Tuesday, 27 August 2013

Head Trauma and Multiple sclerosis

Warren SA, Olivo SA, Contreras JF, Turpin KV, Gross DP, Carroll LJ, Warren KG. Traumatic injury and multiple sclerosis: a systematic review and meta-analysis. Can J Neurol Sci. 2013; 40(2):168-76.


A systematic review/meta-analysis of literature addressing a possible association between traumatic injury and onset of multiple sclerosis was conducted. Medline, Embase, Cochrane DSR, Ovid HealthStar, CINAHL, ISI Web of Science and Scopus were searched for analytical studies from 1950 to 2011. Two investigators independently reviewed articles for inclusion, assessing their quality using the Newcastle-Ottawa Scale. Of the 13 case-control studies included, 8 were moderate quality and 5 low; of the 3 cohort studies 2 were high and 1 moderate. Meta-analysis including moderate and low quality case-control studies produced a modest but significant odds ratio: 1.41 (95% confidence interval: 1.03, 1.93). However, when low quality studies were excluded, the resulting odds ratio was non-significant. Cohort studies produced a non-significant standardized incidence ratio of 1.00 (95% confidence interval: 0.86, 1.16). These findings support the conclusion that there is no association between traumatic injury and multiple sclerosis onset; more high quality cohort studies would help to confirm this observation.

Head Trauma and MS onset there appears to be no link

23 comments:

  1. Mouse Doctor, What are your thoughts on :
    Trauma to the Central Nervous System May Result in Formation or Enlargement of Multiple Sclerosis Plaques
    Charles M. Poser, MD, FRCP
    Arch Neurol. 2000;57(7):1074-1077. doi:10.1001/archneur.57.7.1074

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  2. It is what it is.. a commentary. Could trauma effect established MS, well if it brings cells into CNS that shouldn't be there the chance of them doing something you don't want is increased.

    This current post indicates there is no good evidence to link the two events and shows if you look at the no so good evidence the risk of developing MS after MS is small.

    Is this a your theory/experience of why we get MS?

    Is this the reason why in iran the female to male ratio is 5:1 or 3:1 in many other places. How many men have had a concussion whilst playing sport..., you don't get many concussions playing computers? All questions. It is hard to know definitively

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  3. mouse doctor, what are your thoughts on these?

    Acute cervical hyperextension-hyperflexion injury mayprecipitate and/or exacerbate symptomatic multiple sclerosis
    Eur J Neurol 2001 Nov;8(6):659-64.
    Chaudhuri A, Behan PO

    2002 Whiplash Trauma and Multiple Sclerosis
    by Daniel J. Murphy, DC, FACO

    THESE AUTHORS ALSO NOTE:
    The cause of multiple sclerosis (MS) is unknown.
    Axonal pathology from focal trauma with an increase in nitric oxide in the brain, leads to demyelinating injury.
    Certain factors modify the clinical course for MS by precipitating or
    aggravating the clinical symptoms, including:
    (1) infections
    (2) pregnancy
    (3) electrical injuries
    (4) penetrating and surgical wounds of the brain
    (5) acute emotional psychological stress
    (6) certain vaccinations
    “Breakdown in the blood-brain barrier (BBB) is an early and obligatory event in the development of acute MS lesions"
    These authors have documented 39 patients who developed symptomatic MS or in whom a stable disease with minimal disability was converted to a rapidly progressive form within some days to weeks after an acute hyperextension-hyperflexion injury to the cervical spinal cord.

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    1. The Chaudhuri and Behan hypothesis has been subject to legal scrutiny in an English court. It didn't hold up to legal bar of 'beyond reasonable doubt', which is a much lower bar the a scientific one. It remains a hypothesis and one which I think has not held up to recent scientific discoveries. The fact that the cause of MS maybe unknown does not make trauma the cause. The complex epidemiology of MS cannot be explained by trauma.

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  4. Professor G.
    Since we don't know what causes MS, would be
    Curious of people who developed symptomatic MS or in whom a stable disease with minimal disability was converted to a rapidly progressive form within some days to weeks after an injury.
    IE: would be interesting data to understand if a injury to head or spine aggravates dormant MS, or MS that may be milder in nature becomes rapidly progressing

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    1. We know that MS reduces the brain and spinal cords reserve capacity, i.e. its ability to recover. Therefore, MSers are more likely to suffer negative consequences of trauma or any other brain or spinal disease for that matter. I am not sure if there is any evidence that trauma makes MS worse. I would support the opposite that MS makes trauma worse, and that trauma can consume the remaining reserve of the brain and spinal cord and hence tip someone into the progressive phase of MS.

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    2. Interesting, I was a victim of a street mugging, thrown into the road on my back. One month later I had double vision and pins and needles. I was diagnosed with MS six months later. I don't believe it caused my MS, but it brought on my symptoms earlier.

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  5. I had lived with and ignored mild MS symptoms for 10 plus years. Surgery brought out severe symptoms which then receded several months later, after MS diagnosis. I was already past 40 years. Without that physical shock, I might not have been diagnosed until secondary progression hit.

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  6. Also, if time is brain, it seems to me that more needs to be done to educate GP's in recognizing and investigating mild neurological symptoms.

    The few times I asked doctors about my mild symptoms, which included tingling, numbness, lack of sensation in my chin and parts of my face, I was told my tests were normal and it was probably depression. No neurological evaluation was done at all, even by the GP. The surgeon spotted my facial tremor but attributed it to anxiety. Knowing I had MS before surgery would have saved me a terrifying experience.

