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Multiple Sclerosis and Trauma

Fairfax Injury Lawyer Brien Roche Addresses Multiple Sclerosis Trauma

Brien Roche

I wish I could claim actual authorship of what follows.  However I cannot.  Also I don’t know who the author is of what follows. However it is an article that I found in one of my files.  The article is well done and I believe still current.  Whoever the author may be, I wish to give attribution to that person.

Nicholas Dingley, a police officer, sustained a whiplash injury to his neck. The van in which he was a passenger overturned.  Seventeen days after the crash he began to have the first symptoms of multiple sclerosis.  His condition worsened. Finally he was forced to retire three years later.1  As a result the question arose as whether there is a causal nexus between the injury and the onset of MS.

What is MS

First, what is multiple sclerosis?  It is an autoimmune, demyelinating disease. It affects the central nervous system.2  In other words the disease attacks the myelin sheath of the central nervous system (CNS). It causes neurological dysfunction. 3 For instance difficulty with movement, coordination, blurred vision and loss of bladder control.4  The reason for this loss of function is that the myelin sheath acts as the insulation for the nerves.  MS attacks this insulation. Therefore it causes “short circuits” along the network.  The regions that are attacked show a formation of lesions, otherwise known as plaque.  Also the disease is progressive. In other words it leads to increasing neurological loss. Therefore it results in a slow and frequently fatal deterioration.  However relapses and remissions can occur. Patients can remain functionally employed upwards of twenty years.5Call, or contact us for a free consult.

Multiple Sclerosis Trauma-Causes Unknown

However the exact causes of multiple sclerosis are unknown.  It has been stated that MS is a quiescent disease. In other words it may lay dormant until triggered by some catalyst.  This theory is supported by autopsies showing MS plague formations in people who were asymptomatic.6  Therefore the question becomes, can trauma be that catalyst?

For the myelin sheath to become vulnerable, there must be a breach of the blood-brain barrier (BBB).7  The blood-brain barrier is a “barrier created by the modification of brain capillaries… that prevents many substances from leaving the blood and crossing the capillary walls into the brain tissues.”8  Therefore “It is obvious that any mechanism which physically destroys the components of the BBB will render the CNS open to the cellular and molecular constituents of the blood.”9  For instance such a mechanism can be physical trauma.10  As a result the breach then permits the injury site to become inflamed.11  The connection between this trauma and the triggering or worsening of MS has been a source of contention among medical researchers.

Multiple Sclerosis Trauma-Connection Suspected

A causal connection between trauma and the onset of MS has been suspected since the 19th Century.12  In a 1964 study of seven patients, Dr. Henry Miller concluded, “these patients were probably already suffering from pathological multiple sclerosis without clinical signs, and that trauma converted a silent into an overt disease.”13  Furthermore in March 2000 Drs. Chaudhuri and Behan wrote of seeing over a five-year period “a total of 39 cases of clinically definite MS after cervical whiplash injury.  In the majority of cases symptoms of MS were of new onset.  However in the 15 other cases, cervical whiplash injury caused an exacerbation of previously diagnosed benign MS.”14

In addition Dr. Charles M. Poster has written multiple articles on the connection between trauma and MS.15  However opponents of a connection between trauma and MS point to their own case studies. Such as a study of 389 MS patients by the Mayo Clinic and a study of 50 patients at the MS Clinic of the University of British Columbia. However neither found a causal connection between trauma and the onset of MS.16  In addition the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology also came out against a causal connection. The “reports that propose such a causal link are either uncontrolled series or reports using very small sample sizes”.17

Proving Causation

Where does this conflict among medical authorities leave the personal injury lawyer  The defense will argue that the plaintiff would have become symptomatic even without the trauma.  However these arguments can be defeated. In other words the plaintiff must prove that the negligently induced trauma was a cause of the symptoms.  Call, or contact us for a free consult.

