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Gadolinium-enhanced brain lesions in multiple sclerosis relapse.

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  • 1Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

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Multiple sclerosis (MS) relapses often involve multiple gadolinium-enhanced (Gd+) lesions on brain MRI, even without brain symptoms. This highlights the clinico-radiological paradox in MS and the importance of MRI.

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Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
  • MS relapses are characterized by new neurological deficits, often investigated with MRI.
  • The relationship between clinical symptoms and MRI findings in MS relapses is not always straightforward.

Purpose of the Study:

  • To investigate the clinico-radiological paradox in multiple sclerosis (MS) relapses.
  • To analyze the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI prior to methylprednisolone (MP) treatment.

Main Methods:

  • Analysis of brain MRI scans from 90 relapsed MS patients in Phase IV clinical trials.
  • MRI performed at baseline before MP treatment and within 15 days of symptom onset.
  • Univariate analysis to study associations between lesion characteristics and clinical presentation.

Main Results:

  • 62% of patients had at least one Gd+ lesion; 41% had two or more.
  • Subcortical lesions were most frequent (41.4%).
  • Gd+ lesions were present in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms, and 55.5% with optic neuritis.
  • 30% of patients with brain symptoms and 56.4% of patients with non-brain symptoms lacked symptomatic Gd+ lesions.
  • A negative correlation was found between age and the number of Gd+ lesions (p=0.002).

Conclusions:

  • The majority of MS relapses exhibit multiple Gd+ lesions on brain MRI, irrespective of symptom location.
  • These findings underscore the clinico-radiological paradox in MS relapse.
  • Brain MRI is a valuable tool for assessing MS relapse activity, even in the absence of overt neurological deficits.