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  7. Interesting. I went from perfect health. Took a fall. Gait became off, double with blurry vision crept up. Within three months Grasp failed, Doughy hands not regulating temperature, electrical zaps and stabs in body parts. Initial thought was CRPS. Hospital MRI told me I had a cold.
    Correct MS diagnosis given by Neurologist who looked at MRI, saw new and old lesions, did spinal tap, ran battery of test before confirming. Progression has continued without getting better.
    So I don't say the fall caused MS, but that was the catalyst that triggered the fast progression.
    Would be a interesting poll to see posts on

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  8. Maybe Prof G will do a poll.

    The problem is we all try and link events

    Two weeks ago I could not walk because of back pain. Was it because I fell in the road whilst moving a fallen tree (2 days before the event), because I was doing back exercises (1 day before the event) or because I was cutting nettles (15 minutes before the event).

    Unless there are lots of people having the same problem it is difficult to definitely link the two events as a cause and effect. I have cut weeds loads of times in the past and never had the problem. But I have done other things like playing football or singing and then then can't walk.

    This appears the case with MS. I am sure not all people that have MS can remember a fall head trauma that precipitates MS. It does not mean that head trauma was not the problem but it means that there is not enough definitive evidence. Maybe the fall was the consequence of MS and not the cause.

    I don't know

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    1. I was asked all sorts of questions when I had my first episode of MS. What were the good things and bad things that had happened to me. Did I have a dog as a child? Did I have many childhood illnesses. Does the patient history still include incidents prior to the illness. With respect I don't think you can compare your gardening exploits to the onset of symptoms of MS.

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  9. Many years ago (in the time before MRIs) I had a high-speed departure from a horse and wrapped my head / neck around a tree. Six months later blurred vision, muscle spasms and tingling were investigated by Barts neurologists - inconclusive findings from tests.

    When I was eventually diagnosed the majority of lesions were found to be in my cervical spinal cord.

    I don't think the riding accident caused my MS but I do wonder if it's another predisposing factor, along with my birth month.

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  10. I also had a head trauma - as a (prematurely-born) baby I fell off my cot and crashed on a wooden floor with my head. Start of MS in childhood - who knows??

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  11. Professor G.
    How about a survey? : it may be quite interesting to see the MS onset from people who have a clear cut known spine/head trauma to MS disease progression, along with those that may not know if MS was that caused injury, but progressed quickly afterwards.
    More on if MS was already in your body, did items hasten its progression?
    Perhaps more ?

    Mine, perfect health for 48 years, puddle of water that was hidden, which I slipped and fell. Landed real hard on spine/head. So if MS is dormant in my body for years, and this event, the only one, within three months I have symptoms that became diagnosed as MS.

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    1. I dealt with a similar situation. Slip and fall at work. Now, since I'm finally getting to doctors a few years later, my MRI and symptoms show possible MS. I did NOT have these issues prior to the incident. All of these issues started after my trauma. Regardless of an alleged 'predisposition', this injury caused by health to spiral to a low I had never imagined possible. More studies need to be done.

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  12. I was brutally assaulted and beaten around the head; lost consciousness repeatedly during the attack. Six months later, I lost my sight more-or-less overnight. Hospital tests revealed swelling in the brain and there was talk of having to insert a shunt to drain it. Being in the UK, and therefore reliant on the NHS, they never bothered. I was diagnosed with M.S. five months later. I am convinced that the physical and psychological trauma were precursors to my development of the disease. I really do not think these theories should be dismissed prior to comprehensive research.

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  13. I too believe there is a correlation between trauma and illness showing up. For me I am using EFT as well as ramping up on vitamin D as well as msm. Good luck to u and keep the faith!

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  14. Looking into this as I have a lesion in the spine at the level of a disk herniation, and oligoclonal bands...possible CIS of MS. I found this study which seems to confirm spinal injury triggers autoimmunity, at least in mice... http://www.ncbi.nlm.nih.gov/pubmed/17081140 This talks about Lupus tough, not MS...Perspectives from anyone who understands this study better would be welcome

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    1. This shows that when you get tissue damage you get can get B cell, in the about case they found anti-DNA antibodies and also against CNS proteins so they could say MS-like disease as well as lupus-like disease but they did not show that the mice got disease. Having self reactive cells which we all have is not the same as MS, so the direct link has yet to be proven

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  15. I think my MS was triggered by a head injury I had. I was well before then. I even had the flu, quite a nasty long bout of it six months before this head injury and I had no MS type symptoms before this head injury. The head injury triggered something in my brain. Then the first relapse was triggered by infection and was not treated with antibiotics. The second relapse was triggered by stress, exhaustion and mass anxiety. Both relapses aviodable.

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  16. The study cited above is an epidemiological (statistical) study of decades of epidemiological studies. The problem with epidemiological studies is the cohorts they choose to study and the biological plausibility of the type of trauma. Most of the studies on a connection between MS and trauma include traumas that are biologically highly implausible, such as extremity fractures, low back injuries, dental extractions etc. Instead the focus should be on traumatic brain injuries and whiplash-type traumas. Whiplash causes rapid reflux inversion flows through the vertebral veins that reach the dural sinuses and may play a role in the supratentorial, periventricular perivenular location of MS lesions. Trauma to the craniocervical junction can result in chronic structural strains and deformation of blood and CSF pathways, which can lead to chronic ischemia, edema and dissociation of CSF flow. Dissociation of CSF flow can result in destructive pressure waves in the brain. CSF is the lymphatic system of the brain. Sluggish CSF flow may also play a role in the aggregation of proteins, bacteria viruses and heavy metals seen in neurodegenerative diseases. Rather than more useless epidemiological studies, it would be far more productive to do physiological studies of blood and CSF flow in the craniocervical junction of MS patients using upright and cine MRI. A history of significant head and neck trauma with clear signs on brain scans of chronic strains of the craniocervical junction and obstruction to blood and CSF flow is a sure sign of a connection between trauma and neurodegenerative diseases.

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