Association of acute stress with multiple sclerosis onset and relapse in Saudi Arabia

Anwar S. AlZahrani, Foziah J. Alshamrani, Fahd A. Al-Khamis, Abdulla A. Al-Sulaiman, Walaa S. Al Ghamdi, Omar A. Al Ghamdi, Maryam Y. Mohammad, Mashail S. Alshayea, Razan A. Alhazmi, Mohamed A. Alkhaja


Objectives: To determine if there is a relationship between acute stress and either the onset or relapse of multiple sclerosis (MS) and to discover how different types of acute stressors may be involved. 

Methods:  This study was carried out in Saudi Arabia between September 2017 and June 2018 and involved King Fahad University Hospital in Eastern province, Arfa Multiple Sclerosis Society in the Central and Western province of Saudi Arabia. A cross-sectional descriptive study was performed using an Arabic self-constructed questionnaire consisted of 4 sections: 1) demographic data and time of diagnosis; 2) emotional/psychological stressors; 3) environmental/physical stressors; and 4) 4 specific stressors measuring their effect on the severity and recurrence of attacks. 

Results: A total of 370 patients participated in the study. Almost half of patients reported no effect of family problems on their disease, whereas the other reported that family problems have an impact on the onset or relapse of the disease. Majority of patients reported that work and social life stressors affect the recurrence of attacks. Cold weather showed no effect on MS; however, hot weather and physical activity increased the number of attacks. Continuous thinking about social stress and problems, mood swings, and sleep deprivation showed an impact on the severity and recurrence of attacks. Financial problems showed no effect. 


Conclusion: Study indicates that an association exists between acute stress and relapse in MS but not the disease onset.


Saudi Med J 2019; Vol. 40 (4): 372-378
doi: 10.15537/smj.2019.4.24010

How to cite this article:
AlZahrani AS, Alshamrani FJ, Al-Khamis FA, Al-Sulaiman AA, Al Ghamdi WS, Al Ghamdi OA, et al. Association of acute stress with multiple sclerosis onset and relapse in Saudi Arabia. Saudi Med J. 2019 Apr;40(4):372-378. doi: 10.15537/smj.2019.4.24010.


Acute stress; multiple sclerosis; recurrence; relapses

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Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Revue Neurologique 2016; 172: 3-13.

Heydarpour P, Khoshkish S, Abtahi S, Moradi-Lakeh M, Sahraian MA. Multiple sclerosis epidemiology in Middle East and North Africa: A systematic review and meta-analysis. Neuroepidemiology 2015; 44: 232-244.

Rapaport B, Karceski S. Multiple sclerosis and stress. Neurology 2012; 79: e47-e49.

Association AP. Stress: The different kinds of stress. Retrieved from American Psychological Association. Available from URL: http://www apa org/helpcenter/stress-kinds aspx

Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD. Relationship between stress and relapse in multiple sclerosis: Part I. Important features. Mult Scler 2006; 12: 453-464.

Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of Neurology 2011; 69: 292-302.

Settle J, Culpepper W, Wallin M. Marital status and functional systems scores in a population-based multiple sclerosis cohort. Neurology 2015; 84 (14 Suppl): p.5.199.

Bjornevik K, Riise T, Cortese M, Holmoy T, Kampman MT, Magalhaes S, et al. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study. Mult Scler 2016; 22: 104-111.

Flensner G, Ek AC, Soderhamn O, Landtblom AM. Sensitivity to heat in MS patients: a factor strongly influencing symptomology--an explorative survey. BMC Neurology 2011; 11: 27.

Christogianni A, Bibb R, Davis SL, Jay O, Barnett M, Evangelou N, et al. Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptoms. Temperature 2018; 5: 208-223.

Veauthier C. Sleep disorders in multiple sclerosis. Curr Neurol Neurosci Rep 2015; 15: 21.

Tullman MJ. Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis. Am J Manag Care 2013; 19(2 Suppl): S15-S20.

Briones-Buixassa L, Mila R, J MfA, Bufill E, Olaya B, Arrufat FX. Stress and multiple sclerosis: A systematic review considering potential moderating and mediating factors and methods of assessing stress. Health Psychol Open 2015; 2: 2055102915612271.

Edwards T, Pilutti LA. The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions. Mult Scler Relat Disord 2017; 16: 31-39.

Janssens AC, van Doorn PA, de Boer JB, van der Meche FG, Passchier J, Hintzen RQ. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurologica Scandinavica 2003; 108: 389-395.

Oveisgharan S, Hosseini SS, Arbabi M, Nafissi S. Stress differentially predicts multiple sclerosis relapses. Neurology Asia 2014; 19: 53-58.


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