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Extent of Brain Involvement at Diagnosis May Predict Brain Atrophy

In patients with recently diagnosed multiple sclerosis, the extent of accumulated brain tissue loss and overall// lesion load as determined by magnetic resonance imaging (MRI) may predict the rate of cerebral atrophy.

MRI provides valuable information about the progression of multiple sclerosis (MS), according to background information in the article. MRI is used to monitor the number and volume of MS-related lesions (damaged tissue), which can help monitor the evolution of the disease but does not appear to be associated with the patient’s disability status. Brain volume, also measured by MRI, “is currently considered to be a marker of the neurodegenerative component of MS pathological features, thereby better reflecting the pathological background of irreversible clinical disability in MS,” the authors write.

Bas Jasperse, M.D., and colleagues at the VU University Medical Center, Amsterdam, the Netherlands, performed brain MRI shortly after diagnosis and again after two years in 89 patients with MS (average age, 37.5). The numbers and volume of two types of lesions apparent on MRI, black hole (dark appearing lesions that indicate the loss of myelin, neurons’ protective coating) and T2 (newer, brighter appearing lesions), were recorded along with brain volume. Change in brain volume between scans was calculated, and participants were also assessed for neurologic disability.

“The mean [average] annualized rate of cerebral atrophy was -0.9 percentage of brain volume change per year,” the authors write. “Baseline normalized brain volume and baseline T2 lesion load were identified as explanatory variables for the subsequent percentage of brain volume change per year and yielded a regression model that explained 31.2 percent of the variance in percentage of brain volume change per year.”

In other words, “patients who have acquired more brain tissue loss and more T2 lesions are prone to have a higher rate of subsequent brai n atrophy,” the authors conclude. “In this relationship, the extent of brain tissue loss seemed more important than lesional activity. Because a higher rate of cerebral atrophy is predictive of worse clinical functioning at a later stage in the MS disease course, our findings suggest that these two baseline variables could have prognostic value for clinical functioning in early MS.”

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