified using the Iranian MS Society based on 2010 McDonald criteria. We used standard random digit dialing protocol for control selection. Logistic regression model was applied to estimate the odds ratios (95% CI) adjusted for physical activity, age, gender, tobacco smoking, waterpipe smoking and passive smoking. RESULTS While total life events number was not associated with risk of MS, homeless periods OR 3.85 (1.65-8.90), p = 0.002 as well as divorce OR 2.11 (1.24-3.58), p = 0.005 increased the risk of MS. However, marriage OR 0.59 (0.41-0.86), p = 0.006, death of ones' dear OR 0.60 (0.44-0.82), p = 0.002 and joblessness OR 0.61 (0.41-0.91) reduced the risk of MS. CONCLUSION We could not detect a statistically significant role for the total stressful life event during the last 3 years and MS diagnosis. However, there is some evidence confirming the possible role of some individual life events, i.e. divorce and periods of homelessness as potential risk factors for MS and conversely, having married as a protective factor in MS onset.
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Affiliation(s)
- Ibrahim Abdollahpour
- Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak, Iran.
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Svetlana Eckert
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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25
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Immunoregulatory effect of mast cells influenced by microbes in neurodegenerative diseases. Brain Behav Immun 2017; 65:68-89. [PMID: 28676349 DOI: 10.1016/j.bbi.2017.06.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/17/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023] Open
Abstract
When related to central nervous system (CNS) health and disease, brain mast cells (MCs) can be a source of either beneficial or deleterious signals acting on neural cells. We review the current state of knowledge about molecular interactions between MCs and glia in neurodegenerative diseases such as Multiple Sclerosis, Alzheimer's disease, Amyotrophic Lateral Sclerosis, Parkinson's disease, Epilepsy. We also discuss the influence on MC actions evoked by the host microbiota, which has a profound effect on the host immune system, inducing important consequences in neurodegenerative disorders. Gut dysbiosis, reduced intestinal motility and increased intestinal permeability, that allow bacterial products to circulate and pass through the blood-brain barrier, are associated with neurodegenerative disease. There are differences between the microbiota of neurologic patients and healthy controls. Distinguishing between cause and effect is a challenging task, and the molecular mechanisms whereby remote gut microbiota can alter the brain have not been fully elucidated. Nevertheless, modulation of the microbiota and MC activation have been shown to promote neuroprotection. We review this new information contributing to a greater understanding of MC-microbiota-neural cells interactions modulating the brain, behavior and neurodegenerative processes.
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26
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Dehghani A, Nayeri ND, Ebadi A. Development and validation of the coping with multiple sclerosis questionnaire. Mult Scler Relat Disord 2017; 18:49-55. [PMID: 29141821 DOI: 10.1016/j.msard.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/02/2017] [Accepted: 09/10/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Development of a self-report measure of coping with multiple sclerosis is required based on cultural factors, which can advance our understanding of the level of coping for care planning and improvement of coping and quality of life. The current study aimed to develop and validate the scale of coping with Multiple Sclerosis. METHODS This methodological study was conducted in three phases. In the first phase, the concept of coping with MS was defined by the hybrid model. In the second phase, the item pool was generated from findings of the first phase. In the third phase, psychometric properties of the scale were evaluated including face, content and construct validity as well as reliability. RESULTS 192 items in primary item pool were finally reduced to 35 items after evaluating the validity (face, content and construct validity) and reliability. Factor analyses revealed five factors: self-efficacy, self-regulation, accepting the current situation, treatment seeking and adherence to it, and emotional balance. Internal consistency and stability of the developed questionnaire confirmed with 0.93 and 0.96 respectively that indicated excellent reliability. CONCLUSION The 35-item developed questionnaire is valid and reliable for assessment of levels of coping in Iranian people with MS.
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Affiliation(s)
- Ali Dehghani
- Department of Nursing, School of Nursing and Paramedical, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Nursing Faculty of Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Gerrard B, Singh V, Babenko O, Gauthier I, Wee Yong V, Kovalchuk I, Luczak A, Metz GAS. Chronic mild stress exacerbates severity of experimental autoimmune encephalomyelitis in association with altered non-coding RNA and metabolic biomarkers. Neuroscience 2017; 359:299-307. [PMID: 28739526 DOI: 10.1016/j.neuroscience.2017.07.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/25/2017] [Accepted: 07/13/2017] [Indexed: 01/17/2023]
Abstract
The causal factors determining the onset and severity of multiple sclerosis (MS) are not well understood. Here, we investigated the influence of chronic stress on clinical symptoms, metabolic and epigenetic manifestations of experimental autoimmune encephalomyelitis (EAE), a common animal model of MS. Lewis rats were immunized for monophasic EAE with MBP69-88 and were exposed to chronic stress for 37days starting 7days prior to immunization. The exposure to stress accelerated and exacerbated the clinical symptoms of EAE. Both stress and EAE also disrupted metabolic status as indicated by trace elemental analysis in body hair. Stress particularly exacerbated chlorine deposition in EAE animals. Moreover, deep sequencing revealed a considerable impact of stress on microRNA expression in EAE. EAE by itself upregulated microRNA expression in lumbar spinal cord, including miR-21, miR-142-3p, miR-142-5p, miR-146a, and miR-155. Stress in EAE further up-regulated miR-16, miR-146a and miR-155 levels. The latter two microRNAs are recognized biomarkers of human MS. Thus, stress may synergistically exacerbate severity of EAE by altering epigenetic regulatory pathways. The findings suggest that stress may represent a significant risk factor for symptomatic deterioration in MS. Stress-related metabolic and microRNA signatures support their value as biomarkers for predicting the risk and severity of MS.
