Cortical atrophy is relevant in multiple sclerosis at clinical onset.

The Multiple Sclerosis Centre of Veneto Region,

First Neurology Clinic,

Dept. of Neurosciences,

University Hospital of Padova,

Via Giustiniani 5, 35128,

Padova, Italy,

 


INTRODUCTION:

 

Increasing evidence suggests relevant cortical gray matter pathology in patients with Multiple Sclerosis (MS), but how early this pathology begins; its impact on clinical disability and which cortical areas are primarily affected needs to be further elucidated.

 

METHODS:

 

115 consecutive patients (10 Clinically Isolated Syndrome (CIS),

32 possible MS (p-MS),

42 Relapsing Remitting MS (RR-MS),

31 Secondary Progressive MS (SP-MS)), and

40 age/gender-matched healthy volunteers (HV)

 

underwent a neurological examination and a 1.5 T MRI. Global and regional Cortical Thickness (CTh) measurements, brain parenchyma fraction and T2 lesion load were analyzed.

 

RESULTS:

 

We found a significant global cortical thinning in p-MS (2.22 +/- 0.09 mm), RR-MS (2.16 +/- 0.10 mm) and SP-MS (1.98 +/- 0.11 mm) compared to CIS (2.51 +/- 0.11 mm) and HV (2.48 +/- 0.08 mm). The correlations between mean CTh and white matter (WM) lesion load was only moderate in MS (r = -0.393, p = 0.03) and absent in p-MS (r = -0.147, p = 0.422). Analysis of regional CTh revealed that the majority of cortical areas were involved not only in MS, but also in p-MS. The type of clinical picture at onset (in particular, pyramidal signs/symptoms and optic neuritis) correlated with atrophy in the corresponding cortical areas.

 

DISCUSSION:

 

Cortical thinning is a diffuse and early phenomenon in MS already detectable at clinical onset. It correlates with clinical disability and is partially independent from WM inflammatory pathology.