Denial of compensation for patients who developed multiple sclerosis or have existing disease made worse following acute stress or trauma

An important legal question is the role of acute trauma on the central nervous system with stress in precipitating or worsening multiple sclerosis (MS). At present, the prevailing view in neurology is that there is no relationship. We show here that this opinion needs to be reappraised. Medicolegal decisions for compensation in court have hinged on this question, as do the future research and treatment. A critical analysis of highly important but hitherto neglected articles shows the prevailing view to be gravely mistaken. Modern molecular medicine has shown conclusively that trauma and stress (either alone or together) to the central nervous system cause disruption of the blood–brain barrier (BBB). Disruption of this BBB, a complex molecular process, is the basic pathological feature of MS and is affected in both trauma and stress. Its further study should lead to a rational mode of therapy and resolve the legal quagmire.