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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis

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White matter changes in paediatric multiple sclerosis and monophasic demyelinating disorders.

Giulia Longoni^1,2,3, Robert A Brown³, Parya MomayyezSiahkal³

¹Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Brain : a Journal of Neurology

|March 24, 2017

Summary

Paediatric multiple sclerosis impairs white matter development and causes tissue loss. Monophasic disease also affects white matter development, particularly with brain lesions at onset.

Keywords:

acute disseminated encephalomyelitis clinically isolated syndrome demyelination multiple sclerosis: imaging neuroinflammation

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Area of Science:

Neuroscience
Developmental Neuroscience
Neurology

Background:

Acquired demyelinating syndromes in children can be monophasic or lead to paediatric-onset multiple sclerosis (MS).
Understanding white matter development in paediatric demyelinating diseases is crucial for prognosis.

Purpose of the Study:

To examine longitudinal diffusion properties of normal-appearing white matter in children with acquired demyelinating syndromes.
To compare white matter development trajectories between paediatric MS, monophasic disease, and healthy controls.

Main Methods:

Linear mixed effects models were used to analyze diffusion tensor imaging data from serial scans.
Diffusion properties of normal-appearing white matter were assessed in 132 paediatric participants with demyelinating syndromes and 80 healthy controls.
Participants were followed for a median of 4.4 years, with 53 diagnosed with paediatric-onset MS.

Main Results:

Paediatric MS showed decreased fractional anisotropy and increased mean diffusivity in normal-appearing white matter, indicating failed development and tissue loss.
Monophasic disease participants did not show progressive loss but had altered diffusion trajectories, especially with brain lesions at onset.
Monofocal presentations without brain lesions showed trajectories closer to normal development; sexual dimorphism was also observed.

Conclusions:

Paediatric-onset MS is characterized by impaired white matter maturation and progressive tissue integrity loss.
Even a single demyelinating event with brain lesions negatively impacts white matter development in children.
Monophasic syndromes have varied impacts on white matter development depending on clinical presentation and lesion load.