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Brain Advance Access originally published online on November 17, 2004
Brain 2005 128(1):29-34; doi:10.1093/brain/awh323
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Brain Vol. 128 No. 1 © Guarantors of Brain 2004; all rights reserved

Pathological study of spinal cord atrophy in multiple sclerosis suggests limited role of local lesions

N. Evangelou1, G. C. DeLuca2, T. Owens3 and M. M. Esiri2,4

1 Department of Neurology, Queen's Medical Centre NHS Trust, Nottingham, 2 Department of Clinical Neurology, University of Oxford, Oxford, 3 Department of Economics, University of Nottingham, Nottingham and 4 Department of Neuropathology, Oxford Radcliffe NHS Trust, Oxford, UK

Correspondence to: Dr Nikos Evangelou, Department of Neurology, Queen's Medical Centre, University Hospital NHS Trust, Nottingham NG7 2UH, UK E-mail: nikos_evangelou{at}doctors.org.uk

Imaging studies in multiple sclerosis have shown that spinal cord atrophy correlates with clinical disability. The pathological substrate of atrophy has not as yet been investigated adequately. In order to determine the cause of spinal cord atrophy in multiple sclerosis, five different sections of the spinal cord were examined histopathologically in 33 controls and 55 multiple sclerosis cases. In the multiple sclerosis cases in each section the total lesion load and the cross-sectional area of the cord were measured. Multiple regression models were estimated, controlling for sex, age, duration of the disease and location of the cord sections. The multiple sclerosis cords were found to be significantly smaller than the controls. The duration of the disease played the most important role in determining cord atrophy. The degree of atrophy varied in different parts of the cord. Individual lesions played a minor role in local atrophy. Our findings suggest that axonal degeneration, possibly caused by the cumulative number of lesions in the brain and cord, or an alternative atrophic process, is responsible for spinal cord atrophy in multiple sclerosis, rather than tissue loss within individual lesions.


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