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Inflammatory cortical demyelination in early multiple sclerosis.

Claudia F Lucchinetti1, Bogdan F G Popescu, Reem F Bunyan

  • 1Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. lucchinetti.claudia@mayo.edu

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Cortical demyelination is common in early multiple sclerosis and is inflammatory. These lesions are linked to meningeal inflammation, impacting disease progression and cognitive function.

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Area of Science:

  • Neurology
  • Immunology
  • Pathology

Background:

  • Cortical disease is key in multiple sclerosis (MS) pathogenesis, linked to progression and cognitive impairment.
  • Historically, cortical lesions were considered non-inflammatory and studied in chronic MS.
  • Emerging MRI evidence suggests early cortical damage in MS.

Purpose of the Study:

  • To determine the prevalence and characteristics of demyelinating cortical lesions in early MS.
  • To investigate the inflammatory nature and meningeal associations of these lesions.

Main Methods:

  • Evaluated cortical tissues from 138 MS patients undergoing stereotactic biopsy for suspected tumors.
  • Used immunohistochemistry to assess demyelination, inflammation, and meningeal involvement.
  • Followed up diagnoses in 77 patients for a median of 3.5 years.

Main Results:

  • Cortical demyelination found in 38% of patients (53/138), with 82% showing T-cell infiltrates and 41% macrophage-associated demyelination.
  • Cortical demyelination was topographically associated with meningeal inflammation.
  • Long-term follow-up confirmed definite MS in a high percentage of patients with and without cortical demyelination.

Conclusions:

  • Cortical demyelinating lesions are frequent and inflammatory in early MS.
  • These lesions are strongly associated with meningeal inflammation.
  • Findings highlight the early and inflammatory nature of cortical involvement in MS pathogenesis.