Objective:

This study aims to assess the impact of war-related psychological stress on multiple sclerosis (MS) activity using magnetic resonance imaging (MRI) scans and clinical follow-up.

Background:

Psychological stress has been suggested as a contributory factor in the onset and progression of MS. The October 7th, 2023 terrorist attacks in Israel caused significant psychological stress, providing a unique context to study its impact on MS activity.

Design/Methods:

This observational retrospective case-control study includes 93 patients with MS (pwMS) who had routine annual MRI scans from three periods (October 7th, 2021, through January 7th, 2022; October 7th, 2022, through January 7th, 2023; and October 7th, 2023, through January 7th, 2024). Data were collected from medical records and MRI scans at Hadassah Medical Center. MRI scans were classified as active if new or enlarging T2-lesions and/or enhancing T1-lesions were present.

Results:

MRI activity significantly increased among pwMS during the first three months of the war compared to the corresponding period in the preceding year (11/93 vs. 23/93, p=0.0139), with an OR of 4.0 (95%-CI: 1.29-16.442). pwMS with an EDSS score ≥ 4 showed a significant increase in MRI activity (p=0.045), whereas no significant increase was observed in patients with an EDSS score ≤ 3.5 (p=0.23). Additionally, MRI activity increased later during the war compared to the previous year (p<0.0001).

Conclusions:

This study provides evidence of increased MRI-detected disease activity in pwMS during periods of war-related psychological stress. Our findings highlight the importance of considering psychological stress in MS management. Healthcare providers should be aware of the potential for increased disease activity in pwMS during extreme stress and may consider more frequent monitoring, including MRI scans, or treatment adjustments during such periods.