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A surface-in gradient of thalamic damage evolves in pediatric multiple sclerosis.

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Multiple sclerosis (MS) involves brain pathology. In children with MS, a surface-in pattern of thalamic injury was observed early in the disease course, suggesting a progressive biological process.

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Area of Science:

  • Neurology
  • Neuroscience
  • Immunology

Background:

  • Multiple sclerosis (MS) pathology involves central nervous system (CNS) injury, including focal inflammation and damage to superficial cortical regions.
  • A gradient of damage from the surface inward has been reported in the cortex, suggesting a potential progressive disease mechanism.

Purpose of the Study:

  • To investigate the early onset of a "surface-in" injury process in the thalamus during the initial stages of multiple sclerosis (MS) in children.
  • To differentiate MS-specific injury patterns from general demyelination effects.

Main Methods:

  • Assessed thalamic volume changes using deformation-based morphometry in a cohort of children with MS, monophasic demyelination, and healthy controls.
  • Analyzed volume changes in relation to the distance from the cerebrospinal fluid (CSF) interface using mixed-effects modeling and semiparametric smoothing.

Main Results:

  • Children with MS and monophasic demyelination showed thalamic volume loss near white matter compared to controls.
  • Children with MS uniquely exhibited a surface-in gradient of thalamic injury on the ventricular side, evident within the first year and worsening over time.

Conclusions:

  • A disease-specific, surface-in injury process in multiple sclerosis can be detected at the earliest clinical stages.
  • This finding supports the concept of progressive biology contributing to MS pathogenesis from the outset.