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Controversies in Neurology
July 2000

Trauma and Multiple Sclerosis

Author Affiliations
 

N. WHITAKERJOHNMD

Arch Neurol. 2000;57(7):1078. doi:10.1001/archneur.57.7.1078

TRAUMA AND multiple sclerosis (MS) is a topic that smolders and flares. As soon as a semblance of consensus settles upon the literature, a court case ignites the debate anew.

Poser argues that MS begins with a breach of the blood-brain barrier (BBB). Trauma can cause a local disruption of the BBB and serve as a portal for immunological attacks upon the brain's white matter. He stresses that it is not trauma per se but trauma to the central nervous system that can trigger an MS attack or recurrence. Cook notes that BBB breakdown can be the consequence and not the cause of white matter inflammation and that if trauma were an important cause or precipitant of MS, men and athletes would have a higher prevalence of MS, which they do not.

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