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Published on: December 9, 2015
Quantitative determination of regional lesion volume and distribution in children and adults with relapsing-remitting
Rezwan Ghassemi1, Sridar Narayanan1, Brenda Banwell2
1Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
Introduction:
Onset of MS occurs during childhood in about 5% of cases. It is unclear whether very young age at MS onset, when the nervous system is still myelinating, affects MS lesion accrual or regional distribution.
Objective:
To compare the frequency, volume and distribution of T2 and T1 lesions in children and adults with relapsing-remitting multiple sclerosis (RRMS).
Methods:
Lesions were segmented on T2- and T1-weighted MRI images from 29 children and 29 adults with RRMS, matched for disease duration.
Results:
All subjects exhibited T2-weighted brain lesions. Children had higher whole-brain T2-weighted-lesion-volume (T2LV) compared to adults (mean (SD) in cm(3): 12.76(2.7) vs. 10.03(3.4), p<0.0013). The supratentorial-T2LV was similar in children and adults (8.45(1.7) vs. 7.94(1.7), mean (SD), p = 0.2582), but adults were more likely to have supratentorial lesions (96.5% vs. 68.9%, p<0.012). Children were more likely to have infratentorial-T2-weighted lesions (75.9% vs. 43.4%, p<0.03), specifically in the brainstem (62.1% vs. 26.7%, p<0.019) and the pons (48.3% vs. 17.24%, p<0.024), had higher infratentorial-T2-weighted-lesion counts (4.1(5.6) vs. 1.45(2.3), p<0.021), a greater infratentorial-T2LV (4.31(2.7) vs. 2.08(2.4), p<0.0013), and a greater infratentorial-T1-weighted-lesion-volume (T1LV) (3.7(2.5) vs. 1.08(1.9), p<0.0007). Whole-brain-T1LV was higher in children (9.3(2.5) vs. 6.43(2.1), p>0.001). Adult MS patients had higher supratentorial-T1LV (5.5(0.92) vs. 6.41(2.1), mean (SD), p<0.034), whereas children were more likely to have infratentorial-T1-weighted lesions (58.6% vs. 23.3%, p<0.015).
Discussion:
Onset of MS during childhood is associated with a higher volume of brain lesions in the first few years of disease relative to adults. Children with MS are more likely than adults to have T2 and T1 lesions in the infratentorial white matter, raising the possibility of preferential immune targeting of more mature myelin. Children with MS have a lower supratentorial T1 lesion burden, possibly reflecting more effective remyelination and repair in brain regions that are still engaged in active primary myelination.
Insights
Children with multiple sclerosis (MS) show higher brain lesion volumes and infratentorial lesions compared to adults. This suggests potential differences in immune targeting and repair mechanisms during early development.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Radiology
Background:
- Multiple sclerosis (MS) onset in childhood occurs in approximately 5% of cases.
- The impact of very young age at MS onset on lesion accrual and distribution during nervous system myelination remains unclear.
Purpose of the Study:
- To compare the frequency, volume, and distribution of T2 and T1 lesions in pediatric and adult patients with relapsing-remitting multiple sclerosis (RRMS).
Main Methods:
- Lesion segmentation was performed on T2- and T1-weighted MRI scans.
- The study included 29 children and 29 adults with RRMS, matched for disease duration.
Main Results:
- Children exhibited higher whole-brain T2 lesion volume (T2LV) than adults.
- Children were more likely to have infratentorial T2 and T1 lesions, particularly in the brainstem and pons.
- Adults showed a higher likelihood of supratentorial lesions.
Conclusions:
- Childhood MS onset is linked to increased brain lesion volume in early disease stages compared to adults.
- Pediatric MS patients demonstrate a higher prevalence of infratentorial lesions, potentially indicating immune targeting of mature myelin.
- Lower supratentorial T1 lesion burden in children may reflect enhanced remyelination in actively developing brain regions.
