Brain, Vol. 117, No. 4, 759-765, 1994
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research-article |
A comparison of the pathology of primary and secondary progressive multiple sclerosis
1Department of Neuropathology, Institute of Neurology London, UK 2Department of Clinical Neurology, Institute of Neurology London, UK
Correspondence to:
0Correspondence to: Dr T. Revesz, Department of Neuropathology, Institute of Neurology, Queen Square, London WC1N 3BG, UK
The dynamics of primary progressive multiple sclerosis differ from those of the more common secondary progressive form. The observation by MRI that the frequency of enhancement with gadolinium-DTPA, a marker for blood-brain barrier dysfunction, is significantly less in the primary progressive form, has led to the hypothesis that inflammation is less intense in this group. To test this, we have studied postmortem material from nine cases judged from a retrospective analysis of case notes to show clear clinical evidence of either primary progressive or secondary progressive disease. Five hundred and seventy-eight lesions were analysed. There was significantly more inflammation in secondary progressive multiple sclerosis (as judged by the frequency of perivascular cuffing and cellularity of the parenchyma) than in primary progressive disease. These observations have implications for therapeutic strategies in progressive multiple sclerosis.
multiple sclerosis; progression; pathology; demyelination; inflammation
Received January 10, 1994. Revised April 20, 1994. Accepted April 21, 1994.
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