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Physical trauma and risk of multiple sclerosis: a systematic review and meta-analysis of observational studies
Carole A Lunny1, Shawn N Fraser1, Jennifer A Knopp-Sihota1
1Faculty of Health Disciplines, Athabasca University, Alberta, Canada.
Background:
We aimed to examine physical trauma as a risk factor for the subsequent diagnosis of MS.
Methods:
We searched for observational studies that evaluated the risk for developing MS after physical trauma that occurred in childhood (≤20 years) or "premorbid" (>20 years). We performed a meta-analysis using a random effects model.
Results:
We identified 1362 individual studies, of which 36 case-control studies and 4 cohort studies met the inclusion criteria for the review. In high quality case-control studies, there were statistically significant associations between those sustaining head trauma in childhood (OR=1.27; 95% CI, 1.12-1.44; p<0.001), premorbid head trauma (OR=1.40; 95% CI, 1.08-1.81; p=0.01), and other traumas during childhood (OR=2.31; 95% CI, 1.06-5.04; p=0.04) and the risk of being diagnosed with MS. In lesser quality studies, there was a statistical association between "other traumas" premorbid and spinal injury premorbid. No association was found between spinal injury during childhood, or fractures and burns at any age and the diagnosis of MS. The pooled OR of four cohort studies looking at premorbid head trauma was not statistically significant.
Conclusions:
The result of the meta-analyses of high quality case-control studies suggests a statistically significant association between premorbid head trauma and the risk for developing MS. However, cohort studies did not. Future prospective studies that define trauma based on validated instruments, and include frequency of traumas per study participant, are needed.
Insights
Physical trauma, especially head injuries, may increase the risk of developing multiple sclerosis (MS). High-quality studies show a link, but more research is needed to confirm findings from cohort studies.
Area of Science:
- Neurology
- Epidemiology
- Trauma Research
Background:
- Investigating physical trauma as a potential risk factor for multiple sclerosis (MS).
- Examining trauma occurring in childhood (≤20 years) and adulthood (premorbid, >20 years).
Purpose of the Study:
- To assess the association between physical trauma and the subsequent diagnosis of MS.
- To synthesize evidence from observational studies through meta-analysis.
Main Methods:
- Systematic review and meta-analysis of observational studies.
- Inclusion of case-control and cohort studies evaluating MS risk after trauma.
- Random effects model used for meta-analysis.
Main Results:
- Significant associations found between childhood head trauma, premorbid head trauma, and other childhood traumas with increased MS risk in high-quality case-control studies.
- Lesser quality studies indicated associations for premorbid other traumas and spinal injury.
- No significant association observed for childhood spinal injury, fractures, or burns.
- Pooled analysis of cohort studies on premorbid head trauma did not yield statistically significant results.
Conclusions:
- High-quality case-control studies suggest a significant link between premorbid head trauma and MS risk.
- Cohort studies did not corroborate this association.
- Need for future prospective studies with validated trauma assessment tools and frequency data.
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