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Prospective study on the relationship between infections and multiple sclerosis exacerbations.
D Buljevac1, H Z Flach, W C J Hop
1Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
Brain : a Journal of Neurology
|April 19, 2002
Summary
Systemic infections increase the risk of multiple sclerosis exacerbations, leading to more sustained disability. This study found infections heighten immune activity but do not increase blood-brain barrier lesions.
Area of Science:
- Neuroimmunology
- Infectious Disease Epidemiology
Background:
- Multiple sclerosis (MS) is characterized by unpredictable relapses and remissions, linked to immune system activity.
- Exacerbations in MS can cause short-term morbidity and contribute to long-term disability.
Purpose of the Study:
- To investigate the role of systemic infections in MS exacerbations.
- To determine if infections increase the number of gadolinium-enhancing lesions on MRI.
Main Methods:
- A longitudinal study of 73 relapsing-remitting MS patients over 6466 patient-weeks.
- Observed 167 infections and 145 exacerbations, analyzing exacerbations within a predefined at-risk period (ARP) following infection.
- Assessed sustained disability increase (Expanded Disability Status Scale - EDSS) and measured soluble intracellular adhesion molecule 1 (sICAM-1) levels.
Main Results:
- An increased risk of exacerbations (rate ratio 2.1) was observed during the ARP (2 weeks before to 5 weeks after infection).
- Exacerbations during the ARP were more likely to cause sustained disability (rate ratio 3.8).
- ARP exacerbations showed higher sICAM-1 plasma levels, indicating heightened immune activation, but no increase in gadolinium-enhancing lesions was detected.
Conclusions:
- Systemic infections contribute to MS exacerbations, leading to more significant and sustained neurological damage.
- The increased damage appears linked to enhanced immune activation rather than increased blood-brain barrier permeability.