The role of the stress adaptive response in multiple sclerosis

Multiple sclerosis (MS) is the commonest autoimmune inflammatory neurological disease presenting multifocal demyelinating lesions in the white matter of the central nervous system (CNS). Its pathogenesis involves genetic and environmental mechanisms which lead to immune cell-mediated destruction of myelin and axonal damage and glial scars in CNS. Stress adaptive response might cause MS exacerbation by triggering release of hormones and neuropeptides leading to immune dysregulation and altered cytokine production. The exact link between the stress adaptive response and MS physiopathology is not clear, although neuro-immunological studies have shown alterations in cytokines and lymphocytes in MS patients, under stress, which might have clinical significance. Dysregulation of the principal components of the stress system, i.e. the hypothalamic–pituitary–adrenal axis, the sympathetic nervous system and the dopaminergic system, have been described in MS patients. In this critical review the role of the stress adaptive response in the manifestation and exacerbation of MS is described.