MS is a neurodegenerative disease from the outset

Epub ahead of printBergsland et al. Subcortical and Cortical Gray Matter Atrophy in a Large Sample of Patients with Clinically Isolated Syndrome and Early Relapsing-Remitting Multiple Sclerosis. AJNR Am J Neuroradiol. 2012 Apr 12. 

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 conversion to clinically definite MS. Their aim was to investigate the difference in the extent of subcortical and deep gray matter (SDGM) and cortical atrophy in a large sample of MSers with CIS and early RRMS and to explore the relationship between SDGM and cortical atrophy and other MR imaging and clinical outcomes.

cortical gray matter = gray matter on the surface of the brain
subcortical and deep gray matter = gray matter in the centre of the brain.

Please remember gray matter is largely made up of the cell bodies of neurones and the white matter from axonal processes covered in myelin.

MATERIALS AND METHODS: Two hundred twelve MSers with CIS recruited at the first clinical event (mean age, 29.3 years; median EDSS, 1.5; median disease duration, 3 months) and 177 MSers with early RRMS (mean age, 30.7 years; median EDSS, 2.0; median disease duration, 47 months) were imaged on a 1.5T scanner.

RESULTS: MSers with early RRMS showed significantly lower SDGM but not cortical volumes compared with patients with CIS. MSers with CIS with higher T2 lesion volumes showed lower total SDGM and volumes and higher lateral ventricle volume (P = .001) than those with a lower T2 lesion volumes. 

CONCLUSIONS: Significant SDGM, but not cortical, atrophy develops during the first 4 years of the RRMS. GM atrophy is relevant for disease progression from the earliest clinical stages.

“This study confirms that at the earliest stages of the disease MSers have degeneration of their gray matter. This is supported by pathological studies on biopsy specimens from people with early MS. This data is not new; these findings have been seen by other investigators in the field. This means  that we should be looking for therapies that impact on gray matter pathology and to try and prevent gray matter atrophy ASAP after the onset of the disease. We also need to find out what is driving this gray matter atrophy and try and switch it off. The reality of this work is rather depressing for MSers, but it points to the disease as being very complex and it is clear that there is a lot we don’t know about this disease.”

Other posts of interest

05 Jun 2011
Grey Matter (1) – Cortical demyelination and diffuse white matter injury in multiple sclerosis. Due to the interest shown in the issue around gray matter and cortical pathology in MS the next series of posts will discuss the issue 
16 Aug 2011
“This study supports previous work in this area demonstrating that inflammation on the surface of the brain may be responsible for gray matter pathology in MS. Another reason to target these structures as part of an MS therapy 
07 Sep 2011
Discussion: RRMS’ers with epilepsy had a more severe and rapidly evolving cortical pathology (cortical lesions and gray matter atrophy) compared with RRMS’ers without epilepsy. The RRMS’ers with epilepsy were also 

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