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Affiliation(s)
- Brietta Gerrard
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Vaibhav Singh
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Olena Babenko
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada; Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4 Canada
| | - Isabelle Gauthier
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - V Wee Yong
- Hotchkiss Brain Institute, Departments of Clinical Neurosciences and Oncology, University of Calgary, Calgary, AB T2N 4N1 Canada
| | - Igor Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4 Canada
| | - Artur Luczak
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada.
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Chiu CY, Motl RW, Ditchman N. Validation of the Social Provisions Scale in people with multiple sclerosis. Rehabil Psychol 2016; 61:297-307. [PMID: 27088267 PMCID: PMC4982855 DOI: 10.1037/rep0000089] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the factorial and construct validity of the Social Provisions Scale (SPS) in a sample of people with multiple sclerosis (MS). METHOD Participants included 292 individuals with MS (83.9% women) recruited from the Greater Illinois, Gateway, and Indiana chapters of the National Multiple Sclerosis Society. Participants completed the SPS and pain, fatigue, depression, anxiety, MS self-efficacy, quality of life, and satisfaction with life measures. Factorial validity was tested using confirmatory factor analysis (CFA), and construct validity was examined based on the strength of bivariate correlations with scores on related measures. RESULTS Findings from the CFA indicated that a first-order, 6-factor measurement model provided a good fit for the 24 items of the SPS (CFI = .94, TLI = .93, RMSEA = 0.07) and that the 6 factors could be described by a single, second-order factor of the overall social provisions (CFI = .93, TLI = .92, RMSEA = 0.08). Cronbach's alpha was .89 for the global score and between .66 and .81 for the 6 subscales. The SPS global and subscale scores correlated significantly with satisfaction with life, depression, anxiety, MS self-efficacy, and quality of life measures. CONCLUSIONS Findings from this study support the factorial validity, construct validity, and reliability of the SPS as a measure of social provisions for use with people with MS. (PsycINFO Database Record
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Brown RF, Tennant CC, Dunn SM, Pollard JD. A review of stress-relapse interactions in multiple sclerosis: important features and stress-mediating and -moderating variables. Mult Scler 2016; 11:477-84. [PMID: 16042233 DOI: 10.1191/1352458505ms1170oa] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies do not provide a consensus opinion of the relationship between stress and relapse in relapsing=remitting multiple sclerosis (RRMS). Few studies have defined the critical features of these stressful situations, or examined the role of stress-mediating and -moderating variables. Available evidence indicates that the relationship between life stress and relapse is complex, and is likely to depend on factors such as stressor chronicity, frequency, severity and type, and individual patient characteristics such as depression, health locus of control and coping strategy use. Little is known about how these factors, individually or in combination, are related to MS disease activity. Viral infections are also likely to precipitate relapse in MS, and significant life-stress may further enhance this relationship. The nature and strength of these interrelationships have strong clinical implications. MS patients are particularly vulnerable to a deteriorating cycle of stressful life events, illness episodes and disability. Timely multidisciplinary care interventions aimed at both minimizing psychological distress and physical symptoms may halt this downward reciprocal cycle. Little is known of the pathogenesis of these putative stress-induced changes in disease activity, and almost all stressor studies suffer from some biases or limitations.
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Affiliation(s)
- R F Brown
- Psychology Department, University of New England, Armidale, NSW, Australia.
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30
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Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD. Relationship between stress and relapse in multiple sclerosis: part I. Important features. Mult Scler 2016; 12:453-64. [PMID: 16900759 DOI: 10.1191/1352458506ms1295oa] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective The aim of this two-year prospective study was to examine the relationship between multiple aspects of life-event stress and relapse in multiple sclerosis (MS) patients. Background Few studies have defined the critical features of this life-event stress; for example, stressor duration, frequency, severity, disease-dependency, valency, or stressor constructs, such as the propensity to cause emotional distress/threat or the frustration of life goals. Methods 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life events were assessed at study-entry and at three-monthly intervals for two years. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. Results Acute events, but not chronic difficulties (CDs), predicted relapse occurrence: acute stressor frequency counts predicted greater relapse risk, along with low disability score (EDSS) and being male. We also confirmed the bi-directional stress-illness hypothesis: stressors predicted relapse, and relapse separately predicted stressors. Conclusions Life-event stress impacts to a small degree on MS relapse. The number and not the severity of acute stressors are most important; chronic stressors do not predict later relapse. Males and those with early stage disease are also at greater risk of relapse. MS patients should be encouraged to reduce acute stressors during times of high stress, and feel reassured that disease-related chronic stressors do not increase their relapse risk.
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Affiliation(s)
- R F Brown
- Department of Psychology, University of New England, Armidale, NSW 2351, Australia.
