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Updated: Jun 19, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
The effect of war stress on multiple sclerosis exacerbations and radiological disease activity
Bassem Yamout1, Salam Itani, Roula Hourany
1Department of Internal Medicine, American University of Beirut - Medical Center, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon.
Objective:
The relationship between stressful life events and multiple sclerosis (MS) exacerbations or radiological disease activity is at best controversial. The aim of this study is to examine the relationship between exposure to war-related events incurred during the July 2006 Israeli-Lebanese war and clinical relapses and MRI disease activity among Lebanese MS patients.
Methods:
We studied a group of 216 patients with clinically definite relapsing remitting MS (RRMS), on whom clinical data was available for the war period and for the preceding and following year(s). The number of relapses was determined during the war period and during similar periods over a 3-year span. All patients with brain MRI during the war period had their scans reviewed for evidence of disease activity as defined by the presence of gadolinium enhancing (Gd+) lesions. A group of patients with brain MRI performed outside the war period was used for comparison.
Results:
The total number of relapses during the war period (n=23) was significantly higher than during non-war periods (mean=8.4, SD=0.86) (p=0.006). Of the 18 patients with brain MRI during the war, 5/7 with relapses and 1/11 without relapses had Gd+ lesions (p=0.013). More patients had Gd+ lesions during the war period (33%) compared to controls (13%) (p=0.075).
Interpretation:
Our study shows that exposure to war-related events is likely to lead to an increase in both clinical relapses and MRI disease activity in patients with MS.
Insights
War-related stress significantly increased multiple sclerosis (MS) relapses and MRI-detected disease activity in Lebanese patients. This highlights the impact of severe stress on MS progression and exacerbations.
Area of Science:
- Neuroimmunology
- Epidemiology of Neurological Disorders
Background:
- The link between stressful life events and multiple sclerosis (MS) activity remains debated.
- Previous research has yielded controversial findings regarding stress-induced MS exacerbations or radiological progression.
Purpose of the Study:
- To investigate the association between exposure to war-related events during the 2006 Israeli-Lebanese conflict and clinical relapses.
- To assess the impact of war-related stress on magnetic resonance imaging (MRI) detected disease activity in Lebanese MS patients.
Main Methods:
- A cohort of 216 patients with relapsing-remitting MS (RRMS) was analyzed for clinical relapses during the war and comparable non-war periods.
- Brain MRI scans from the war period were reviewed for gadolinium-enhancing (Gd+) lesions, with a comparison group of patients scanned outside the war period.
Main Results:
- A significant increase in relapses was observed during the war period (23 events) compared to non-war periods (mean 8.4 events).
- Among patients with MRIs during the war, those with relapses showed a higher prevalence of Gd+ lesions (5/7) compared to those without relapses (1/11).
- A trend towards increased Gd+ lesions during the war period (33%) versus control periods (13%) was noted, though not statistically significant (p=0.075).
Conclusions:
- Exposure to war-related events is strongly associated with increased clinical relapses in MS patients.
- War-related stress appears to elevate MRI-detected disease activity, indicating a heightened inflammatory state in MS.
- These findings underscore the detrimental effect of severe stress on the course of multiple sclerosis.
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