Background: Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS).
Objectives: To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort.
Methods: Military Veterans with MS and PTSD prior to symptom onset (MS, = 96) were identified using the Department of Veterans Affairs MS databases. MS cases were matched to MS controls without PTSD ( = 95). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019.
Results: The mean annualized relapse rate was greater in the MS group versus controls (0.23 vs 0.06, respectively; < 0.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; < 0.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5 years, < 0.05) in relapsing MS patients with PTSD.
Conclusion: Patients with MS have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.
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