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Harris ML, Byles JE, Townsend N, Loxton D. Perceptions of coping with non-disease-related life stress for women with osteoarthritis: a qualitative analysis. BMJ Open 2016; 6:e010630. [PMID: 27188808 PMCID: PMC4874169 DOI: 10.1136/bmjopen-2015-010630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Coping with arthritis-related stress has been extensively studied. However, limited evidence exists regarding coping with stress extraneous to the disease (life stress). This study explored life stress and coping in a subset of older women with osteoarthritis from a larger longitudinal study. SETTING An Australian regional university. DESIGN This qualitative study involved semistructured telephone interviews. Potential participants were mailed a letter of invitation/participant information statement by the Australian Longitudinal Study on Women's Health (ALSWH). Invitations were sent out in small batches (primarily 10). Interviews were conducted until data saturation was achieved using a systematic process (n=19). Digitally recorded interviews were transcribed verbatim and deidentified. Data were thematically analysed. PARTICIPANTS Women who indicated being diagnosed or treated for arthritis in the previous 3 years in the fifth survey of the ALSWH (conducted in 2007) provided the sampling frame. Potential participants were randomly sampled by a blinded data manager using a random number generator. RESULTS Coping with life stress involved both attitudinal coping processes developed early in life (ie, stoicism) and transient cognitive and support-based responses. Women also described a dualistic process involving a reduction in the ability to cope with ongoing stress over time, coupled with personal growth. CONCLUSIONS This is the first study to examine how individuals cope with non-arthritis-related stress. The findings add to the current understanding of stress and coping, and have implications regarding the prevention of arthritis in women. Importantly, this study highlighted the potential detrimental impact of persistent coping patterns developed early in life. Public health campaigns aimed at stress mitigation and facilitation of adaptive coping mechanisms in childhood and adolescence may assist with arthritis prevention.
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Affiliation(s)
- Melissa L Harris
- Faculty of Health and Medicine, Research Centre for Generational, Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie E Byles
- Faculty of Health and Medicine, Research Centre for Generational, Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Natalie Townsend
- Faculty of Health and Medicine, Research Centre for Generational, Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah Loxton
- Faculty of Health and Medicine, Research Centre for Generational, Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
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Porcelli B, Pozza A, Bizzaro N, Fagiolini A, Costantini MC, Terzuoli L, Ferretti F. Association between stressful life events and autoimmune diseases: A systematic review and meta-analysis of retrospective case–control studies. Autoimmun Rev 2016; 15:325-34. [DOI: 10.1016/j.autrev.2015.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/15/2015] [Indexed: 01/06/2023]
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Amiri M, Rabiei M, Donyavi V. Effectiveness of Mindfulness Training in Enhancing Executive Function and Decreasing Symptoms of Depression and Anxiety in Patients with Multiple Sclerosis (MS). ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jbbs.2016.68032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Latham LB, Lee MJ, Lincoln JA, Ji N, Forsthuber TG, Lindsey JW. Antivirus immune activity in multiple sclerosis correlates with MRI activity. Acta Neurol Scand 2016; 133:17-24. [PMID: 25939660 DOI: 10.1111/ane.12417] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether reactivation of Epstein-Barr (EBV) or activation of the anti-EBV immune response correlates with MS disease activity on MR imaging. METHODS Subjects with early, active relapsing-remitting MS were studied for 16 weeks with blood and saliva samples collected every 2 weeks and brain MRI performed every 4 weeks. We isolated peripheral blood mononuclear cells from each blood sample and tested the immune response to EBV, autologous EBV-infected lymphoblastoid cell lines (LCL), human herpesvirus 6 (HHV6), varicella zoster virus (VZV), tetanus, and mitogens. We measured the proliferative response and the number of interferon-γ secreting cells with ELISPOT. We measured the amounts of EBV, HHV6, and VZV DNA in blood and saliva with quantitative PCR. On MRI, we measured number and volume of contrast enhancing and T2 lesions. We tested for correlation between the immunologic assays and the MRI results, assessing different time intervals between the MRI and immunologic assays. RESULTS We studied 20 subjects. Ten had enhancing lesions on one or more MRI scans and one had new T2 lesions without enhancement. The most significant correlation was between proliferation to autologous LCL and the number of combined unique active lesions on MRI 4 weeks later. Both proliferation and number of cells secreting interferon-γ in response to LCL correlated with the number of enhancing lesions 8 weeks later. CONCLUSIONS We find evidence for correlation of antiviral immune responses in the blood with subsequent disease activity on MRI scans.
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Affiliation(s)
- L. B. Latham
- Department of Neurology; University of Texas Health Science Center at Houston; Houston TX USA
| | - M. J. Lee
- Clinical and Translational Sciences; University of Texas Health Science Center at Houston; Houston TX USA
| | - J. A. Lincoln
- Department of Neurology; University of Texas Health Science Center at Houston; Houston TX USA
| | - N. Ji
- Department of Biology; University of Texas San Antonio; San Antonio TX USA
| | - T. G. Forsthuber
- Department of Biology; University of Texas San Antonio; San Antonio TX USA
| | - J. W. Lindsey
- Department of Neurology; University of Texas Health Science Center at Houston; Houston TX USA
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Goodin DS. The epidemiology of multiple sclerosis: insights to a causal cascade. HANDBOOK OF CLINICAL NEUROLOGY 2016; 138:173-206. [PMID: 27637959 DOI: 10.1016/b978-0-12-802973-2.00011-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
MS-pathogenesis involves both genetic-susceptibility and environmental determinants. Three (or more) sequential environmental-factors are implicated. The first acts near birth, the second acts during childhood/adolescence, and the third acts subsequently. Two candidate factors (vitamin D deficiency and Epstein-Barr viral infection) seem particularly well-suited to the first two environmental-events but other factors (e.g., obesity and smoking behavior) seem also to be involved in the causal scheme. MS-pathogenesis can be modeled by incorporating both the environmental and genetic-factors into a causal scheme, which can then help to explain some of the changes in MS-epidemiology (e.g., increasing disease-prevalence, changing sex-ratio, and regional-variations in monozygotic-twin-concordance-rates), which have been taking place recently. This model suggests that genetic-susceptibility is overwhelmingly the most important determinant of MS and that, at least, 92.5% of individuals (and likely much more) are, essentially, incapable of developing MS, regardless of their specific environmental-exposures. Nevertheless, the genetics is complex and the contribution of any specific gene to MS-susceptibility seems to be quite modest. Thus, even for the DRB1*1501 allele (the strongest known MS-susceptibility marker), most carriers are not in the genetically-susceptible group. Moreover, 45-50% of individuals with MS lack this allele entirely and some of the haplotypes that carry this allele don't also confer any disease-risk. Finally, because the prevalence of genetic-susceptibility seems to be so similar throughout North America and Europe, and despite the crucial importance of a person's genetic make-up to disease pathogenesis, it is the environmental-factors, which largely responsible for the observed regional variations in disease-characteristics. Thus, despite MS being more common in women, men are more likely to be genetically-susceptible. This apparent paradox seems to relate to the fact that women are much more responsive than men to the recent changes in environmental-exposure (whatever these have been). These gender-differences may help to explain changes in the sex-ratio and the increasing disease-prevalence, which have both been observed recently. The potential importance of these conclusions regarding the role of environment in MS-pathogenesis is that they open the door to the possibility of pursuing strategies for primary primary disease prevention in the future.
