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Updated: Dec 12, 2025
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Disability Improvement Is Associated with Less Brain Atrophy Development in Multiple Sclerosis
E Ghione1, N Bergsland1,2, M G Dwyer1,3
1From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center.
Background And Purpose:
It is unknown whether deceleration of brain atrophy is associated with disability improvement in patients with MS. Our aim was to investigate whether patients with MS with disability improvement develop less brain atrophy compared with those who progress in disability or remain stable.
Materials And Methods:
We followed 980 patients with MS for a mean of 4.8 ± 2.4 years. Subjects were divided into 3 groups: progress in disability (n = 241, 24.6%), disability improvement (n = 101, 10.3%), and stable (n = 638, 65.1%) at follow-up. Disability improvement and progress in disability were defined on the basis of the Expanded Disability Status Scale score change using standardized guidelines. Stable was defined as nonoccurrence of progress in disability or disability improvement. Normalized whole-brain volume was calculated using SIENAX on 3D T1WI, whereas the lateral ventricle was measured using NeuroSTREAM on 2D-T2-FLAIR images. The percentage brain volume change and percentage lateral ventricle volume change were calculated using SIENA and NeuroSTREAM, respectively. Differences among groups were investigated using ANCOVA, adjusted for age at first MR imaging, race, T2 lesion volume, and corresponding baseline structural volume and the Expanded Disability Status Scale.
Results:
At first MR imaging, there were no differences among progress in disability, disability improvement, and the stable groups in whole-brain volume (P = .71) or lateral ventricle volume (P = .74). During follow-up, patients with disability improvement had the lowest annualized percentage lateral ventricle volume change (1.6% ± 2.7%) followed by patients who were stable (2.1% ± 3.7%) and had progress in disability (4.1% ± 5.5%), respectively (P < .001). The annualized percentage brain volume change values were -0.7% ± 0.7% for disability improvement, -0.8% ± 0.7% for stable, and -1.1% ± 1.1% for progress in disability (P = .001).
Conclusions:
Patients with MS who improve in their clinical disability develop less brain atrophy across time compared with those who progress.
Insights
Patients with multiple sclerosis (MS) who show disability improvement experience less brain atrophy over time compared to those with worsening disability. This finding suggests a link between clinical improvement and reduced brain volume loss in MS patients.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Brain atrophy is a key feature in multiple sclerosis (MS).
- The relationship between clinical disability changes and the rate of brain atrophy in MS is not well understood.
- Investigating this association can inform disease management and treatment strategies.
Purpose of the Study:
- To determine if patients with MS experiencing disability improvement exhibit less brain atrophy compared to those with disability progression or stable disease.
- To quantify and compare brain volume changes and lateral ventricle expansion across different disability trajectories in MS patients.
Main Methods:
- Longitudinal study of 980 MS patients over approximately 4.8 years.
- Patients categorized into disability progress, disability improvement, or stable groups based on Expanded Disability Status Scale (EDSS) changes.
- Normalized whole-brain volume and lateral ventricle volume assessed using SIENAX and NeuroSTREAM, respectively, from MRI scans.
- Statistical analysis using ANCOVA to compare atrophy rates, adjusting for relevant covariates.
Main Results:
- No significant baseline differences in whole-brain or lateral ventricle volume among the groups.
- Patients with disability improvement showed significantly lower annualized lateral ventricle volume change (1.6%) compared to stable (2.1%) and progress (4.1%) groups (P < .001).
- Annualized brain volume change was also significantly lower in the disability improvement group (-0.7%) versus stable (-0.8%) and progress (-1.1%) groups (P = .001).
Conclusions:
- Disability improvement in MS patients is associated with a reduced rate of brain atrophy.
- Slower brain volume loss and lateral ventricle expansion correlate with clinical disability improvement in multiple sclerosis.
- These findings highlight the potential for neuroprotective effects or treatment efficacy in MS patients showing clinical gains.
