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Distinct local brain atrophy pattern in clinically stable multiple sclerosis patients during the peri-pregnancy
Małgorzata Siger1, Mariusz Stasiołek2, Halina Bartosik-Psujek3,4
1Department of Neurology, Medical University of Lodz, Poland. malgorzata.siger@umed.lodz.pl.
Aim Of The Study:
The objective of the study was to evaluate local brain volume in short and long follow-up periods in the same group of women with multiple sclerosis (MS), which was evaluated in our in previous study during the peri-pregnancy period (PPP).
Clinical Rationale For The Study:
In our previous study we observed a significant reduction in thalamus volume (TV) during PPP in clinically stable patients with MS. In this follow-up study we determined whether the observed regional brain volume change during the PPP was also a long-term effect.
Materials And Methods:
We included 11 patients with MS and clinical and magnetic resonance imaging (MRI) data, obtained at 4 time points: time point 1 (TP1) up to 6 months before pregnancy; time point 2 (TP2) up to 6 months after delivery; time point 3 (TP3) > 12 months after TP2, "short-term follow-up"; time point 4 (TP4) > 24 months after TP2, "long follow-up". MRI analysis including assessment of T2 lesion volume, T2LV; T1 lesion volume, T1LV; number of gadolinium-enhanced lesions, T1GD+; TV and corpus callosum volume (CCV) was performed at each time points.
Results:
At TP3, CCV was significantly lower compared with TP2 (p = 0.02). We also found that T1LV significantly increased at TP3 compared with TP2 (p = 0.02). In the short follow-up we observed a slightly greater change in CCV than in the primary study (p = 0.06). At TP4, CCV was significantly lower and T1LV was significantly higher compared with TP2 (p = 0.02, p = 0.02, respectively). We observed a significant increase of T1LV at all time points beginning with TP1.
Conclusion:
Our study demonstrates that in clinically stable patients with multiple sclerosis in the peri-pregnancy period regional brain atrophy and burden of focal lesions progress in the short and long term despite re-initiating the same therapy. These observations suggest that the protective effects of pregnancy on the pathological processes in MS are limited.
Clinical Implications:
Our findings provide relevant clinical information. Local brain atrophy and increase of focal lesion burden should be considered for decision-making in the treatment of women with MS early in the postpartum period to prevent disease progression.
