Brain, Vol 121, Issue 2 225-231, Copyright © 1998 by Oxford University Press
N Tubridy, AJ Coles, P Molyneux, DA Compston, F Barkhof, AJ Thompson, WI McDonald and DH Miller
We report the findings in 60 patients with secondary progressive multiple
sclerosis who had monthly brain MRI studies for 4 months (one baseline and
three follow-up scans). The purpose was to define the short-term MRI
natural history in a large cohort with secondary progressive disease and to
ascertain its relationship with other clinical and MRI features. The
patients were participating in either a natural history study or the
placebo arm or non-treatment phase of a therapeutic trial. The cohort had
clinical features typical of secondary progressive disease: thus, all had
moderate or severe locomotor disabilities [Expanded Disability Status Scale
(EDSS), score 3.5-8], with a median disease duration of 12 years. There was
equal representation of males and females. During the 3 months of follow-up
there was a total of 362 new enhancing lesions seen in 42 patients, and
there were 24 relapses in 20 patients. There was no correlation between new
enhancing lesions and age at study entry, age of disease onset, gender
disease duration or EDSS, but there was a strong correlation with the
number of enhancing lesions on the baseline scan (r = 0.65, P < 0.0001)
and subsequent activity. There was a non-significant trend for higher
numbers of new enhancing lesions in those having relapses during the 3
months of scanning (P = 0.14) or in the preceding 6 months (P = 0.06). The
34 patients who did not relapse in either period had significantly fewer
new active lesions (P = 0.02) than those who relapsed at some stage during
the 9 months. Nevertheless, considerable activity was seen in the
non-relapsing cohorts: there was a mean of 3.5 (median 2) new enhancing
lesions in those not relapsing during the 3 month study, and 5.5 (median 2)
in those not relapsing in the previous 6 months. We conclude that
short-term MRI activity is generally high in secondary progressive disease,
confirming a useful role for the technique in exploratory trials. Further
work should concentrate on elucidating the mechanisms of secondary
progression by longer term follow-up studies of larger cohorts using
multiple MRI and clinical measurements.
ARTICLES
Secondary progressive multiple sclerosis: the relationship between short-term MRI activity and clinical features
NMR Research Unit, Institute of Neurology, London, UK.
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