Wednesday, 7 January 2015

Spinal cord injury increases MS risk

Does spinal cord trauma increase your risk of getting MS? #MSBlog #MSResearch

"This study below suggests that people with spinal cord injury are more likely to develop MS than control subjects. This study is interesting, but needs to be reproduced as the conclusions are based on very few numbers (9 cases of spinal cord injury). Are there large enough data sets available to reproduce these results? Yes, I think there are. The Scandinavian, Kaiser-Permanente and the Veterans Administration databases may have sufficient data to look at this. It would also be worth looking at the NHS HES (hospital-episode statistics) database as well. Why is this important? A large number of MSers feel trauma has been involved in triggering their MS. At present the link between trauma, including neurotrauma, and MS is weak and a large number of us are worried about so called recall bias. In other words if you have a disease such as MS you are more likely to recall a significant recent event to which you ascribe a causal link. Recall bias is a big problem in most case-based epidemiological studies, particularly if they use retrospective (historical) methods. This is why prospective, non-biased studies are more convincing. 

The other issue is reverse causation; i.e. are people who are at risk of developing MS or who possibly have asymptomatic MS are increased risk of sustaining trauma? The is not a trivial issue. I have already mentioned in an earlier post this year that MS probably has a long asymptomatic period and during this time it could affect neurological functioning in subtle ways, for example it may slow down reflexes that protect you from having accidents. Therefore it is possible that the trauma is due to subtle alterations in neurological function that protect you from having accidents, an good example will be balance and righting reflexes. If these reflexes are not functioning optimally you are more likely to have falls. Reverse causation is an intractable problem, hence the need to be very careful about assigning causation to any association between two factors." 


Epub: Lin et al. Spinal cord injury is related to an increased risk of multiple sclerosis: a population-based, propensity score-matched, longitudinal follow-up study. J Neurotrauma. 2014.

Background: MS is a demyelinating autoimmune disease of the central nervous system (CNS). Trauma to CNS has been postulated to play a role in triggering CNS autoimmune disease. Although the association between traumatic brain injury and MS has been suggested in previous studies, epidemiological data on the association between spinal cord injury (SCI) and MS is still lacking. 


Aim: The aim of the present population-based, propensity score-matched, longitudinal follow-up study was therefore to investigate whether patients with SCI were at a higher risk of developing MS. 

Method: A total of 11913 subjects aged between 20 and 90 years with at least two ambulatory visits with the principal diagnosis of SCI in 2001 were enrolled in the SCI group. We used a logistic regression model that included age, sex, pre-existing comorbidities, and socioeconomic status as covariates to compute the propensity score. The non-SCI group consisted of 59565 propensity score-matched, randomly sampled subjects without SCI. Stratified Cox proportional hazard regression with patients matched by propensity score was used to estimate the effect of SCI on the risk of developing subsequent MS. 

Results: During follow-up, 5 subjects in the SCI group and 4 in the non-SCI group developed MS. The incidence rates of MS were 17.60 (95% confidence interval [CI], 5.71 to 41.0) per 100,000 person-years in the SCI group and 2.82 (95% CI, 0.77 to 7.22) per 100,000 person-years in the non-SCI group. Compared to the non-SCI group, the HR of MS for the SCI group was 8.33 (95% CI, 1.99 to 34.87, P =0.0037). 

Conclusion: Our study therefore shows that patients with SCI have an increased risk of developing MS.

8 comments:

  1. Yes I think this is relevant, that an injury to the head or spine may increase the chance of developing MS. I did read about a man who lifted something very heavy (extremely heavy) and this resulted in him having fasciculations over his body. There were investigations after this and possibilities included motor neurone disease. Head injurys can result in white matter lesions. From my understanding is that boxers can develop white matter lesions from their head injurys.

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    1. I hit a tree skiing. Fractured my lower back. Years after healing a started running which agitated my old injury and triggered optic neuritis. This led me to discovering that I had MS. Docs have claimed that there is no known link however I'm convinced the two are co-related.

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  2. I have had several accidents. Fell off horse 26 years ago, broke arm and a few ribs. Car accident 15 years ago, I was a passenger and a heavy car didn't break behind us at traffic lights, I got whip lash. Then hurt my head 3 years ago.

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  3. Do street fighters, boxers and similar have an increased risk of developing MS? If these injurys can cause white matter lesions. Has any research been done into this?

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    1. They get head injuries, there is a suggestion that footballers soocer and US get a more motorneuron disease

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  4. I think the question is : does traumatic spinal cord injury elicit an inflammatory cascade that may eventually lead to chronic CNS inflammation in genetically predisposed patients? As noted, reverse causation is difficult to prove.

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    1. You mention cascade, that's a good word to use.

      What is apparent to me is that could a series of unfortunate events that all effect the CNS lead to the first relapse or MS symptom appearing?
      In my case I had a relationship breakdown, left my very stressful job, house move, trauma to the head, trauma to the spine a month later, time of high stress and anxiety, bad infection, vertigo, more stress and anxiety then a very severe relapse. The CNS can only take so much and then it becomes unbalanced.

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  5. I hurt my neck in 1996 and it hurt more than labour and toothache. had a stiff neck on and off for 15 years and was just given painkillers. in 2010 after 3 weeks of agony asked for a scan and had 3 discs in my neck that had damaged my spinal cord. was given an urgent discectomy so I wasn't paralysed from the neck down (free on the NHS 💜) 4 years later got diagnosed with generalised dystonia. on tablets that we axing and stopped trots and spasms (trihexyphenydil) over the years I'd sprained both my ankles badly at least 25 times each foot. landed on my hand once and badly sprained my hand when I fell and now it is extremely jerky. can't find anything that says dystonia causes sprains or the other way round. does anyone else know? I feel like all my old injuries are enhanced now as if the pills loosen everything which is great but the bad things are looser so more vulnerable so are more spasmodic.if I'm cold or sneezemail or yawn my hands go into spasm?!!?

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