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A reassessment of the plateauing relationship between T2 lesion load and disability in MS

From the Biostatistics Unit (M.P.S.), Department of Health Sciences (DISSAL), University of Genoa; and the Neuroimaging Research Unit (M.R., M.F.) and Department of Neurology (G.C.), Institute of Experimental Neurology, Division of Neuroscience, University Hospital San Raffaele, Milan, Italy is currently affiliated with the Multiple Sclerosis Centre, Scientific Institute Santa Maria Nascente, Fondazione Don Gnocchi, Milan, Italy.

Address correspondence and reprint requests to Dr. Massimo Filippi, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, University Hospital San Raffaele, via Olgettina 60, 20132 Milan, Italy filippi.massimo{at}hsr.it

Objective: A recent cross-sectional study has shown a plateauing relationship between T2 lesion volume (T2LV) and disability in patients with multiple sclerosis (MS). In this analysis, which also included longitudinal observations, we investigated whether such a relationship is a consequence of the decreased frequency of "inflammatory" events occurring in more disabled patients, rather than reflecting their disability status.

Methods: The placebo arms of 2 clinical trials were analyzed. One cohort consisted of 548 patients with relapsing-remitting (RR) MS enrolled in a 14-month, randomized, double-blind, placebo-controlled trial of oral glatiramer acetate. The second cohort consisted of 358 patients with secondary progressive (SP) MS still experiencing relapses enrolled in a 3-year, randomized, double-blind, placebo-controlled trial of interferon beta-1b.

Results: At baseline, T2LV was associated with disease duration (p < 0.001), age at MS onset (p < 0.001), and disability (p < 0.001). The relationship between baseline T2LV and Expanded Disability Status Scale (EDSS) was not significantly different between patients with RRMS and SPMS. At a multivariate analysis, T2LV change was associated with the number of on-trial relapses (p < 0.001) and age at MS onset (p = 0.02). The correlations of T2LV change with baseline EDSS and EDSS changes were not significant.

Conclusions: We showed that the plateauing relationship between T2 lesion volume and disability in multiple sclerosis is not always present and is likely due to the reduced frequency of "inflammatory" events in the most common form of secondary progressive multiple sclerosis.

Abbreviations: EDSS = Expanded Disability Status Scale; MS = multiple sclerosis; RR = relapsing-remitting; SLCMSR = Sylvia Lawry Center for MS Research; SP = secondary progressive; T2LV = T2 lesion volume.

Editorial, page 1524

e-Pub ahead of print on September 30, 2009, at www.neurology.org.

Disclosure: Author disclosures are provided at the end of the article.

Received May 11, 2009. Accepted in final form August 11, 2009.

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				J. S. Wolinsky MRI lesion loads and disability relationships in MS: More similar than different? Neurology, November 10, 2009; 73(19): 1524 - 1525. [Full Text] [PDF]