title: The effect of war stress on multiple sclerosis exacerbations and radiological disease activity.
abstract: OBJECTIVE
  The relationship between stressful life events and multiple sclerosis (MS) exacerbations or radiological disease activity is at best controversial. The aim of this study is to examine the relationship between exposure to war-related events incurred during the July 2006 Israeli-Lebanese war and clinical relapses and MRI disease activity among Lebanese MS patients.
  
  
  METHODS
  We studied a group of 216 patients with clinically definite relapsing remitting MS (RRMS), on whom clinical data was available for the war period and for the preceding and following year(s). The number of relapses was determined during the war period and during similar periods over a 3-year span. All patients with brain MRI during the war period had their scans reviewed for evidence of disease activity as defined by the presence of gadolinium enhancing (Gd+) lesions. A group of patients with brain MRI performed outside the war period was used for comparison.
  
  
  RESULTS
  The total number of relapses during the war period (n=23) was significantly higher than during non-war periods (mean=8.4, SD=0.86) (p=0.006). Of the 18 patients with brain MRI during the war, 5/7 with relapses and 1/11 without relapses had Gd+ lesions (p=0.013). More patients had Gd+ lesions during the war period (33%) compared to controls (13%) (p=0.075).
  
  
  CONCLUSIONS
  Our study shows that exposure to war-related events is likely to lead to an increase in both clinical relapses and MRI disease activity in patients with MS.
authors.affiliation: Department of Internal Medicine, American University of Beirut - Medical Center, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon.
authors.forename: Bassem
authors.initials: B
authors.lastname: Yamout
authors.forename: Salam
authors.initials: S
authors.lastname: Itani
authors.forename: Roula
authors.initials: R
authors.lastname: Hourany
authors.forename: Abla Mehio
authors.initials: AM
authors.lastname: Sibaii
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D007861:Lebanon; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000453:epidemiology* / Q000473:pathology*; D011859:Radiography; D012008:Recurrence; D013315:Stress, Psychological / Q000150:complications* / Q000000981:diagnostic imaging; D014857:Warfare
chemical_list: D003287:Contrast Media; D007372:Interferons; D005682:Gadolinium