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Major differences in the dynamics of primary and secondary progressive multiple sclerosis
A J Thompson1, A G Kermode, D Wicks
1Multiple Sclerosis NMR Research Group, Institute of Neurology, London, Great Britain.
Annals of Neurology
|January 1, 1991
Summary
Secondary progressive multiple sclerosis (MS) shows significantly more new, enhancing brain lesions on MRI compared to primary progressive MS. This suggests different disease activity dynamics, impacting clinical trial strategies.
Area of Science:
- Neuroscience
- Radiology
Background:
- Multiple sclerosis (MS) presents in primary progressive (PPMS) and secondary progressive (SPMS) forms.
- Cerebral magnetic resonance imaging (MRI) reveals distinct abnormalities between PPMS and SPMS patients.
Purpose of the Study:
- To compare the disease activity and lesion enhancement patterns in SPMS versus PPMS using serial MRI.
- To investigate the inflammatory component differences in progressive MS subtypes.
Main Methods:
- Serial gadolinium-enhanced MRI scans were performed over 6 months in 24 matched patients (12 SPMS, 12 PPMS).
- New lesion formation and enhancement within existing lesions were quantified.
- Clinical deterioration was assessed over the study period.
Main Results:
- SPMS patients developed significantly more new brain lesions (18.2/patient/year) than PPMS patients (3.3/patient/year).
- Eighty-seven percent of new SPMS lesions showed enhancement, compared to only one lesion in the PPMS group.
- Enhancement was observed in new and pre-existing lesions in SPMS, but not PPMS.
- No significant difference in clinical deterioration was noted between the groups over 6 months.
Conclusions:
- SPMS exhibits a higher degree of inflammatory lesion activity compared to PPMS, as evidenced by MRI.
- These findings highlight distinct disease dynamics and have implications for patient selection and monitoring in MS clinical trials.