Zveik Omri, Friedman-Korn Tal, Rechtman Ariel, Ganz Tal, Hoichman Garrick, Shweiki Lyne, Ekstein Dana, Vaknin-Dembinsky Adi
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
The Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Ann Clin Transl Neurol. 2025 Jan;12(1):17-25. doi: 10.1002/acn3.52241. Epub 2024 Nov 6.
Psychological stress has been suggested as a contributory factor in the onset and progression of multiple sclerosis (MS). The 7 October 2023 terrorist attacks in Israel caused significant psychological stress, providing a unique context to study its impact on MS activity. This study aims to assess the impact of war-related psychological stress on MS activity using magnetic resonance imaging (MRI) scans and clinical follow-up.
This observational retrospective case-control study includes 93 patients with MS (pwMS) who had routine annual MRI scans from three periods (7 October 2021 to 7 January 2022; 7 October 2022 to 7 January 2023; and 7 October 2023 to 7 January 2024). Data were collected from medical records and MRI scans at Hadassah Medical Center. MRI scans were classified as active if new or enlarging T2 lesions and/or enhancing T1 lesions were present.
MRI activity significantly increased among pwMS during the first 3 months of the war compared to the corresponding period in the preceding year (11/93 vs. 23/93, P = 0.0139), with an OR of 4.0 (95% confidence interval: 1.29-16.442). pwMS with an EDSS score ≥4 showed a significant increase in MRI activity (P = 0.045), whereas no significant increase was observed in patients with an EDSS score ≤3.5 (P = 0.23). Additionally, MRI activity increased later during the war compared to the previous year (P < 0.0001).
This study provides evidence of increased MRI-detected disease activity in pwMS during periods of war-related psychological stress. Our findings highlight the importance of considering psychological stress in MS management. Healthcare providers should be aware of the potential for increased disease activity in pwMS during extreme stress and may consider more frequent monitoring, including MRI scans, or treatment adjustments during such periods.
心理压力被认为是多发性硬化症（MS）发病和进展的一个促成因素。2023年10月7日以色列发生的恐怖袭击造成了巨大的心理压力，为研究其对MS活动的影响提供了一个独特的背景。本研究旨在通过磁共振成像（MRI）扫描和临床随访评估与战争相关的心理压力对MS活动的影响。
这项观察性回顾性病例对照研究纳入了93例患有MS（pwMS）的患者，他们在三个时间段（2021年10月7日至2022年1月7日；2022年10月7日至2023年1月7日；以及2023年10月7日至2024年1月7日）进行了常规年度MRI扫描。数据从哈达萨医疗中心的病历和MRI扫描中收集。如果存在新的或扩大的T2病变和/或强化的T1病变，则MRI扫描被分类为活跃。
与前一年的相应时期相比，战争头3个月期间pwMS的MRI活动显著增加（11/93 vs. 23/93，P = 0.0139），比值比为4.0（95%置信区间：1.29 - 16.442）。扩展残疾状态量表（EDSS）评分≥4的pwMS患者的MRI活动显著增加（P = 0.045），而EDSS评分≤3.5的患者未观察到显著增加（P = 0.23）。此外，与前一年相比，战争后期的MRI活动增加（P < 0.0001）。
本研究提供了证据，表明在与战争相关的心理压力期间，pwMS患者经MRI检测到的疾病活动增加。我们的研究结果强调了在MS管理中考虑心理压力的重要性。医疗保健提供者应意识到在极端压力期间pwMS患者疾病活动增加的可能性，并可能考虑更频繁的监测，包括MRI扫描，或在此期间进行治疗调整。
