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A systematic literature review of the association between global brain atrophy and the Expanded Disability Status
Robert Zivadinov1,2, Hoa H Le3, Alexander Keenan4
1Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Background:
Brain atrophy (BA) is a useful predictor of clinical outcomes in people with multiple sclerosis (PwMS). For this reason, MAGNIMS (Magnetic Resonance Imaging in Multiple Sclerosis), an expert consensus group, recommended that global brain volume loss (BVL) is included as a secondary outcome in therapeutic clinical trials. However, there has not been a recent review of the evidence of the association, or strength of association, between global BA and disability in PwMS.
Objectives:
Our aim is to review articles from 2013 onward measuring the associations between percentage of brain volume loss (PBVL), normalized brain volumes (NBV) or normalized brain parenchymal volume (NBPV), and the Expanded Disability Status Scale (EDSS), or disability progression (DP) measured by EDSS in PwMS.
Design:
Systematic review.
Methods:
We searched Medline, Embase, Cochrane Library, Cochrane Clinical Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cumulative Index to Nursing and Allied Health Literature for observational studies, clinical trials and modelling studies measuring the association between global BVL, PBVL, NBV or NBPV, and EDSS score or DP in PwMS. We included people with clinically isolated syndrome and excluded studies with a population greater than 20% primary progressive multiple sclerosis patients.
Results:
We found 58 studies were eligible for the review. Most longitudinal studies (19/23) observed a significant association between global BVL and change in EDSS score or DP. Similarly the majority of cross-sectional studies (26/29) observed an association between baseline BV measures and EDSS. Most studies investigating the association between baseline brain volume (BV) measures and follow-up EDSS, that is, asking if baseline BV is a predictor of DP, or future EDSS score, did not find an association (4/15 observed an association).
Conclusion:
Around a 1% (range 0.4%-1.3%) decrease in global BV per year was associated with DP, but caution in comparing studies is recommended due to variations in the definition of DP.
Insights
Brain atrophy predicts outcomes in multiple sclerosis. A 1% yearly decrease in brain volume correlates with disability progression, but definitions vary.
Area of Science:
- Neurology
- Radiology
- Clinical Trials
Background:
- Brain atrophy (BA) is a key indicator of clinical outcomes in people with multiple sclerosis (PwMS).
- Global brain volume loss (BVL) is recommended as a secondary outcome in clinical trials for PwMS.
- Recent evidence on the association between BA and disability in PwMS requires updated review.
Purpose of the Study:
- To systematically review studies from 2013 onwards examining the relationship between brain volume loss (BVL) and disability in PwMS.
- To assess associations between percentage of brain volume loss (PBVL), normalized brain volumes (NBV), or normalized brain parenchymal volume (NBPV) and the Expanded Disability Status Scale (EDSS) or disability progression (DP).
Main Methods:
- Systematic review of observational studies, clinical trials, and modeling studies.
- Searched major databases (Medline, Embase, Cochrane Library, CINAHL) for relevant literature.
- Included studies on clinically isolated syndrome and limited primary progressive MS (≤20%).
Main Results:
- 58 studies were eligible.
- Most longitudinal studies (19/23) found a significant association between BVL and EDSS score changes or DP.
- Most cross-sectional studies (26/29) found an association between baseline brain volume measures and EDSS.
- Few studies (4/15) found baseline brain volume to be a predictor of future disability.
Conclusions:
- A decrease of approximately 1% in global brain volume per year is associated with disability progression in PwMS.
- Variations in the definition of disability progression necessitate caution when comparing study results.
