Despite being on rituxumab, could a stressful life event (or series of events) cause progression or lesions? I can understand activation or exacerbation of existing lesions, but can MS persist in cases of extreme stress despite DMDs?
The short answer is, MS activity can always occur despite disease modifying therapies. There are responders and non-responders to every therapy. Why breakthrough disease occurs is unknown. We think significant stress can upregulate immune system pathways, but the data linking to this to MS relapses is limited. Some of the studies done have shown that major life stressors did increase risk of a relapse, but correlations with chronic daily stress is lacking.
Benjamin M. Greenberg, MD, MHS, FAAN, FANA, CRND
Vice Chair Translational Research and Ambulatory Affairs
Department of Neurology and Neurotherapeutics
Director, Transverse Myelitis and Neuromyelitis Optica Program
Co-Director, Pediatric CONQUER Program
Department of Pediatrics