[Physical trauma and psychological stress in multiple sclerosis (author's transl)]

In spite of the fact tht knowledge of the pathogenesis of multiple sclerosis remains incomplete, no evidence supports the hypothesis that physical trauma or psychological stress plays a role in its causation. Exacerbations of MS are much more likely to represent the effects of already existing plaques than be the clinical manifestations of newly developed ones. Careful review and analysis of preceding historical events often uncovers episodes of physical trauma or significant psychological stress. The occurrence of a symptomatic exacerbation shortly after an accident, especially at work not infrequently leads to litigation. Trauma and stress must be considered precipitating factors, not causal ones. The existence of unsuspected, asymptomatic lesions has now been well documented in the living patient by means of a number of diagnostic techniques. These can then explain how psychological and psychophysiological alterations produced by trauma or psychological stress rather than by the more classical changes in body temperature or calcium concentration, may lead to the emergence of clinical symptoms. These physiologic alterations, to our knowledge, do not influence the pathological manifestations of the disease in the central nervous system. It is undeniable that an accident may induce a symptomatic exacerbation but there is nothing to suggest that even severe physical trauma leads to the formation of new plaques or causes progression of the illness.