{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T19:10:31Z","timestamp":1790536231696,"version":"4.1.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Military Veterans with MS and PTSD prior to symptom onset (MS\n                      <jats:sub>PTSD<\/jats:sub>\n                      , n\u2009=\u200996) were identified using the Department of Veterans Affairs MS databases. MS\n                      <jats:sub>PTSD<\/jats:sub>\n                      cases were matched to MS controls without PTSD ( n\u2009=\u200995). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean annualized relapse rate was greater in the MS\n                      <jats:sub>PTSD<\/jats:sub>\n                      group versus controls (0.23 vs 0.06, respectively; p\u2009&lt;\u20090.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; p\u2009&lt;\u20090.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5\u2009years, p\u2009&lt;\u20090.05) in relapsing MS patients with PTSD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      Patients with MS\n                      <jats:sub>PTSD<\/jats:sub>\n                      have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585211058361","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T05:28:38Z","timestamp":1638422918000},"page":"1257-1266","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of comorbid post traumatic stress disorder on multiple sclerosis in military veterans: A population-based cohort study"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-3983","authenticated-orcid":false,"given":"Mark","family":"Leekoff","sequence":"first","affiliation":[{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA\/Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA"},{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8520-7400","authenticated-orcid":false,"given":"William","family":"Culpepper","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA\/Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA"},{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Jin","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA \/Department of Neurology,School of Medicine,University of Maryland,Baltimore, MD, USA"},{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Lee-Wilk","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA \/Department of Neurology,School of Medicine,University of Maryland,Baltimore, MD, USA"},{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Wallin","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"bibr1-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007035"},{"key":"bibr2-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0004565"},{"key":"bibr3-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000010135"},{"key":"bibr4-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70135-6"},{"key":"bibr5-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1177\/1352458514564487"},{"key":"bibr6-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2004.09.0117"},{"key":"bibr7-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1177\/1352458508099477"},{"key":"bibr8-13524585211058361","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.8794"},{"key":"bibr9-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.6.593"},{"key":"bibr10-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1023\/B:JOTS.0000048955.65891.4c"},{"key":"bibr11-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0000000000000780"},{"key":"bibr12-13524585211058361","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2016.00526"},{"key":"bibr13-13524585211058361","unstructured":"Leekoff M, Reddi A, Wallin MT, et al. Impact of comorbid post traumatic stress disorder on outcomes in multiple sclerosis patients: A pilot cross-sectional study. In:\n                      National multiple sclerosis Tykeson fellows conference\n                      , Atlanta, GA, 10 November 2019."},{"key":"bibr14-13524585211058361","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007043"},{"key":"bibr15-13524585211058361","unstructured":"Department of Veterans Affairs. Interactive US and map of VISNs facilities, https:\/\/www.va.gov\/directory\/guide\/map.asp?dnum=1 (accessed 28 February 2021)."},{"key":"bibr16-13524585211058361","unstructured":"Veterans Affairs. 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