A chronic, unpredictable neurological disease in which the body attacks itself by mistake that affects some 2.8 million people around the world and about 10,000 Israelis, multiple sclerosis (MS) damages the myelin that coats the nerves so they can’t conduct electrical impulses normally to and from the brain.
MS is mostly caused by the autoimmune system attacking the body, but viruses and other infectious agents, genetics, and environmental factors, including where one lives (those in the north are more susceptible than those in warmer climates), are also factors.
Some people with MS may have only mild symptoms, while others may lose their ability to see clearly, write, speak, or walk. It can cause muscle weakness, pain, difficulty balancing, numbness, fatigue, dizziness, and bowel and bladder problems, and usually shows up in younger adults aged 20 to 45.
Now, neurologists at the Hadassah-University Medical Center in Jerusalem’s Ein Kerem have examined the progression of the disease in a first-of-its-kind study and have found increased activity of neurological symptoms in the first three months of the Israel-Hamas War.
Hadassah treats 3,000 MS patients per year, performing MRIs to assess any changes. The proportion of patients who showed MS-related activity on MRI scans in the year preceding the war doubled due to war-related stress during the same period of time the following year.
The study, just published in the Annals of Clinical and Translational Neurology under the title “Subclinical imaging activity in multiple sclerosis patients during war-related psychological stress,” was led by Dr. Omri Zveik, Dr. Tal Friedman-Korn, Dr. Ariel Rechtman, Dr. Tal Ganz, Dr. Garrick Hoichman, Dr. Lyne Shweiki, Dr. Dana Ekstein, and Prof. Adi Vaknin-Dembinsky.
Conducted after the Hamas terrorist attacks
Conducted in the wake of the vicious October 7, 2023, terrorist attack by Hamas, the study is among the few in the world to examine how extreme stressful events such as war affect the progression of MS, using MRI imaging – and the first to examine the impact of October 7 on MS patients in Israel.
The study involved 93 MS patients who were followed up at the Hadassah Neurology Clinic who had undergone routine annual brain scans at the same time each year for at least three years from October 2021 to January 2022; October 2022 to 7 January 2023; and 7 October 2023 to January 2024.
By analyzing MRI scans over this period, a clear increase in disease activity was observed in the first three months after the October 7 attack compared to the same period in previous years.
Zveik told The Jerusalem Post that he and his team were “not very surprised by results. From the 18th century, there were animal studies that showed stress can worsen MS, but there were very few human studies that just showed MS victims suffering from extra stress from divorce or being fired from one’s job had more attacks.
“We studied MS patients who underwent MRI scans consistently for three years at the same time. Most of those didn’t feel their disease was active, but the MRI, which is very sensitive, discovered that stress did harm them, and that the harmful effect was four times that they had before.”
While only 11.83% of patients showed activity on MRI scans in the same period in the year before the war, this rate doubled to 24.73% in 2023 due to war-related stress. During the war, MS patients were four times more likely to show new disease activity on MRI scans, suggesting an increased risk of disease activity during times of extreme stress. Patients with more severe disease were even more vulnerable.
Although most patients in the study did not experience visible symptoms of a flare-up, MRI scans revealed background disease activity. This finding suggests that even when MS patients appear stable, extreme psychological stress can worsen the disease, which could subsequently affect long-term health.
The study highlights the importance of regular MRI surveillance for MS patients, especially during periods of increased psychological stress, using imaging that makes possible the detection of changes in the disease even before symptoms appear.
Doctors should be aware of the possibility of increased disease activity in MS patients during periods of extreme stress and should consider more frequent surveillance, including MRI scans, or treatment adjustments.
The researchers stressed the importance of psychological support for patients during periods of significant stress. Although the study itself did not involve various stress-reducing interventions, this is the team’s next goal.
Recent prospective studies report that following the October 7 terrorist attack, nearly half of the Israeli population experienced high levels of stress, depression, and anxiety, affecting both Jewish and Arab Israelis.
Studying the effects of stress on biomarkers in MS may provide essential insights and establish a biological connection between stress and neurological damage in MS patients, as well as highlight the importance of considering psychological stress in MS management, they concluded.