StudyDesign & populationInterventionOutcomesResultsStudy quality
Mohr (2000)[245]Cohort study
N = 36
Relapsing remitting and secondary progressive MS
Major negative events.
Conflict and disruption in routine.
Daily hassles.
Positive life events.
EDSS (disability) Development of MRI lesions.
Patients assessed every 4 weeks for 28 to 96 weeks
Increased conflict and disruption in routine increased risk of developing new lesions at 4 and 8 weeks.
Daily hassles increased risk of developing new lesions at 8 weeks.
Nisipeanu (1993)[246]Cohort study
N = 32
Relapsing remitting
Psychological stress – threat of missile attacksFrequency of relapses during war and following 2 months.No effect of psychological stress on frequency of relapses.Poor;
Assessment of outcome not blinded. No statistics.
Schwartz (1999)[247]Case control
N = 197
Clinically definite MS
Stress – negative and positive life eventsPatient reported Functional Systems Scale (FSS)Significantly increased risk of MS progression when rate of reported stressful events higher.
Significantly increased risk of reported stressful events when rate of MS progression higher.
Patient self-scoring may be subjective.
Rodriguez (1994)[262]Case control study
N = 162
Clinically definite MS
Trauma vs no traumaEDSS (disability)No significant effect of trauma on EDSS (disability)Poor. Confounding factors not taken into consideration.
No baseline patient characteristics.
Sibley (1991)[249]Cohort study.
N = 170
Patients with MS, 134 controls, monthly diaries
TraumaRelapse rate.Patients had more trauma than controls.
Relapses not associated with preceding trauma.
Closely observed patients studied prospectively
Gasperini (1995)[248]Case-control study
N = 178
Relapsing remitting MS
Infectious diseases Stressful life events Trauma
Physical overexertion Temperature variation Vaccination
Exposure to toxins Anaesthesia
Frequency of relapseNo significant association between any potential risk factors and relapse frequency.Poor;
Confounding factors not discussed
Bamford (1978)[243]Retrospective cohort
N = 33
MS patients
General anaesthesia
Spinal anaesthesia
Relapse rate in at risk period (within 1 month of anaesthetic)1/88 episodes of general anaesthesia was associated with MS relapse.
10% incidence of MS symptom exacerbation in post spinal anaesthetic month (however small sample)
No statistics.
Kytta (1984)[244]Retrospective cohort
N = 71
General anaesthesia
Regional Anaesthesia
Infiltration anaesthesia
Relapse rateNo association between type of anaesthetic and deterioration of MS.Very poor.
Bader (1988)[241]Cohort
N = 18
Anaesthesia during pregnancy
Epidural vs local vs general
Lidocaine vs bupivicaine vs chloroprocaine
Frequency of relapseWomen who suffered a relapse during first 3 months postpartum received higher concentration of local anaestheticPoor;
No baseline characteristics of patients. Small study.
Relapse defined as “worsening of neurological condition”.
No discussion of confounding factors. No statistics.

From: Appendix I, Evidence tables

Cover of Multiple Sclerosis
Multiple Sclerosis: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.
NICE Clinical Guidelines, No. 8.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2004, Royal College of Physicians of London.

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