“I have started thinking about MS as my cardiology and nephrology colleagues think about the heart and kidneys, respectively. They talk about end-organ damage and try and prevent it. When it comes to the heart and kidney it is easy to measure this with functional outcomes. In MS the brain and spinal cord function is much more difficult to measure, because of mutiple pathways and the ability for the damaged nervous system to adapt to damage (plasticity). Therefore a good measure of this is change in volume of the brain; i.e. brain volume loss is a good integrator of end organ damage in MS. This study below confirms other data sets that in MSers who progress they lose much more brain volume than those who don’t progress. This is an important point and we therefore should be targeting normalisation of brain volume loss as the ultimate treatment aim in MS after we have switched off inflammation. This is why we want to keep the definition of NEDA (no evident disease activity) open to change. For us to incorporate brain volume loss into NEDA we need to standardise the measure of brain volume loss and get all MS Centres to do the necessary MRI scans to measure it. A question for your neurologist next time you see him/her is to ask if you have progressive brain atrophy. Some centres are already measuring this routinely, but this is a very small number.”
|Please compare the size of the central black areas between the 18 month scans and the baseline; this is how much brain volume loss can occur in a RRMSer in 18 months.|
Epub: Jacobsen et al. Brain atrophy and disability progression in multiple sclerosis patients: a 10-year follow-up study. J Neurol Neurosurg Psychiatry. 2014 Feb 19.
OBJECTIVES: To identify MRI biomarkers associated with long-term disability progression in patients with multiple sclerosis (MS), and to define the rate of evolution of global, tissue-specific and regional atrophy in patients with MS over long-term.
METHODS: MRI of the brain and clinical neurological assessment was performed in 81 patients at time of first visit and after 5 and 10 years of follow-up. MRI was acquired on 1.5 T scanners. T1-lesion and T2-lesion volumes (LVs) were calculated. Global and tissue-specific atrophy changes were longitudinally assessed, using a direct measurement approach, by calculating percentage volume changes between different time points. Regional tissue volumes for the subcortical deep grey matter (SDGM) structures were also obtained. Disability progression was defined as an increase in Expanded Disability Status Scale of ≥1.0 compared to baseline at 5-year and 10-year follow-up.
RESULTS: Over 5 years, patients with disability progression showed significantly increased loss of whole brain (-3.8% vs -2.0%, p<0.001), cortical (-3.4% vs -1.8%, p=0.009) and putamen volume changes (-10.6% vs -3.8%, p=0.003) compared to patients with no disability progression. No significant change in white matter (WM) volume was observed when comparing progressing and non-progressing patients. Over 10 years, there was a trend for greater decrease in whole brain volume (-5.5% vs -3.7%, p=0.015) in the progressing patients. No significant changes in LV measures were detected between the patients with and without disability progression.
CONCLUSION: This long-term study shows that whole brain, cortical and putamen atrophy occurs throughout the 10-year follow-up of this MS cohort and is more pronounced in the group that showed disability progression at 5, but not at 10 years of follow-up. Overall, GM atrophy showed better association with disease progression than WM atrophy over 5-year and 10-year follow-up.