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Affiliation(s)
- D S Goodin
- Multiple Sclerosis Center at the University of California, San Francisco, San Francisco, CA, USA.
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36
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Briggs FB, Green MC, Ritterman Weintraub ML. Role of socioeconomic position in multiple sclerosis etiology. Neurodegener Dis Manag 2015; 5:333-43. [DOI: 10.2217/nmt.15.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating autoimmune disease with a prominent inflammatory component. There have been strides identifying genetic and environmental MS risk factors, though much of the disease risk remains unknown. Recent large observational studies suggest adverse socioeconomic position increases the risk for MS, however the mediating biological processes are not understood. We hypothesize a prominent role for stress response, both the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, which become maladaptive under frequent or chronic stimulation resulting in a proinflammatory phenotype. Thus, adverse SEP and chronic stress may predispose individuals for MS.
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Affiliation(s)
- Farren B Briggs
- Department of Epidemiology & Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4945, USA
| | - Matthew C Green
- Department of Public Health, Touro University California, CA 94592, USA
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Briones-Buixassa L, Milà R, Mª Aragonès J, Bufill E, Olaya B, Arrufat FX. Stress and multiple sclerosis: A systematic review considering potential moderating and mediating factors and methods of assessing stress. Health Psychol Open 2015; 2:2055102915612271. [PMID: 28070374 PMCID: PMC5193283 DOI: 10.1177/2055102915612271] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Research about the effects of stress on multiple sclerosis has yielded contradictory results. This study aims to systematically review the evidence focusing on two possible causes: the role of stress assessment and potential moderating and mediating factors. The Web of Knowledge (MEDLINE and Web of Science), Scopus, and PsycINFO databases were searched for relevant articles published from 1900 through December 2014 using the terms "stress*" AND "multiple sclerosis." Twenty-three articles were included. Studies focused on the effect of stress on multiple sclerosis onset (n = 9) were mostly retrospective, and semi-structured interviews and scales yielded the most consistent associations. Studies focused on multiple sclerosis progression (n = 14) were mostly prospective, and self-reported diaries yielded the most consistent results. The most important modifying factors were stressor duration, severity, and frequency; cardiovascular reactivity and heart rate; and social support and escitalopram intake. Future studies should consider the use of prospective design with self-reported evaluations and the study of moderators and mediators related to amount of stress and autonomic nervous system reactivity to determine the effects of stress on multiple sclerosis.
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Affiliation(s)
- Laia Briones-Buixassa
- Centre d’Estudis Sanitaris i Socials (CESS),Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Spain
| | - Raimon Milà
- Centre d’Estudis Sanitaris i Socials (CESS),Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Spain
| | | | | | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Francesc Xavier Arrufat
- Centre d’Estudis Sanitaris i Socials (CESS),Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Spain
- Consorci Hospitalari de Vic, Spain
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Shirazipour CH, Baillie CPT, Galaviz K, Jarvis JW, Latimer-Cheung AE. Evaluating the theoretical content of online physical activity information for people with multiple sclerosis. Int J MS Care 2015; 17:91-100. [PMID: 25892979 DOI: 10.7224/1537-2073.2013-048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical activity can aid people with multiple sclerosis (MS) in managing symptoms and maintaining functional abilities. The Internet is a preferred source of physical activity information for people with MS and, therefore, a method for the dissemination of behavior change techniques. The purpose of this study was to examine the coverage and quality of physical activity behavior change techniques delivered on the Internet for adults with MS using Abraham and Michie's taxonomy of behavior change techniques. METHODS Using the taxonomy, 20 websites were coded for quality (ie, accuracy of information) and coverage (ie, completeness of information) of theoretical behavior change techniques. RESULTS RESULTS indicated that most websites covered a mean of 8.05 (SD 3.86, range 3-16) techniques out of a possible 20. Only one of the techniques, provide information on behavior-health link and consequences, was delivered on all websites. The websites demonstrated low mean coverage and quality across all behavior change techniques, with means of 0.64 (SD 0.67) and 0.62 (SD 0.37) on a scale of 0 to 2, respectively. However, coverage and quality improved when websites were examined solely for the techniques that they covered, as opposed to all 20 techniques. CONCLUSIONS This study, which examined quality and coverage of physical activity behavior change techniques described online for people with MS, illustrated that the dissemination of these techniques requires improvement.
