Social and Environmental Triggers of Multiple Sclerosis onset: A Retrospective Study from Iran

• Published in: Multiple sclerosis and related disorders Vol. 71; p. 104317
• Main Authors: Abbasi, Naghmeh, Ghadiri, Fereshteh, Moghadasi, Abdorreza Naser, Khodaei, Faezeh, Karaminia, Maryam, Sahraian, Mohammad Ali
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.03.2023
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2022.104317

Multiple sclerosis (MS) is an often-disabling disease of the central nervous system (CNS). The possible triggers of its first presentation such as stressful events, viral infections, vaccinations, and labor are still a matter of debate among scientists. Considering the possible role of infections in MS onset and the reported cases of CNS demyelination following COVID-19 infection and variety of COVID-19 vaccines, this study was conducted to investigate and compare the possible social, environmental, and physical triggers of MS onset before and during the COVID-19 pandemic. A cross-sectional study was conducted from 28 February 2022 to 9 June 2022. A researcher-made questionnaire was designed in MS research center of Iran and distributed as an online google form on social media among 1340 Iranian MS patients. Demographic information, MS disease-related data, possible MS triggers (stressful life events, COVID-19 and other infections, COVID-19 and other vaccines, pregnancy or labor, head trauma, surgery, weight loss) were recorded. Patients were divided into two groups regarding the time of MS diagnosis (before and during the COVID-19 pandemic). Binary logistic regression method was used to determine the possible association between patient-reported triggers and diagnosis time (before and during the pandemic) adjusting for possible confounders. Of 920 participants, 670 (72.8 %) were female, and the mean age (SD) was 35.63 (±8.1). The majority of participants 637 (69.2%) had non-progressive forms of MS, and only 70 (7.6 %) needed assistance for ambulation. The time of MS diagnosis was before the start of the COVID-19 pandemic in 635 (69 %) participants. The differences between the most common first symptoms which led to MS diagnosis, visual type (n: 317 (49.9 %)) before the pandemic and sensory type (n: 170 (59.6 %)) after the pandemic were significant (p-values: 0.008 and <0.01 respectively). A stressful life event was the most common patient-reported MS trigger in both groups, (n: 356 (56.1%)) in patients who were diagnosed before the COVID-19 pandemic, and (n: 156 (54.7%)) in the latter group. Comparing two groups (MS diagnosed before and during the pandemic), economic problems (AOR: 1.81; 95%ACI: 1.23-2.65) and job loss (AOR: 2.89; 95%ACI: 1.37-6.08) were significantly more frequent stressful life event which trigger MS onset in the latter group while, the stress of occupational or educational exams (AOR: 0.52; 95%ACI: 0.34-0.79) was more prevalent in the first group. Social triggers such as stressful life events are closely associated with MS onset that had been increased in some categories after the COVID-19 pandemic. If truly recognized, they could be used to prevent the development and exacerbation of the disease.