Facts Are Important

First of all a convincing and well-informed neurologist is critical to pursue such a claim.  Furthermore the opinion expressed by that doctor must be founded on some unshakeable factual predicates:

  • The plaintiff has shown no symptoms of MS prior to the trauma.  This is important, because if the plaintiff has shown symptoms of MS before the trauma, it becomes difficult to argue that the trauma itself is what induced the symptoms.
  • In addition the trauma, while not necessarily debilitating, must be significant enough that it detracts from the ability of the plaintiff’s immune system to fight off the MS virus.  Medical literature reports cases where a mild head or neck injury was sufficient to cause the onset of MS symptoms.
  • Also the injury must be to the head, neck or upper back. “Only trauma affecting the head, neck or upper back, that is, to the brain and/or spinal cord, can be considered significant.”18
  • In addition the symptoms of MS begin to manifest themselves close to the trauma.  This is where lay testimony is going to be critical. The symptoms themselves may be somewhat generalized. However they may not be appreciated by a medical doctor until they have progressed to the point they become debilitating.  Furthermore a partial list of symptoms that need to be looked are set out below
  • Symptoms

    a.  Loss of consciousness

    b.  Lack of stamina

    c.  Balance problems

    d.  Lethargy

    e.  Inability to grasp objects with the hands

    f.  Headaches

    g.  Dizziness

    h.  Blurred vision

    i.  Non-localized pain

    j.  Circulation problems

    k.  Decreased coordination

    l.  Finally lack of sensation in the extremities

  • There is no other significant trauma that is a potential factor.
  • In addition a factor to be considered is whether the trauma has been to the area of the body where the MS is diagnosed, i.e., the neck.  In other words while there is no medical authority establishing a causal link between the site of injury and the site of diagnosis, the connection can be convincing to a jury.
  • Multiple Sclerosis Trauma-Handle With Care

    These cases should be approached with caution.  For instance the Illinois Appellate Court upheld a $2 Million verdict because the evidence was sufficient for a jury to find a causal link between an auto crash and the onset of MS.19 However the British House of Lords upheld a reversal of an $820,875 verdict in favor of Nicholas Dingley because that causal connection was not proven to the Court’s satisfaction.20  However this caveat aside, there is convincing medical literature espousing a causal link. As a result that authority, plus the factual predicates set forth above and convincing medical testimony from the treating doctor are enough to create  a jury question as to the issue of causation. Hence this could well be devastating to the defense.

    Call, or contact us for a free consult. Also for more info on MS see the Wikipedia pages. Also see the post on this site dealing with personal injury issues.

    Footnotes

    1  Dingley v. Chief Constable of Strathclyde, 2000 S.C. (H.L.) 77, 2000 WL 191166.

    2  Wendy Morrison et al., Environmental Triggers in Multiple Sclerosis:  Fact or Fallacy?, September 1994 Axon 23-26, 23.

    3  Id.

    4  Michael J. Moore, et al., Multiple Sclerosis.  53:4 Postgraduate Medicine 75-80, 76 (1973)

    5  Id at 77.

    6  Valiulis v. Scheffels, 547 N.E.2d 1289, 1297 (Ill.App. 1989).

    7  Enrico Granieri, Exogeneous Factors in the Aetiology of Multiple Sclerosis, 6:Suppl 2 Journal of NeuroVirology S141-S146, S144 (2000).

    8  Merriam-Webster’s Medical Dictionary, 1995 Ed., on www.WebMD.com.

    9  William F. Hickey, Migration of Hematogenous Cells Through the Blood-Brain Barrier and the Initiation of CNS Inflammation.  1 Brain Pathology 97-105, 97 (1991).

    10  Id.

    11  Id.

    12  Henry Miller, Trauma and Multiple Sclerosis.  18 April 1964 The Lancet 848-850, 849

    13  Id at 850.

    14  A. Chaudhuri & P.O. Behan, Letter.  54 Neurology 1393 (2000).

    15  See Charles M. Poser, Trauma to the Central Nervous System May Result in Formation or Enlargement of Multiple Sclerosis Plaques. 57 Arch Neurol 1074-1076 (2000); Charles M. Poser, The Role of Trauma in the Pathogenesis of Multiple Sclerosis:  A Review. 96 Clinical Neurology and Neurosurgery 103-110 (1994); among others.

    16 Morrison, et al., at 24-25.

    17 D.S. Goodin, et al. The Relationship of MS to Physical Trauma and Psychological Stress.  52 Neurology 1737-1745, 1737 (1999).

    18  Charles M. Poser, Trauma to the Central Nervous System May Result in Formation or Enlargement of Multiple Sclerosis Plaques. 57 Arch Neurol 1074-1076 (2000).

