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Cerebral volume changes in multiple sclerosis patients treated with high-dose intravenous methylprednisolone
E L J Hoogervorst1, C H Polman, F Barkhof
1Department of Neurology, VU Medical Center, Amsterdam, The Netherlands. e.hoogervorst@vumc.nl
Objective:
Multiple sderosis (MS) patients develop varying degrees of cerebral atrophy, which may already begin at disease onset The purpose of this study is to examine the effect of steroid treatment on cerebral volume in MS patients.
Methods:
Thirty-five MS patients participating in a clinical trial of oral interferon beta, which induded monthly MRI, were included in this study. They suffered from an acute relapse and were treated with intravenous methylprednisolone (IV-MP); 13 of the patients were treated with oral prednisolone tapering after IV-MP. The last MRI scan before and the first (and second for oral tapering patients) scan after IV-MP treatment were used for measuring parenchymal fraction (PF) and ventricular fraction (VF). Changes in PF and VF were analysed using Student's t test.
Results:
For the total population no significant changes in PF or VF were found. However, the subgroup of patients receiving oral tapering after IV-MP showed changes, compatible with atrophy in both PF and VF, that were significant immediately after IV-MP treatment and still persisted (though not statistically significant anymore) after a mean interval of 30 days. The magnitude of these changes was about the same as the annual change in cerebral volume as reported in natural history studies.
Conclusion:
Our data indicate that short courses of intravenous steroids (restricted to three or five days) have no major impact, whereas prolonged treatment with oral tapering does significantly affect brain volume. These findings are important for longitudinal studies and clinical trials in which brain volume is used as an outcome measure.
Insights
Prolonged oral steroid tapering significantly impacts brain volume in multiple sclerosis (MS) patients, suggesting caution in clinical trials. Short intravenous steroid courses show minimal effect on cerebral atrophy.
Area of Science:
- Neuroscience
- Radiology
- Pharmacology
Background:
- Multiple sclerosis (MS) is associated with progressive cerebral atrophy.
- Understanding factors influencing brain volume changes is crucial for MS management and research.
Purpose of the Study:
- To investigate the impact of steroid treatment on cerebral volume in MS patients.
- To differentiate effects of short-term intravenous vs. prolonged oral steroid courses.
Main Methods:
- 35 MS patients undergoing MRI during a clinical trial were analyzed.
- Parenchymal fraction (PF) and ventricular fraction (VF) were measured before and after intravenous methylprednisolone (IV-MP).
- A subgroup received oral prednisolone tapering post-IV-MP, with serial MRI scans.
Main Results:
- No significant changes in PF or VF were observed for the total patient group.
- A subgroup receiving oral tapering showed significant decreases in PF and VF post-IV-MP, persisting for 30 days.
- The observed brain volume changes in the tapering subgroup were comparable to annual changes in natural history studies.
Conclusions:
- Short courses (3-5 days) of IV steroids have a negligible effect on brain volume in MS.
- Prolonged oral steroid tapering significantly reduces brain volume, indicating potential atrophy.
- These findings are critical for interpreting brain volume as an outcome in MS longitudinal studies and clinical trials.