title: Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: a prospective study.
abstract: OBJECTIVE
  Self-reported stressful life events and infections have been associated with relapses in multiple sclerosis. Also, anxiety has been reported to influence other diseases of unpredictable course. To study relation of self-reported stressful life events, levels of anxiety, and episodes of infection, with relapses of the disease in women with multiple sclerosis.
  
  
  METHODS
  This is a one-year prospective study. Thirty seven women with multiple sclerosis were regularly seen every four weeks, for one year. They were keeping diaries of events they considered stressful. These events were ranked according to the Holmes and Rahe Social Readjustment Rating Scale. Their anxiety levels were assessed with the Hamilton rating scale for anxiety. Relapses and episodes of infection were verified at additional visits. Results were studied using a survival analysis model adapted for several recurrent events.
  
  
  RESULTS
  A total of 291 stressful events, 37 episodes of infection, and 48 relapses, were registered. High level of anxiety were stongly related to the number and the severity of reported stressful events during the preceding period and with the advent of a relapse in the following period (Hamilton score greater than 18 is associated with 4.2 times the rate of relapsing and three or more reported stressful events with 5.7 times the rate of relapsing).
  
  
  CONCLUSIONS
  Anxiety and self-reported stressful events may in fact be two measures of the same underlying emotional factor, which plays an important role on the course of the disease, in addition to episodes of infection.
authors.affiliation: Department of Neurology, University of Athens School of Medicine, Unit of Demyelinating Diseases, Eginition Hospital, Athens, Greece. cpotagas@ath.forthnet.gr
authors.forename: C
authors.initials: C
authors.lastname: Potagas
authors.forename: C
authors.initials: C
authors.lastname: Mitsonis
authors.forename: L
authors.initials: L
authors.lastname: Watier
authors.forename: G
authors.initials: G
authors.lastname: Dellatolas
authors.forename: A
authors.initials: A
authors.lastname: Retziou
authors.forename: Pa
authors.initials: P
authors.lastname: Mitropoulos
authors.forename: C
authors.initials: C
authors.lastname: Sfagos
authors.forename: D
authors.initials: D
authors.lastname: Vassilopoulos