BACKGROUND AND OBJECTIVE: The onset of multiple sclerosis is relapsing remitting or primary progressive. An improved understanding of the causes of early progressive disability in primary progressive multiple sclerosis (PPMS) could provide mechanistic targets for therapeutic intervention. METHODS: Five magnetic resonance imaging (MRI) parameters that could potentially cause progressive disability were investigated in 43 patients with early PPMS and in 37 patients with early relapsing remitting multiple sclerosis (RRMS): atrophy in brain, both grey matter and white matter; intrinsic abnormality in brain, both grey matter and white matter (measured by the magnetisation transfer ratio (MTR)); and atrophy of the upper cervical spinal cord. Both groups were also compared with controls. RESULTS: Patients with PPMS were older and more likely to be men. Both patient groups had atrophy of brain grey matter and white matter, and intrinsic abnormality in MTR of normal-appearing grey matter and white matter. Cord atrophy was present only in the PPMS (mean cord area: PPMS, 67.8 mm2; RRMS, 72.7 mm2; controls, 73.4 mm2; p = 0.007). This was confirmed by multivariate analysis of all five MRI parameters, age and sex. CONCLUSION: Grey matter and white matter of the brain are abnormal in both early RRMS and PPMS, but cord atrophy is present only in PPMS. This is concordant with myelopathy being the usual clinical presentation of PPMS. Measurement of cord atrophy seems to be clinically relevant in PPMS treatment trials.
BACKGROUND AND OBJECTIVE: The onset of multiple sclerosis is relapsing remitting or primary progressive. An improved understanding of the causes of early progressive disability in primary progressive multiple sclerosis (PPMS) could provide mechanistic targets for therapeutic intervention. METHODS: Five magnetic resonance imaging (MRI) parameters that could potentially cause progressive disability were investigated in 43 patients with early PPMS and in 37 patients with early relapsing remitting multiple sclerosis (RRMS): atrophy in brain, both grey matter and white matter; intrinsic abnormality in brain, both grey matter and white matter (measured by the magnetisation transfer ratio (MTR)); and atrophy of the upper cervical spinal cord. Both groups were also compared with controls. RESULTS: Patients with PPMS were older and more likely to be men. Both patient groups had atrophy of brain grey matter and white matter, and intrinsic abnormality in MTR of normal-appearing grey matter and white matter. Cord atrophy was present only in the PPMS (mean cord area: PPMS, 67.8 mm2; RRMS, 72.7 mm2; controls, 73.4 mm2; p = 0.007). This was confirmed by multivariate analysis of all five MRI parameters, age and sex. CONCLUSION: Grey matter and white matter of the brain are abnormal in both early RRMS and PPMS, but cord atrophy is present only in PPMS. This is concordant with myelopathy being the usual clinical presentation of PPMS. Measurement of cord atrophy seems to be clinically relevant in PPMS treatment trials.
Authors: M Filippi; M Bozzali; M A Horsfield; M A Rocca; M P Sormani; G Iannucci; B Colombo; G Comi Journal: Neurology Date: 2000-01-11 Impact factor: 9.910
Authors: C M Poser; D W Paty; L Scheinberg; W I McDonald; F A Davis; G C Ebers; K P Johnson; W A Sibley; D H Silberberg; W W Tourtellotte Journal: Ann Neurol Date: 1983-03 Impact factor: 10.422
Authors: Geert Lycklama; Alan Thompson; Massimo Filippi; David Miller; Chris Polman; Franz Fazekas; Frederik Barkhof Journal: Lancet Neurol Date: 2003-09 Impact factor: 44.182
Authors: D Kidd; J W Thorpe; A J Thompson; B E Kendall; I F Moseley; D G MacManus; W I McDonald; D H Miller Journal: Neurology Date: 1993-12 Impact factor: 9.910
Authors: G R Davies; L Ramió-Torrentà; A Hadjiprocopis; D T Chard; C M B Griffin; W Rashid; G J Barker; R Kapoor; A J Thompson; D H Miller Journal: J Neurol Neurosurg Psychiatry Date: 2004-07 Impact factor: 10.154
Authors: Waqar Rashid; Gerard R Davies; Declan T Chard; Colette M Griffin; Dan R Altmann; Ros Gordon; Raju Kapoor; Alan J Thompson; David H Miller Journal: J Magn Reson Imaging Date: 2006-04 Impact factor: 4.813
Authors: Klaus Schmierer; Francesco Scaravilli; Daniel R Altmann; Gareth J Barker; David H Miller Journal: Ann Neurol Date: 2004-09 Impact factor: 10.422
Authors: Angeliki Filippatou; Thomas Shoemaker; Megan Esch; Madiha Qutab; Natalia Gonzalez-Caldito; Jerry L Prince; Ellen M Mowry; Peter A Calabresi; Shiv Saidha; Elias S Sotirchos Journal: Mult Scler Date: 2018-12-03 Impact factor: 6.312
Authors: J Hodel; P Besson; O Outteryck; H Zéphir; D Ducreux; A Monnet; D Chéchin; M Zins; M Rodallec; J P Pruvo; P Vermersch; X Leclerc Journal: AJNR Am J Neuroradiol Date: 2012-08-23 Impact factor: 3.825
Authors: T Hayton; J Furby; K J Smith; D R Altmann; R Brenner; J Chataway; R A C Hughes; K Hunter; D J Tozer; D H Miller; R Kapoor Journal: J Neurol Date: 2009-03-06 Impact factor: 4.849
Authors: M P Sampat; A M Berger; B C Healy; P Hildenbrand; J Vass; D S Meier; T Chitnis; H L Weiner; R Bakshi; C R G Guttmann Journal: AJNR Am J Neuroradiol Date: 2009-08-20 Impact factor: 3.825
Authors: Regina Schlaeger; Nico Papinutto; Valentina Panara; Carolyn Bevan; Iryna V Lobach; Monica Bucci; Eduardo Caverzasi; Jeffrey M Gelfand; Ari J Green; Kesshi M Jordan; William A Stern; H-Christian von Büdingen; Emmanuelle Waubant; Alyssa H Zhu; Douglas S Goodin; Bruce A C Cree; Stephen L Hauser; Roland G Henry Journal: Ann Neurol Date: 2014-08-21 Impact factor: 10.422