Research: White Matter Lesions

EpubFilli L et al Spatiotemporal distribution of white matter lesions in relapsing-remitting and secondary progressive multiple sclerosis .Mult Scler. 2012 Apr 11.

Background: MS is a chronic inflammatory disease of the central nervous system. MS lesions show a typical distribution pattern and primarily affect the white matter (WM) in the periventricular zone and in the centrum semiovale.

Objective: To track lesion development during disease progression, we compared the spatiotemporal distribution patterns of lesions in RRMS and SPMS.

Methods: The investigators used MRI in 209 RRMSers and 62 SPMSers acquired on two different MR scanners in two clinical centers followed up for 25 (± 1.7) months. Both cross-sectional and longitudinal differences in lesion distribution between RRMSers and SPMSers were analyzed.

Results: MS lesions clustered around the lateral ventricles (fluid filled space of the brain) and in the centrum semiovale (deep white matter of the brain). Cross-sectionally, compared to RRMSers, the SPMSers showed a significantly higher regional probability of T1 hypointense lesions (more damaging lesions, also called black holes) (p≤0.03) in the callosal body (structure linking the two halves of the  brain), the corticospinal tract (motor pathways), and other tracts adjacent to the lateral ventricles, but not of T2 lesions (white blobs) (peak probabilities were RRMS: T1 9%, T2 18%; SPMS: T1 21%, T2 27%). No longitudinal changes of regional T1 and T2 lesion volumes between baseline and follow-up scan were found.

Conclusion: The results suggest a particular vulnerability to neurodegeneration during disease progression in a number of white matter tracts.

“This is not surprising as the longer the tract the more likely it is to be damaged in several areas and hence degenerate. This is almost certainly why tracts supplying the legs are more vulnerable than tracts supplying the arms; i.e.  it is commoner to have leg than arm weakness.”

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