Demyelinating Disorders (DN Bourdette and V Yadav, Section Editors)

Current Neurology and Neuroscience Reports

, 13:398

First online:

Stress in Multiple Sclerosis: Review of New Developments and Future Directions

  • Jesus LoveraAffiliated withDepartment of Neurology, LSU Health Sciences Center-New Orleans Email author 
  • , Tara RezaAffiliated withBiomedical Engineering, University of Southern California

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In the experimental autoimmune encephalitis model of multiple sclerosis, the effects of stress on disease severity depend on multiple factors, including the animal’s genetics and the type of stressor. The studies in humans relating stress to the risk of developing multiple sclerosis have found discordant results. The studies looking at the association of stress with relapses show a fairly consistent association, where higher stress is associated with a higher risk of relapse. Higher stress levels also appear to increase the risk of development of gadolinium-enhancing lesions. A recent randomized trial shows that reducing stress using stress management therapy (SMT), a cognitive–behavioral therapy approach, results in a statistically significant reduction in new magnetic resonance imaging lesions. The magnitude of this effect is large and comparable to the effects of existent disease-modifying therapies, but no data exist yet proving that SMT reduces relapses or clinical progression; the effect of SMT appears to be short-lived. Additional work is needed to improve the duration of this effect and make this therapy more widely accessible.


Stress psychological Hypothalamus-pituitary-adrenal axis Glucocorticoids Glucocorticoids resistance Cognitive-behavioral therapy Stress reduction therapy Multiple sclerosis Gadolinium-enhancing lesions MRI New developments Future directions