Brain, Vol. 116, No. 3, 681-693, 1993
© 1993 Guarantors of Brain
research-article |
Multiple sclerosis
Pathology of recurrent lesions
1Department of Veterans Affairs Medical Centre, East Orange Newark, New Jersey, USA 2University of Medicine and Dentistry of New Jersey-New Jersey Medical School Newark, New Jersey, USA 3National Hospitals for Nervous Diseases London, UK
Correspondence to:
Correspondence to: Dr John W. Prineas, Neurology Service (127), VA Medical Center, 385 Tremont Avenue, East Orange, NJ7018, USA.
Recent autopsy studies suggest that remyelinated shadow plaques located in otherwise intact white matter are the outcome of a previous single episode of acute demyelination. In the present study, of 98 remyelinated plaques examined in 15 patients with multiple sclerosis who died between 27 days and 5 years after clinical onset, 15 showed evidence of a superimposed new demyelinating lesion. Inspection of old shadow plaques in a separate series of patients with subacute and long-standing multiple sclerosis revealed that such lesions sometimes exhibit punched-out areas of demyelination and gliosis similar in size and shape to fresh lesions located within or overlapping remyelinated shadow plaques. The findings support magnetic resonance imaging evidence that local recurrence may be as important or more important than progressive edge activity in determining plaque growth and the conversion of nascent lesions into classical demyelinated plaques. The findings also support experimental evidence that recurrent demyelination of the same area of white matter may be one of the factors underlying failed remyelination in multiple sclerosis.
Received July 13, 1992. Revised November 23, 1992. Accepted December 14, 1992.
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