Article References: Thoracic Outlet Syndrome

THORACIC OUTLET SYNDROME

4.AUTHOR	Morrison-W, Nelson-J.
TITLE	Environmental triggers in multiple sclerosis. Fact or fallacy?
SOURCE	Muscle-Nerve 1986 Sep, VOL: 9 (7), P: 632-4, ISSN: 0148-639X.

ABSTRACT

Multiple Sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system. In the early, most common course of the disease there are seemingly random attacks or exacerbations usually followed by partial or complete recovery. It has long been postulated that environmental events such as infection, emotional stress, or trauma play some role in triggering exacerbations, worsening of the disease, or even the onset of MS. Indeed there have been monetary awards by the courts based on possible influence on the disease following motor vehicle accidents. This paper will describe a prospective study undertaken at the UBC MS Clinic evaluating the impact of infection, emotional stress, and physical trauma on the course of the disease in 50 relapsing-remitting patients participating in the Betaseron trial. During the first two years of the clinical trial this cohort kept diaries documenting environmental "events". The participants were evaluated clinically and with Magnetic Resonance Imaging (MRI) every six weeks. The potential triggers or events are correlated with disease activity seen on MRI, relapse occurrence and disease progression according to the neurological exam. The results of the study and their implications for patient counselling will be presented. Author.

1. (Page 24) Introduction and Review of the Literature...Prospective studies by Bamford et al. [page ?, reference ?] and Sibley et al. [page 10, reference 13] have not confirmed the relationship between trauma and disease activity. The only significant association in the Sibley study was a relationship between electrical injury and exacerbation but, when all trauma was evaluated, no statistically significant relationship was evident. A recent population-based study of 389 MS patients from Olmsted County, Minnesota using the unique facilities of the Mayo Clinic again found no association between trauma and the onset, progression or relapses of MS [page 9, reference 12].
2. (Page 25) Results...This preliminary discussion of purported risk factors on MS disease activity shows little relationship, if any, between the two. Further statistical analysis is necessary and is currently underway.
3. Discussion To prove that infection, stress and trauma are actual risk factors in MS, one must show prospectively that exacerbations are occurring more frequently after these events than they are at other times. We have not done that with this small sample.