Abstract

Colin Mumford’s article was timely (Mumford 2002). However, he errs in advising ‘more weight should be placed on the best epidemiological data’, as this comes from really only one prospective study. In this, Sibley and colleagues studied the effects of non-specific physical trauma – rather than CNS-specific trauma – such as suturing of lacerations, removal of skin lesions, uterine dilatation, endoscopic procedures, fractures, sprains, burns, head injuries and abrasions (Sibley et al. 1991). It is hardly surprising that removing a thorn had no effect on the course of MS! Whiplash injury did not feature in this study. The method by which controls were selected was not described, there was a high drop-out rate, and the study lasted only 5.2 years and not 8 years as reported. All patients with MS had established disability, where exacerbations caused by specific focal trauma might have been difficult to assess. With at least eight comparisons among