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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
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Localized grey matter damage in early primary progressive multiple sclerosis contributes to disability.

Z Khaleeli1, M Cercignani, B Audoin

  • 1Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.

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In primary progressive multiple sclerosis (PPMS), grey matter damage is evident in specific brain regions. Magnetization transfer ratio (MTR) changes, indicating tissue damage, are more widespread than atrophy and clinically significant.

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Area of Science:

  • Neuroimaging
  • Neurology
  • Radiology

Background:

  • Disability in primary progressive multiple sclerosis (PPMS) is linked to damage in normal-appearing brain tissues.
  • Magnetization transfer ratio (MTR) and volume changes suggest grey matter damage, but its clinical significance is unclear.

Purpose of the Study:

  • To pinpoint grey matter regions affected by damage in early PPMS.
  • To investigate the clinical impact of MTR changes in these regions.

Main Methods:

  • 46 early PPMS patients and 23 controls underwent Magnetization Transfer (MT) and high-resolution T1-weighted imaging.
  • Clinical assessments included the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) tests.
  • Grey matter volume and MTR were compared between groups, and MTR was correlated with clinical scores.

Main Results:

  • Patients showed reduced MTR and atrophy in motor and sensory cortex regions, insula, and thalamus.
  • Reduced MTR without atrophy was observed in precentral, superior frontal, superior temporal, insula, and visual cortex.
  • Higher EDSS scores correlated with lower MTR in the primary motor cortex.

Conclusions:

  • Localized grey matter damage occurs in early PPMS.
  • MTR changes indicating tissue damage are more widespread than atrophy.
  • Reduced MTR in specific brain areas is clinically significant in PPMS.