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Affiliation(s)
- Celina H Shirazipour
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Colin P T Baillie
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Karla Galaviz
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Jocelyn W Jarvis
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Amy E Latimer-Cheung
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canada
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Kumar P, Kretzschmar B, Herold S, Nau R, Kreutzfeldt M, Schütze S, Bähr M, Hein K. Beneficial effect of chronic Staphylococcus aureus infection in a model of multiple sclerosis is mediated through the secretion of extracellular adherence protein. J Neuroinflammation 2015; 12:22. [PMID: 25644616 PMCID: PMC4322648 DOI: 10.1186/s12974-015-0241-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/10/2015] [Indexed: 12/15/2022] Open
Abstract
Background Bacterial infections have been assumed to worsen multiple sclerosis (MS) disease symptoms and to lead to increased neurodegeneration. However, the underlying biological mechanisms for these effects are complex and poorly understood. Here, we assessed the disease-modulating effects of chronic infection with Staphylococcus aureus, a common human pathogen, on the clinical course and the extent of neurodegeneration in experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Methods To conduct this study, we established a persistent chronic infection in female brown Norway rats by inoculating Staphylococcus aureus (S. aureus) bacteria in a subcutaneously implanted tissue cages. Results In this study, we observed that the introduction of a localized S. aureus infection during the subclinical phase of EAE induced a chronic systemic inflammatory response, consisting of increased T- and B-cell counts and systemic production of proinflammatory cytokines. Unexpectedly, the S. aureus infection completely prevented the development of clinical EAE, and markedly reduced inflammatory infiltration and demyelination of the optic nerve, while it increased the number of surviving retinal neurons. Using a S. aureus strain that lacked the extracellular adherence protein (Eap), we determined that the extracellular adherence protein is at least partially responsible for the inhibitory effect of S. aureus infection on autoimmune inflammation of the central nervous system. Conclusions Our results demonstrate for the first time that chronic infection with S. aureus has a beneficial effect on EAE, indicating a dual role of infection in the pathogenesis of MS. We also showed that secretion of Eap by S. aureus plays a major role in preventing autoimmune inflammation of the CNS. Moreover, we identified Eap as a factor responsible for this protective effect.
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Affiliation(s)
- Prateek Kumar
- Department of Neurology, University Medicine Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
| | - Benedikt Kretzschmar
- Department of Neurology, University Medicine Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
| | - Sabine Herold
- Department of Neurology, University Medicine Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
| | - Roland Nau
- Institute of Neuropathology, University Medicine Goettingen, Goettingen, 37075, Germany.
| | - Mario Kreutzfeldt
- Department of Pathology and Immunology, Centre Médical Universitaire 1, Rue Michel-Servet 1211, Geneva 4, Switzerland.
| | - Sandra Schütze
- Institute of Neuropathology, University Medicine Goettingen, Goettingen, 37075, Germany.
| | - Mathias Bähr
- Department of Neurology, University Medicine Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
| | - Katharina Hein
- Department of Neurology, University Medicine Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
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Nielsen NM, Bager P, Simonsen J, Hviid A, Stenager E, Brønnum-Hansen H, Koch-Henriksen N, Frisch M. Major stressful life events in adulthood and risk of multiple sclerosis. J Neurol Neurosurg Psychiatry 2014; 85:1103-8. [PMID: 24610940 DOI: 10.1136/jnnp-2013-307181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE It is unclear whether psychological stress is associated with increased risk of multiple sclerosis (MS). We studied the association between major stressful life events and MS in a nationwide cohort study using death of a child or a spouse or marital dissolution as indicators of severe stress. METHODS We created two study cohorts based on all Danish men and women born 1950-1992. One cohort consisted of all persons who became parents between 1968 and 2010, and another cohort consisted of all persons who married between 1968 and 2010. Members of both cohorts were followed for MS between 1982 and 2010 using data from the National Multiple Sclerosis Registry. Associations between major stressful life events and risk of MS were evaluated by means of MS incidence rate ratios (RR) with 95% confidence interval (CI) obtained in Poisson regression analyses. RESULTS During approximately 30 million person-years of follow-up, bereaved parents experienced no unusual risk of MS compared with parents who did not lose a child (RR=1.12 (95% CI 0.89 to 1.38)). Likewise, neither divorced (RR=0.98 (95% CI 0.89 to 1.06)) nor widowed (RR=0.98 (95% CI 0.71 to 1.32) persons were at any unusual risk of MS compared with married persons of the same sex. CONCLUSIONS Our national cohort study provides little evidence for a causal association between major stressful life events (as exemplified by divorce or the loss of a child or a spouse) and subsequent MS risk.