    19 Valiulis.

    20 Dingley.  Dingley’s experts included Dr. Charles M. Poser and Dr. Peter O. Behan.

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    Multiple Sclerosis and Trauma

    Fairfax Injury Lawyer Brien Roche Addresses Multiple Sclerosis Trauma

    Brien Roche

    I wish I could claim actual authorship of what follows.  However I cannot.  Also I don’t know who the author is of what follows. However it is an article that I found in one of my files.  The article is well done and I believe still current.  Whoever the author may be, I wish to give attribution to that person.

    Nicholas Dingley, a police officer, sustained a whiplash injury to his neck. The van in which he was a passenger overturned.  Seventeen days after the crash he began to have the first symptoms of multiple sclerosis.  His condition worsened. Finally he was forced to retire three years later.1  As a result the question arose as whether there is a causal nexus between the injury and the onset of MS.

    What is MS

    First, what is multiple sclerosis?  It is an autoimmune, demyelinating disease. It affects the central nervous system.2  In other words the disease attacks the myelin sheath of the central nervous system (CNS). It causes neurological dysfunction. 3 For instance difficulty with movement, coordination, blurred vision and loss of bladder control.4  The reason for this loss of function is that the myelin sheath acts as the insulation for the nerves.  MS attacks this insulation. Therefore it causes “short circuits” along the network.  The regions that are attacked show a formation of lesions, otherwise known as plaque.  Also the disease is progressive. In other words it leads to increasing neurological loss. Therefore it results in a slow and frequently fatal deterioration.  However relapses and remissions can occur. Patients can remain functionally employed upwards of twenty years.5Call, or contact us for a free consult.

    Multiple Sclerosis Trauma-Causes Unknown

    However the exact causes of multiple sclerosis are unknown.  It has been stated that MS is a quiescent disease. In other words it may lay dormant until triggered by some catalyst.  This theory is supported by autopsies showing MS plague formations in people who were asymptomatic.6  Therefore the question becomes, can trauma be that catalyst?

    For the myelin sheath to become vulnerable, there must be a breach of the blood-brain barrier (BBB).7  The blood-brain barrier is a “barrier created by the modification of brain capillaries… that prevents many substances from leaving the blood and crossing the capillary walls into the brain tissues.”8  Therefore “It is obvious that any mechanism which physically destroys the components of the BBB will render the CNS open to the cellular and molecular constituents of the blood.”9  For instance such a mechanism can be physical trauma.10  As a result the breach then permits the injury site to become inflamed.11  The connection between this trauma and the triggering or worsening of MS has been a source of contention among medical researchers.

    Multiple Sclerosis Trauma-Connection Suspected

    A causal connection between trauma and the onset of MS has been suspected since the 19th Century.12  In a 1964 study of seven patients, Dr. Henry Miller concluded, “these patients were probably already suffering from pathological multiple sclerosis without clinical signs, and that trauma converted a silent into an overt disease.”13  Furthermore in March 2000 Drs. Chaudhuri and Behan wrote of seeing over a five-year period “a total of 39 cases of clinically definite MS after cervical whiplash injury.  In the majority of cases symptoms of MS were of new onset.  However in the 15 other cases, cervical whiplash injury caused an exacerbation of previously diagnosed benign MS.”14

    In addition Dr. Charles M. Poster has written multiple articles on the connection between trauma and MS.15  However opponents of a connection between trauma and MS point to their own case studies. Such as a study of 389 MS patients by the Mayo Clinic and a study of 50 patients at the MS Clinic of the University of British Columbia. However neither found a causal connection between trauma and the onset of MS.16  In addition the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology also came out against a causal connection. The “reports that propose such a causal link are either uncontrolled series or reports using very small sample sizes”.17

    Proving Causation

    Where does this conflict among medical authorities leave the personal injury lawyer  The defense will argue that the plaintiff would have become symptomatic even without the trauma.  However these arguments can be defeated. In other words the plaintiff must prove that the negligently induced trauma was a cause of the symptoms.  Call, or contact us for a free consult.

