Stress and exacerbations in multiple sclerosis: Authors' reply

doi:10.1136/bmj.328.7434.287-a

BMJ 2004;328:287 (31 January), doi:10.1136/bmj.328.7434.287-a

Letter

Stress and exacerbations in multiple sclerosis

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—We agree with Galea et al that recall bias couldbe an alternative explanation for our finding that stressfulevents are associated with the risk of exacerbation in multiplesclerosis.

To minimise the possibility of recall bias we chose a high (weekly)sampling frequency. Nevertheless, when patients experiencedan event and still had to complete the questions for the precedingweek, their perception of stress may have been influenced bythe relapse. In such a situation a high frequency of stresswithin or just before the week of the relapse would also beexpected. This was not the case in our study: we found no significantincrease in the number of reported stress events two weeks beforean exacerbation.

Galea et al are right that increases in stressful events precedingexacerbations do not directly prove a causal relation—wedo not claim that. They suggest that subclinical disease processes. . . [Full text of this article]

R Q Hintzen, neurologist

rhintzen@xs4all.nl

D Buljevac, medical doctor

Department of Neurology, Erasmus MC, Postbox 2040, 3000 CA Rotterdam, Netherlands

W C J Hop, biostatistician

Department of Epidemiology and Biostatistics, Erasmus MC

A C J W Janssens, psychologist

Department of Medical Psychology and Psychotherapy, Erasmus MC

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BMJ 2004 328: 287. [Extract] [Full Text]