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Affiliation(s)
- Nete Munk Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Bager
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jacob Simonsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Egon Stenager
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark Multiple Sclerosis Clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Sønderborg, Denmark National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Henrik Brønnum-Hansen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Aarhus, Denmark
| | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Kern S, Rohleder N, Eisenhofer G, Lange J, Ziemssen T. Time matters - acute stress response and glucocorticoid sensitivity in early multiple sclerosis. Brain Behav Immun 2014; 41:82-9. [PMID: 24880115 DOI: 10.1016/j.bbi.2014.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/03/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Psychosocial stress has frequently been associated with disease activity and acute exacerbations in multiple sclerosis (MS). Despite this well established finding, strikingly little is known about the acute hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) stress response in MS. METHODS Twenty-six early relapsing-remitting MS (RRMS) patients and seventeen age- and sex-matched healthy control subjects (CS) took part in the Trier Social Stress Test (TSST), a well validated psycho-social laboratory stress protocol. Repeated blood samples were analyzed for stress-related cortisol and catecholamine levels as well as for glucocorticoid sensitivity (GCS) of target immune cells. Chronic and acute stress appraisals were assessed by self-report measures. RESULTS RRMS patients and CS did not differ in stress-related cortisol/catecholamine levels, GCS or stress appraisal in response to the TSST. However, cortisol release as well as GCS was strongly correlated with time since diagnosis but not with neurological disability. Patients with shorter disease duration (2-12 months) expressed a significantly higher cortisol stress response while MS patients with longer disease duration (14-36 months) showed a significantly diminished HPA response as well as lower post-stress GCS. DISCUSSION There is evidence for a time-dependent variability in the HPA stress system with an increased cortisol stress response in the first year after diagnosis along with a more blunted HPA stress response and a diminished GCS in subsequent disease stages. Data underscore the highly dynamic nature of HPA axis regulation in the MS disease process, which could possibly relate to compensatory mechanisms within a cytokine-HPA axis feedback circuit model.
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Affiliation(s)
- Simone Kern
- Department of Neurology, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Germany.
| | - Nicolas Rohleder
- Department of Psychology & Volen National Center for Complex Systems, Brandeis University, Waltham, MA, USA
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine & Department of Medicine III, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Germany
| | - Jan Lange
- Department of Psychiatry & Psychotherapy, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Germany
| | - Tjalf Ziemssen
- Department of Neurology, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Germany
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Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:231-66. [PMID: 24507521 DOI: 10.1016/b978-0-444-52001-2.00010-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of studying the epidemiology of multiple sclerosis (MS) is twofold. First, it is important to understand clearly the natural history of the illness in order to assist patients in making decisions about their future with respect to issues such as family planning, the importance of securing lifelong healthcare, their ability to get and maintain employment, and making appropriate choices of therapy for their particular circumstances. This is not to suggest that, even with the best possible information, the ultimate prognosis for any individual can be predicted with absolute accuracy. It cannot. Nevertheless, accurate information can be very helpful both to reassure patients that many individuals with MS do remarkably well in the long term (perhaps, especially, with current and future therapies) and also to empower individuals with respect to their ability to make their own life choices. Second, and arguably the more important purpose for studying the epidemiology of MS, is to gain insights to the underlying causes of the disease. Indeed, if the principal mechanisms of disease pathogenesis were to be understood clearly, then it might be possible to entertain notions of either a cure for existing disease or the primary prevention of future disease. Much of our current understanding of disease pathogenesis, as discussed in other chapters of this volume, has been derived from basic science investigations of animal models of MS such as experimental autoimmune encephalomyelitis (EAE), and these models have provided considerable insight both to the complexity of the mammalian immune system and to the mechanisms underlying its dysfunction in inflammatory autoimmune conditions. Nevertheless, MS is a disease of humans without any known, naturally occurring, counterpart in any nonhuman species. For this reason, the clues to disease pathogenesis provided by a study of basic epidemiologic facts regarding MS (and by a systematic consideration of their implications) are essential to a comprehensive understanding of the human illness we call MS.
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Affiliation(s)
- Douglas S Goodin
- Department of Neurology, University of California, San Francisco, USA.
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Halilovic EA, Alimanovic I, Suljic E, Hassan NA. Optic neuritis as first clinical manifestations the multiple sclerosis. Mater Sociomed 2014; 26:246-8. [PMID: 25395886 PMCID: PMC4214814 DOI: 10.5455/msm.2014.246-2481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/25/2014] [Indexed: 01/21/2023] Open
Abstract
Aim: To analyze the clinical signs of multiple sclerosis (MS) and show that optic neuritis is one of the first event, which indicates the development of disease. Patients and methods: The study involved 89 cases in which it confirmed MS at the time of the March 2009–2011. Since ophthalmological parameters were analyzed visual acuity (VA), visual field (VF), and retinal nerve fibre layer (RNFL) thickness of peripapillary rim by optic coherent tomography (OCT). Results: Ten(10) patients had ON as the first clinical manifestation of the disease which was statistically significant (X2 =9,7 p=0,01) compared to the manifestation of other clinical signs of disease. In VF, centrocecal scotomas were predominant in 50% of the subjects; the RNFL thinning of the neuroretinal rim was verified in all patients, most often in the upper quadrant. A month after pulse corticosteroid therapy, visual acuity in all patients with ON ranged from 0.6 to 1.0. Conclusion: ON is one of the first MS clinical manifestation. In VF, the most common disturbances are in the centrocecal area. The RNFL thinning was verified in all patients with OCT.
