Primary and transitional progressive MS: a clinical and MRI cross-sectional study.

Area of Science:

• Neurology
• Neuroimmunology
• Radiology

Background:

• Ten percent of multiple sclerosis (MS) patients present with a progressive disease course from onset.
• A subset of these patients, transitional progressive (TP) MS, experience a single relapse.
• Both primary progressive (PPMS) and TPMS patients have historically been excluded from licensed MS treatments and clinical trials.

Purpose of the Study:

• To characterize the clinical and MRI features of a large cohort of PPMS and TPMS patients.
• To compare these features with a reference group of secondary progressive MS (SPMS) patients.
• To identify potential biomarkers for monitoring disease progression in progressive MS subtypes.

Main Methods:

• Recruitment of patients from six European centers.
• Clinical assessment including Expanded Disability Status Scale (EDSS) scoring.
• Brain and spinal cord MRI to evaluate lesion load and atrophy.

Main Results:

• PPMS patients were older at onset and had lower brain T2 and T1 lesion loads compared to SPMS patients.
• SPMS and TPMS cohorts showed more spinal cord T2 lesions than PPMS patients, with SPMS exhibiting greater atrophy.
• EDSS scores correlated with brain and spinal cord atrophy in PPMS and TPMS patients, but not with brain lesion load.

Conclusions:

• Monitoring PPMS progression is challenging, but atrophy measures show promise for correlation with EDSS.
• This study enhances understanding of unique progressive MS patient groups.
• Acquisition of serial data will further expand insights into these patient populations.