Acute multiple sclerosis lesion pathology does not predict subsequent clinical course-a biopsy study

Area of Science:

• Neurology
• Neuroimmunology
• Pathology

Background:

• Clinical outcomes of tumefactive demyelination are not well understood.
• Limited data exists on the long-term prognosis of biopsy-proven cerebral demyelination.

Purpose of the Study:

• To characterize the natural history of biopsy-proven, pathogen-free cerebral demyelination in adults.
• To investigate the clinical course and outcomes in an Irish population.

Main Methods:

• Retrospective analysis of 21 patients with biopsy-proven demyelination (1999-2017).
• Inclusion criteria: baseline and follow-up MRI scans, clinical details, and disability status.
• Biopsy analysis included myelin debris, axonal dissociation, reactive astrocytes, and lymphocytes.

Main Results:

• 17 out of 21 patients developed multiple sclerosis (MS) within an 8-year follow-up.
• MS subtypes included relapsing-remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS).
• Four patients experienced a monophasic illness with lesion regression and no further disease activity.

Conclusions:

• Biopsy-proven subacute demyelination presents with diverse clinical courses, from monophasic illness to progressive MS.
• Factors beyond the core pathology significantly impact the clinical trajectory of MS.
• Understanding these factors is crucial for predicting and managing MS progression.