Evaluation of the association between multiple sclerosis and trauma according to graded trauma levels

Abstract

Objective: The relationship between trauma and multiple sclerosis (MS) remains unclear, partly due to differences in how trauma is defined and studied. This study examined the association between physical trauma and MS, with a focus on trauma severity. Method: Sixty-five patients with MS and 55 age- and sex-matched healthy controls were included. Trauma exposure was assessed during the one-month period preceding each relapse in the MS group and during the one-month period before each clinical evaluation in controls. Group differences were initially analyzed using the chi-square or Fisher’s exact test. Generalized estimating equations (GEE) were additionally used to account for repeated observations within participants. Results: A total of 226 relapse episodes and 110 control evaluation periods were analyzed. Trauma exposure was observed in 4.4% of pre-relapse periods and 19.1% of control periods. After accounting for repeated observations within participants using generalized estimating equations, trauma exposure was lower during relapse periods (OR = 0.103, 95% CI: 0.048–0.219; p < 0.001). Minor trauma was less frequent during the pre-relapse period (3.1% vs 14.5%; p < 0.001). Surgical procedures were less frequent during the pre-relapse period (0.9% vs 4.5%; p = 0.040). Conclusion: Trauma exposure was not associated with an increased risk of MS relapse in the acute-subacute period. Stratifying trauma by severity may provide a more meaningful understanding of the trauma–MS relationship.