Related Experiment Videos
Quantitative magnetic resonance imaging in multiple sclerosis: the effect of high dose intravenous methylprednisolone
J Kesselring1, D H Miller, D G MacManus
1Multiple Sclerosis NMR Research Group, National Hospital for Nervous Diseases, Queen Square, London.
Abstract:
Magnetic resonance imaging was performed on 50 patients with clinically definite or probable multiple sclerosis before and 15 days after starting treatment with intravenous methylprednisolone (0.5 g daily for 5 days). Scans were abnormal in 49 patients. New lesions had appeared on the second scan in nine individuals and in seven a single pre-existing lesion appeared to have become smaller but in no case were lesions seen to disappear. Two patients showed both reduction in the size of an abnormal area and development of a single new lesion indicating that corticosteroids do not appear rapidly to alter the process underlying plaque formation. Measurements of relaxation times were performed in 12 randomly selected patients. All showed elevated values in normal appearing white matter but not cortex before treatment compared with 18 healthy controls. After treatment a significant decrease of T1 and T2 was observed in cortex, and of T1 alone in normal appearing white matter. No significant change could be detected within lesions, a finding attributed to the wide range of relaxation values observed at these sites before treatment. Since brain water content is increased in normal appearing white matter of multiple sclerosis patients, and is significantly reduced by high-dose methylprednisolone, resolution of oedema may contribute to the rapid spontaneous or corticosteroid induced symptomatic recovery that characterises the disease in its early stages.
Insights
High-dose methylprednisolone treatment in multiple sclerosis patients did not rapidly halt new lesion formation. However, it did reduce brain water content, potentially explaining symptomatic recovery.
Area of Science:
- Neuroimaging
- Neurology
- Biomedical Science
Background:
- Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system.
- Intravenous methylprednisolone is a common treatment for MS exacerbations.
- The rapid symptomatic recovery often seen in early MS stages requires explanation.
Purpose of the Study:
- To investigate the effects of high-dose intravenous methylprednisolone on new lesion formation and brain tissue properties in multiple sclerosis patients.
- To explore the relationship between changes in relaxation times, brain water content, and symptomatic recovery.
Main Methods:
- Magnetic resonance imaging (MRI) was used to assess lesion load in 50 MS patients before and after 5 days of methylprednisolone treatment.
- Relaxation time measurements (T1 and T2) were performed on normal-appearing white matter and cortex in 12 patients and compared to 18 healthy controls.
- Brain water content was inferred from relaxation time changes.
Main Results:
- New lesions appeared in 9 out of 49 scanned patients post-treatment; existing lesions did not disappear.
- Methylprednisolone treatment significantly decreased T1 and T2 relaxation times in the cortex and T1 in normal-appearing white matter.
- No significant changes were observed within MS lesions, likely due to high pre-treatment variability.
Conclusions:
- Corticosteroids do not appear to rapidly halt the underlying process of plaque formation in multiple sclerosis.
- Reduced brain water content (oedema) in normal-appearing white matter following methylprednisolone treatment may contribute to rapid symptomatic recovery.
- Further research is needed to fully elucidate the mechanisms of corticosteroid action in MS.