The relationship of MS to physical trauma and psychological stress: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

To the Editor:

I was shocked to see the Special Article on the relationship of MS to physical trauma and psychological stress.1 As a member of the Therapeutics and Technology Assessment Subcommittee, I had been under the impression that I would not only have an opportunity to review the final version of the report, but also to file a dissent or minority report. The simple notice that I had reviewed the report implies approval and fails to indicate my strong disagreement with its content. The final draft includes none of my comments on preliminary versions to Dr. Goodin, nor does it cite any of the important references in support of my position that certain types of trauma to the head, neck, and upper back, in some MS patients, results in the appearance or recurrence of the symptoms of MS. Although it is true that most of my papers on the subject are cited in the references, they are quickly dismissed without any allusion to their content or detailed documentation.

Sadly, no epidemiologic study has ever been conducted on the most frequent form of trauma responsible for the appearance or recurrence of MS symptoms, the whiplash injury, which results from the often overlooked or forgotten, and rarely asked about, rear-end collision. None of the three epidemiologic studies cited in the report2–4 mention such injuries. Unfortunately, Goodin et al. ignored the seminal publications by Brain and Wilkinson5 and by Oppenheimer6 on the relationship between cervical spondylosis and cervical plaques. I had sent Dr. Goodin pictures of cervical MRIs of MS patients showing the direct geographical relationship between cord compression and cervical plaques, clearly confirming the Brain and Wilkinson and Oppenheimer hypotheses. Cervical cord plaques appearing at the site of compression by spondylosis were first reported by …