    Facts Are Important

    First of all a convincing and well-informed neurologist is critical to pursue such a claim.  Furthermore the opinion expressed by that doctor must be founded on some unshakeable factual predicates:

    • The plaintiff has shown no symptoms of MS prior to the trauma.  This is important, because if the plaintiff has shown symptoms of MS before the trauma, it becomes difficult to argue that the trauma itself is what induced the symptoms.
    • In addition the trauma, while not necessarily debilitating, must be significant enough that it detracts from the ability of the plaintiff’s immune system to fight off the MS virus.  Medical literature reports cases where a mild head or neck injury was sufficient to cause the onset of MS symptoms.
    • Also the injury must be to the head, neck or upper back. “Only trauma affecting the head, neck or upper back, that is, to the brain and/or spinal cord, can be considered significant.”18
    • In addition the symptoms of MS begin to manifest themselves close to the trauma.  This is where lay testimony is going to be critical. The symptoms themselves may be somewhat generalized. However they may not be appreciated by a medical doctor until they have progressed to the point they become debilitating.  Furthermore a partial list of symptoms that need to be looked are set out below
    • Symptoms

      a.  Loss of consciousness

      b.  Lack of stamina

      c.  Balance problems

      d.  Lethargy

      e.  Inability to grasp objects with the hands

      f.  Headaches

      g.  Dizziness

      h.  Blurred vision

      i.  Non-localized pain

      j.  Circulation problems

      k.  Decreased coordination

      l.  Finally lack of sensation in the extremities

  • There is no other significant trauma that is a potential factor.
  • In addition a factor to be considered is whether the trauma has been to the area of the body where the MS is diagnosed, i.e., the neck.  In other words while there is no medical authority establishing a causal link between the site of injury and the site of diagnosis, the connection can be convincing to a jury.
  • Multiple Sclerosis Trauma-Handle With Care

    These cases should be approached with caution.  For instance the Illinois Appellate Court upheld a $2 Million verdict because the evidence was sufficient for a jury to find a causal link between an auto crash and the onset of MS.19 However the British House of Lords upheld a reversal of an $820,875 verdict in favor of Nicholas Dingley because that causal connection was not proven to the Court’s satisfaction.20  However this caveat aside, there is convincing medical literature espousing a causal link. As a result that authority, plus the factual predicates set forth above and convincing medical testimony from the treating doctor are enough to create  a jury question as to the issue of causation. Hence this could well be devastating to the defense.

    Call, or contact us for a free consult. Also for more info on MS see the Wikipedia pages. Also see the post on this site dealing with personal injury issues.

    Footnotes

    1  Dingley v. Chief Constable of Strathclyde, 2000 S.C. (H.L.) 77, 2000 WL 191166.

    2  Wendy Morrison et al., Environmental Triggers in Multiple Sclerosis:  Fact or Fallacy?, September 1994 Axon 23-26, 23.

    3  Id.

    4  Michael J. Moore, et al., Multiple Sclerosis.  53:4 Postgraduate Medicine 75-80, 76 (1973)

    5  Id at 77.

    6  Valiulis v. Scheffels, 547 N.E.2d 1289, 1297 (Ill.App. 1989).

    7  Enrico Granieri, Exogeneous Factors in the Aetiology of Multiple Sclerosis, 6:Suppl 2 Journal of NeuroVirology S141-S146, S144 (2000).

    8  Merriam-Webster’s Medical Dictionary, 1995 Ed., on www.WebMD.com.

    9  William F. Hickey, Migration of Hematogenous Cells Through the Blood-Brain Barrier and the Initiation of CNS Inflammation.  1 Brain Pathology 97-105, 97 (1991).

    10  Id.

    11  Id.

    12  Henry Miller, Trauma and Multiple Sclerosis.  18 April 1964 The Lancet 848-850, 849

    13  Id at 850.

    14  A. Chaudhuri & P.O. Behan, Letter.  54 Neurology 1393 (2000).

    15  See Charles M. Poser, Trauma to the Central Nervous System May Result in Formation or Enlargement of Multiple Sclerosis Plaques. 57 Arch Neurol 1074-1076 (2000); Charles M. Poser, The Role of Trauma in the Pathogenesis of Multiple Sclerosis:  A Review. 96 Clinical Neurology and Neurosurgery 103-110 (1994); among others.

    16 Morrison, et al., at 24-25.

    17 D.S. Goodin, et al. The Relationship of MS to Physical Trauma and Psychological Stress.  52 Neurology 1737-1745, 1737 (1999).

    18  Charles M. Poser, Trauma to the Central Nervous System May Result in Formation or Enlargement of Multiple Sclerosis Plaques. 57 Arch Neurol 1074-1076 (2000).

    19 Valiulis.

    20 Dingley.  Dingley’s experts included Dr. Charles M. Poser and Dr. Peter O. Behan.

    Contact Us For A Free Consultation

    Contact Us For A Free Consultation