Research: brain shrinkage in early MS

#MSBlog: Is your brain, or more importantly your cortex, shrinking?

Epub: Zivadinov et al. Bimonthly Evolution of Cortical Atrophy in Early Relapsing-Remitting Multiple Sclerosis over 2 Years: A Longitudinal Study. Mult Scler Int. 2013;2013:231345. doi: 10.1155/2013/231345.

Background: Brain atrophy, in particular cortical atrophy, is an indicator of the neurodegenerative component of MS. 

Objectives: This study investigated the evolution of cortical atrophy in MSers with early relapsing-remitting (RR) MS and its association with lesion volume (LV) accumulation and disability progression. 

Methods: 136 of 181 RRMSers who participated in the Avonex-Steroids-Azathioprine study were assessed bimonthly for clinical and MRI outcomes over 2 years. MSers with disease duration (DD) at baseline of ≤24 months were classified in the early group (DD of 1.2 years, n = 37), while MSers with DD > 24 months were classified in the late group (DD of 7.1 years, n = 99). Mixed effect model analysis was used to investigate the associations. 

Results: Significant changes in whole brain volume (WBV) (P < 0.001), cortical volume (CV) (P < 0.001), and in T2-LV (P < 0.001) were detected. No significant MRI percent change differences were detected between early and late DD groups over 2 years, except for increased T2-LV accumulation between baseline and year 2 in the early DD group (P < 0.01). No significant associations were found between changes in T2-LV and CV over the follow-up. Change in CV was related to the disability progression over the 2 years, after adjusting for DD (P = 0.01). 

Conclusion: Significant cortical atrophy, independent of T2-LV accumulation, occurs in early RRMS over 2 years, and it is associated with the disability progression.

CV: cortical volume, WBV: whole brain volume, and LV: lesion volume

“This study confirms what we already know from several other studies that MS is associated with progressive brain atrophy that begins early in the disease and is associated with disability progression. This is why it is important to treat MS early, aggressively and actively. Actively means not to assume a clinical response is good enough, i.e. to monitor with MRI and to switch or escalate treatment if there are signs of a non-response. Now that we have drugs that reduce or slow the rate of brain atrophy we need to consider incorporating this variable into our clinical practice.”

“What does brain atrophy look like? Please see our previous post ‘Atrophy: a picture tells a 1000 words‘.”

01 Feb 2013
Atrophy: a picture tells a 1000 words. “As a follow-up to yesterday’s post on brain atrophy; please study the MRIs above. These MRIs are from two MSers I met when I did my PhD from 1993 to 1996; they were participating in a 

Other posts of interest on brain atrophy:

31 Jan 2013
“I was asked by a colleague in Porto last week whether or not I let the presence or absence of brain atrophy on MRI affect my clinical decision making about DMTs and treatment? I had to think about the question and haven’t 
21 Nov 2012
Research: Atrophy occurs early and relapses are important. Epub: Kalincik et al.Volumetric MRI markers and predictors of disease activity in early multiple sclerosis: a longitudinal cohort study.PLoS One. 2012;7(11):e50101.
26 Nov 2012
Poll results: outcome measures and brain atrophy. “The headline result is that MSers rate a delay in disease progression the most important outcome measures in relation to DMTs.” “The problem with disability progression in 
17 Nov 2012
“Data from several emerging DMTs now supports the natural history studies and the observation that there is a disconnect between relapses and disease progression and importantly an impact on brain atrophy. We have 
20 Oct 2012
Natalizumab may reduce cognitive changes and brain atrophy rate in relapsing-remitting multiple sclerosis: a prospective, non-randomized pilot study. Eur J Neurol. 2012 Oct 11. doi: 10.1111/j.1468-1331.2012.03882.x.
29 Nov 2011
Brain atrophy in benign MS. Another post in response to the question about benign MS. Gauthier et al. Rate of brain atrophy in benign vs early multiple sclerosis. Arch Neurol. 2009 Feb;66(2):234-7. BACKGROUND: Benign 
05 Jun 2011
Grey Matter (3) – Atrophy mainly affects the limbic system and the deep grey matter at the first stage of MS. Audoin et al. J Neurol Neurosurg Psychiatry. 2010 Jun;81(6):690-5. Epub 2010 Apr 14. The present study performed 
05 Jun 2011
Grey Matter (2) – Cortical lesions and atrophy associated with cognitive impairment in RRMS. Calabrese et al. Arch Neurol. 2009 Sep;66(9):1144-50. In this study the investigators were able to relate cortical or grey matter 
29 Jan 2013
Are you surprised? Donohue et al. No Regional Gray Matter Atrophy Differences between Pediatric- and Adult-Onset Relapsing-Remitting Multiple Sclerosis.J Neuroimaging. 2013. doi: 10.1111/j.1552-6569.2012.00775.x.
06 Feb 2013
BACKGROUND AND PURPOSE: Optical coherence tomography (OCT) has shown thinning of the retinal nerve fibre layer (RNFL) and total macular volume (TMV) in multiple sclerosis (MS) patients. Measures of retinal atrophy 
20 Mar 2012
Mapping regional grey and white matter atrophy in relapsing-remitting multiple sclerosis.Mult Scler. 2012 Mar 15. [Epub ahead of print] Objective: We aimed to investigate the regional distribution of grey matter (GM) and white 
20 Nov 2012
Regional grey matter atrophy in clinically isolated syndromes at presentation. J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1236-44. BACKGROUND: The presence and degree of neuronal degeneration already existing 
20 Oct 2012
RESULTS: No cord atrophy was found in CIS patients versus HC, while PPMS had significant cord atrophy. Clusters of cord atrophy were found in BMS versus RRMS, and in SPMS versus RRMS, BMS and PPMS patients, 
08 Jan 2012
There are strong correlations between cortical atrophy observed by MRI and clinical disability and disease duration in multiple sclerosis (MS). Objective: To evaluate the progression of cortical atrophy (Shrinkage of the surfae 
30 Sep 2012
Subcortical atrophy and cognition: Sex effects in multiple sclerosis. Neurology. 2012 Sep 26. OBJECTIVES: Gray matter (GM) atrophy is common in multiple sclerosis (MS), as is cognitive dysfunction. Understanding the exact 
18 Jun 2012
Vaneckova M, Kalincik T, Krasensky J, Horakova D, Havrdova E, Hrebikova T, Seidl Z. Corpus Callosum Atrophy – A Simple Predictor of Multiple Sclerosis Progression: A Longitudinal 9-Year Study. Eur Neurol. 2012;68:23-27.
02 Nov 2012
Background: Cognitive dysfunction affects half of MSers. Although brain atrophy generally yields the most robust MRI correlations with cognition, significant variance in cognition between individual MSers remains unexplained 
16 Apr 2012
BACKGROUND AND PURPOSE: Recent studies have shown that selective regional (local or specific gray matter (GM) areas of the brain), but not global (whole brain GM), GM atrophy or shrinkage occurs from clinical onset to 

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