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Limited duration of the effect of methylprednisolone on changes on MRI in multiple sclerosis
F Barkhof1, M W Tas, S T Frequin
1Department of Diagnostic Radiology, Free University Hospital, Amsterdam, The Netherlands.
Abstract:
Treatment with methylprednisolone reduces the duration and severity of clinical relapses in multiple sclerosis (MS), while reducing the number of gadolinium-enhancing lesions on T1-weighted MRI. We performed serial MRI imaging after methylprednisolone treatment to see whether suppression of enhancement persists and whether related abnormalities on T2-weighted images disappear at follow-up. Thirteen patients with definite MS received a total of 31 courses of methylprednisolone over an average period of 50 weeks. Gadolinium-enhanced MRI was obtained before and after treatment, then at monthly intervals, using a standardised repositioning and imaging protocol. Two experienced readers in conference defined the number of active (gadolinium-enhancing and new or enlarging nonenhancing) lesions. We detected 609 active lesions on 195 examinations. Directly after treatment the reduction in the number of enhancing lesions was 78%, indicating restoration of the BBB and suppression of inflammation. It was uncommon for a lesion which stopped enhancing to show enhancement on a subsequent examination. No beneficial effect was observed on the rate of disappearance of related abnormalities on T2-weighted images, indicating persistent change such as oedema, cellular infiltration or demyelination. Moreover, in 89% of cases, an increase in the number of active lesions was observed before new clinical activity, if any, was observed (on average 52% earlier). MRI enabled us to demonstrate that the duration of the effect of methylprednisolone treatment is temporary (on average 9.7 weeks).
Insights
Methylprednisolone treatment temporarily suppresses active lesions in multiple sclerosis (MS) by restoring the blood-brain barrier. However, it does not resolve persistent T2-weighted abnormalities, with effects lasting about 9.7 weeks.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system.
- Methylprednisolone is a corticosteroid used to manage MS relapses.
- The long-term effects of methylprednisolone on MS lesion activity and resolution are not fully understood.
Purpose of the Study:
- To evaluate the persistence of methylprednisolone's effect on gadolinium-enhancing lesions in MS.
- To assess the impact of methylprednisolone on T2-weighted MRI abnormalities.
- To correlate MRI findings with clinical activity and determine the duration of treatment efficacy.
Main Methods:
- Serial MRI scans (gadolinium-enhanced T1 and T2-weighted) were performed on 13 MS patients over 50 weeks.
- Patients received 31 courses of methylprednisolone treatment.
- Active lesions were defined as gadolinium-enhancing or new/enlarging non-enhancing lesions.
Main Results:
- Methylprednisolone treatment reduced enhancing lesions by 78% immediately post-treatment, indicating blood-brain barrier restoration.
- No significant effect was observed on the resolution of T2-weighted abnormalities.
- Active lesions increased before clinical relapse in 89% of cases, with MRI detecting activity 52% earlier on average.
- The therapeutic effect of methylprednisolone on lesion enhancement persisted for an average of 9.7 weeks.
Conclusions:
- Methylprednisolone temporarily suppresses inflammation and restores blood-brain barrier integrity in MS.
- The treatment does not accelerate the resolution of persistent inflammatory changes seen on T2-weighted MRI.
- Serial MRI monitoring can predict clinical relapses earlier than clinical observation and reveals the transient nature of methylprednisolone's anti-inflammatory effects in MS.