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Affiliation(s)
| | - Ilda Alimanovic
- Eye Clinic, Clinical University Center Sarajevo, Bosnia and Herzegovina
| | - Enra Suljic
- Neurological Clinic, Clinical University Center Sarajevo, Bosnia and Herzegovina
| | - Nabil Al Hassan
- Eye Clinic, Clinical University Center Sarajevo, Bosnia and Herzegovina
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Galley JD, Nelson MC, Yu Z, Dowd SE, Walter J, Kumar PS, Lyte M, Bailey MT. Exposure to a social stressor disrupts the community structure of the colonic mucosa-associated microbiota. BMC Microbiol 2014; 14:189. [PMID: 25028050 PMCID: PMC4105248 DOI: 10.1186/1471-2180-14-189] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/30/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The microbiota of the mammalian gastrointestinal (GI) tract consists of diverse populations of commensal bacteria that interact with host physiological function. Dysregulating these populations, through exogenous means such as antibiotics or dietary changes, can have adverse consequences on the health of the host. Studies from laboratories such as ours have demonstrated that exposure to psychological stressors disrupts the population profile of intestinal microbiota. To date, such studies have primarily focused on prolonged stressors (repeated across several days) and have assessed fecal bacterial populations. It is not known whether shorter stressors can also impact the microbiota, and whether colonic mucosa-associated populations can also be affected. The mucosa-associated microbiota exist in close proximity to elements of the host immune system and the two are tightly interrelated. Therefore, alterations in these populations should be emphasized. Additionally, stressors can induce differential responses in anxiety-like behavior and corticosterone outputs in variant strains of mice. Thus, whether stressor exposure can have contrasting effects on the colonic microbiota in inbred C57BL/6 mice and outbred CD-1 mice was also examined. RESULTS In the present study, we used high throughput pyrosequencing to assess the effects of a single 2-hour exposure to a social stressor, called social disruption (SDR), on colonic mucosa-associated microbial profiles of C57BL/6 mice. The data indicate that exposure to the stressor significantly changed the community profile and significantly reduced the relative proportions of two genera and one family of highly abundant intestinal bacteria, including the genus Lactobacillus. This finding was confirmed using a quantitative real-time polymerase chain reaction (qPCR) technique. The use of qPCR also identified mouse strain-specific differences in bacterial abundances. L. reuteri, an immunomodulatory species, was decreased in stressor-exposed CD-1 mice, but not C57BL/6 mice. CONCLUSIONS These data illustrate that stressor exposure can affect microbial populations, including the lactobacilli, that are closely associated with the colonic mucosa. Because the lactobacilli can have beneficial effects on human health, stressor-induced reductions of their population could have important health implications.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael T Bailey
- Biosciences Division, College of Dentistry, The Ohio State University, Columbus, USA.
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Nielsen NM, Pedersen BV, Stenager E, Koch-Henriksen N, Frisch M. Stressful life-events in childhood and risk of multiple sclerosis: a Danish nationwide cohort study. Mult Scler 2014; 20:1609-15. [DOI: 10.1177/1352458514528761] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Current knowledge concerning the association between exposure to stressful life-events (SFLEs) in childhood and later risk of multiple sclerosis (MS) is sparse. Objectives: We studied the associations between SFLEs in childhood and subsequent risk of MS in a nationwide cohort of 2.9 million Danes born from 1968 to 2011. Methods: A SFLE in childhood was defined as exposure before age 18 years to parental divorce, parental death, or death of a sibling, using information from the Danish Civil Registration System. MS cases in the cohort were identified in the Danish Multiple Sclerosis Registry. Associations of SFLE with MS risk were evaluated by incidence rate ratios (RR) of MS obtained in log-linear Poisson regression models. Results: Persons exposed to any SFLE in childhood were at 11% elevated risk of MS (RR = 1.11; 95% confidence interval: 1.03–1.20), compared to non-exposed persons. Stratification by subtype of SFLE showed that parental death and death of a sibling were not associated with MS risk. However, persons exposed to parental divorce were at 13% increased risk of developing MS compared to non-exposed (RR = 1.13; 1.04–1.23). Conclusions: Associations of SFLEs in childhood with risk of MS are weak. However, parental divorce is somehow associated with modestly increased risk of MS.
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Affiliation(s)
- Nete Munk Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Bo V Pedersen
- Department of Epidemiology Research, Statens Serum Institut, Denmark
| | - Egon Stenager
- The Danish MS Registry, the Danish MS Research Center, Rigshospitalet, Copenhagen/Institute of Regional Health Research/Multiple Sclerosis Clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Sønderborg, Denmark and National Institute of Public Health, University of Southern Denmark, Denmark
| | - Nils Koch-Henriksen
- The Danish MS Registry, the Danish MS Research Center, Rigshospitalet, Copenhagen, Denmark/Clinical Institute, Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Denmark
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Lovera J, Reza T. Stress in Multiple Sclerosis: Review of New Developments and Future Directions. Curr Neurol Neurosci Rep 2013; 13:398. [DOI: 10.1007/s11910-013-0398-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Morris G, Maes M. Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics. BMC Med 2013; 11:205. [PMID: 24229326 PMCID: PMC3847236 DOI: 10.1186/1741-7015-11-205] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND 'Encephalomyelitis disseminata' (multiple sclerosis) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are both classified as diseases of the central nervous system by the World Health Organization. This review aims to compare the phenomenological and neuroimmune characteristics of MS with those of ME/CFS. DISCUSSION There are remarkable phenomenological and neuroimmune overlaps between both disorders. Patients with ME/CFS and MS both experience severe levels of disabling fatigue and a worsening of symptoms following exercise and resort to energy conservation strategies in an attempt to meet the energy demands of day-to-day living. Debilitating autonomic symptoms, diminished cardiac responses to exercise, orthostatic intolerance and postural hypotension are experienced by patients with both illnesses. Both disorders show a relapsing-remitting or progressive course, while infections and psychosocial stress play a large part in worsening of fatigue symptoms. Activated immunoinflammatory, oxidative and nitrosative (O+NS) pathways and autoimmunity occur in both illnesses. The consequences of O+NS damage to self-epitopes is evidenced by the almost bewildering and almost identical array of autoantibodies formed against damaged epitopes seen in both illnesses. Mitochondrial dysfunctions, including lowered levels of ATP, decreased phosphocreatine synthesis and impaired oxidative phosphorylation, are heavily involved in the pathophysiology of both MS and ME/CFS. The findings produced by neuroimaging techniques are quite similar in both illnesses and show decreased cerebral blood flow, atrophy, gray matter reduction, white matter hyperintensities, increased cerebral lactate and choline signaling and lowered acetyl-aspartate levels. SUMMARY This review shows that there are neuroimmune similarities between MS and ME/CFS. This further substantiates the view that ME/CFS is a neuroimmune illness and that patients with MS are immunologically primed to develop symptoms of ME/CFS.
