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Updated: Jul 7, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Evidence of thalamic gray matter loss in pediatric multiple sclerosis
S Mesaros1, M A Rocca, M Absinta
1Neuroimaging Research Unit, Scientific Institute and University Hospital San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
Objective:
We used voxel-based morphometry (VBM) to assess the pattern of regional gray matter (GM) loss in patients with pediatric multiple sclerosis (MS) and its relation with the Expanded Disability Status Scale (EDSS) score, disease duration, and the extent of T2 lesion load (LL).
Methods:
From 28 patients with pediatric relapsing-remitting MS (16 girls; mean age = 14.4 years, range = 7 to 16 years) and 21 matched controls, dual-echo and three-dimensional T1-weighted magnetization prepared rapid acquisition gradient echo sequences were acquired. T2 LL was measured using a local thresholding segmentation technique. Data were analyzed using an optimized VBM analysis and statistical parametric mapping.
Results:
In pediatric patients with MS, mean brain T2 LL was 7.8 mL +/- 11.3. Intracranial volume did not differ between patients and controls. Compared to controls, patients with pediatric MS had significant GM loss in the thalamus, bilaterally, which was significantly correlated with T2 LL (r = -0.80 for the right thalamus, r = -0.74 for the left thalamus, p < 0.05, corrected for multiple comparisons). No correlation was found between thalamic GM loss, disease duration, and disability.
Conclusions:
In patients with pediatric multiple sclerosis (MS), differently from what happens in adult-onset MS, gray matter (GM) atrophy seems to involve the thalamus only, with sparing of the cortex and other deep GM nuclei. The correlation found between atrophy and T2 lesion load suggests transsynaptic and Wallerian degenerations as the most likely substrate of tissue loss in the thalamus of these patients.
Insights
Pediatric multiple sclerosis (MS) patients show gray matter loss primarily in the thalamus, linked to T2 lesion load. This atrophy pattern differs from adult MS and suggests specific degeneration mechanisms.
Area of Science:
- Neuroimaging
- Neurology
- Pediatric Neurology
Background:
- Pediatric multiple sclerosis (MS) is a demyelinating disease affecting young individuals.
- Understanding the pattern of brain atrophy in pediatric MS is crucial for disease management and prognosis.
Purpose of the Study:
- To investigate regional gray matter (GM) loss in pediatric MS using voxel-based morphometry (VBM).
- To correlate GM loss with Expanded Disability Status Scale (EDSS) score, disease duration, and T2 lesion load (LL).
Main Methods:
- Voxel-based morphometry (VBM) and statistical parametric mapping were used for data analysis.
- 28 pediatric relapsing-remitting MS patients and 21 controls underwent MRI scans.
- T2 lesion load (LL) was quantified using segmentation techniques.
Main Results:
- Pediatric MS patients exhibited significant bilateral thalamic GM loss compared to controls.
- Thalamic GM loss strongly correlated with T2 lesion load (r = -0.80 for right, r = -0.74 for left).
- No significant correlation was found between thalamic GM loss and disease duration or disability (EDSS).
Conclusions:
- Gray matter atrophy in pediatric MS predominantly affects the thalamus, sparing the cortex and other deep GM nuclei.
- The observed thalamic atrophy is linked to T2 lesion load, suggesting transsynaptic and Wallerian degeneration.
- This pattern of atrophy in pediatric MS differs from that seen in adult-onset MS.