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Affiliation(s)
- Gerwyn Morris
- Tir Na Nog, Pembrey, Llanelli, UK
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Deakin University, Geelong, Australia
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Djelilovic-Vranic J, Alajbegovic A, Tiric-Campara M, Nakicevic A, Osmanagic E, Salcic S, Niksic M. Stress as provoking factor for the first and repeated multiple sclerosis seizures. Mater Sociomed 2013; 24:142-7. [PMID: 23922521 PMCID: PMC3732367 DOI: 10.5455/msm.2012.24.142-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/15/2012] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Multiple sclerosis is an inflammatory, autoimmune, disease of the white mass of the brain, which sometimes may involve the gray matter (subcortical and ones in the anterior horns of the spinal cord) with the chronic nature and generally with progressive course. As a possible cause of this disease state are listed genetic predisposition, early viral infections and environmental factors, with special effects of stress as a provoking factor in first episode of the disease and relapses because stress leads to modulation of the immune system and immune response to various causes. GOAL To determine the existence of intense stressful events as a factor in the development of the first episode of illness and worsening of the seizures. MATERIAL AND METHODS We analyzed all newly discovered cases of multiple sclerosis over a two year period (January 2010 - December 2011) during the first or second hospitalization, and worsening of seizures for previously diagnosed patients in this period. In order to confirm the MS diagnosis are taken history, neurological examination, MRI of the brain, VEP, CSF examination and for those with repeated hospitalization only follow-up of EDSS scores trough neurological examination. RESULTS During the two year period there were 109 newly diagnosed cases of MS from which 80 F and 29 M (ratio 2.7:1), aged 17-59 years, mean age 32.93±9.69 years and 41 patients (29 F and 12M with seizures worsening in previously diagnosed disease. Disease duration was from 6 months to 17 years. 72.94% had relapsing-remitting course of the disease (RRMS) and 27.1% had secondary progressive type (SPMS). Stress as a provoking factor preceded in 47.44% the first episode of the disease, infections (respiratory) in 18.3%, and the pregnancy with postpartum period in 8.77% women, whereas in the group of patients with previously diagnosed illness relapse (n=41) showed that the infection is most common precipitating factor which preceded relapse in 58.54% of patients, stress in 29.02%) and the pregnancy with postpartum period in 12.5% of patients. CONCLUSION An intensive stressor is certainly one of the triggers for the development of Multiple Sclerosis, as the first episode and worsening of previously established disease.
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Effect of stress on brain inflammation and multiple sclerosis. Autoimmun Rev 2013; 12:947-53. [DOI: 10.1016/j.autrev.2013.02.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 02/28/2013] [Indexed: 12/18/2022]
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50
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Martinez-Pasamar S, Abad E, Moreno B, Velez de Mendizabal N, Martinez-Forero I, Garcia-Ojalvo J, Villoslada P. Dynamic cross-regulation of antigen-specific effector and regulatory T cell subpopulations and microglia in brain autoimmunity. BMC SYSTEMS BIOLOGY 2013; 7:34. [PMID: 23618467 PMCID: PMC3651362 DOI: 10.1186/1752-0509-7-34] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 04/23/2013] [Indexed: 12/28/2022]
Abstract
Background Multiple Sclerosis (MS) is considered a T-cell-mediated autoimmune disease with a prototypical oscillatory behavior, as evidenced by the presence of clinical relapses. Understanding the dynamics of immune cells governing the course of MS, therefore, has many implications for immunotherapy. Here, we used flow cytometry to analyze the time-dependent behavior of antigen-specific effector (Teff) and regulatory (Treg) T cells and microglia in mice model of MS, Experimental Autoimmune Encephalomyelitis (EAE), and compared the observations with a mathematical cross-regulation model of T-cell dynamics in autoimmune disease. Results We found that Teff and Treg cells specific to myelin olygodendrocyte glycoprotein (MOG) developed coupled oscillatory dynamics with a 4- to 5-day period and decreasing amplitude that was always higher for the Teff populations, in agreement with the mathematical model. Microglia activation followed the oscillations of MOG-specific Teff cells in the secondary lymphoid organs, but they were activated before MOG-specific T-cell peaks in the CNS. Finally, we assessed the role of B-cell depletion induced by anti-CD20 therapy in the dynamics of T cells in an EAE model with more severe disease after therapy. We observed that B-cell depletion decreases Teff expansion, although its oscillatory behavior persists. However, the effect of B cell depletion was more significant in the Treg population within the CNS, which matched with activation of microglia and worsening of the disease. Mathematical modeling of T-cell cross-regulation after anti-CD20 therapy suggests that B-cell depletion may influence the dynamics of T cells by fine-tuning their activation. Conclusions The oscillatory dynamics of T-cells have an intrinsic origin in the physiological regulation of the adaptive immune response, which influences both disease phenotype and response to immunotherapy.
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Affiliation(s)
- Sara Martinez-Pasamar
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
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