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March 21, 2005

Gray and white matter volume changes in early RRMS
A 2-year longitudinal study

M. Tiberio, MD, D. T. Chard, MRCP, D. R. Altmann, DPhil, G. Davies, MRCP, C. M. Griffin, MD, W. Rashid, MRCP, J. Sastre-Garriga, MD, A. J. Thompson, FRCP, and D. H. Miller, FRCPAuthors Info & Affiliations
March 22, 2005 issue
64 (6) 1001-1007
https://doi.org/10.1212/01.WNL.0000154526.22878.30
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Abstract

Background: Brain atrophy, in excess of that seen with normal aging, has been observed early in the clinical course of relapsing-remitting multiple sclerosis (RRMS). Previous work has suggested that at this stage of the disease, gray matter (GM) atrophy progresses more rapidly than the white matter (WM) atrophy.
Objectives: To characterize the evolution of GM and WM volumes over 2 years, and their associations with lesion loads in a cohort of patients with clinically early RRMS.
Methods: Twenty-one patients with RRMS (mean age 37.5 years, mean disease duration from symptom onset 2.1 years) and 10 healthy control subjects (mean age 37.1 years) were studied. Tissue volumes, as fractions of total intracranial volumes, were estimated at baseline and 1- and 2-year follow-up. Brain parenchymal fractions (BPF), GM fractions (GMF), and WM fractions (WMF) were estimated. In subjects with MS, brain lesion loads were determined on conventional T2-weighted along with pre- and post-gadolinium (Gd) enhanced T1-weighted images at each timepoint.
Results: A decrease in GMF was observed in subjects with MS vs normal controls over the 2 years of the study (mean −2.1% vs −1.0%, p = 0.044), while no change was seen in WMF over the same period (mean −0.09% vs +0.09%, p = 0.812). However, when the MS cohort was divided in half, dependent upon change in Gd-enhancing lesion load over 2 years (n = 20), a decrease in WMF was seen in the group (n = 10) with the largest decline in Gd volume, whereas WMF increased in the other half (n = 10) concurrent with a net increase in volume of Gd-enhancing lesions (difference between groups: p = 0.034).
Conclusions: Increasing gray matter but not white matter (WM) atrophy was observed early in the clinical course of relapsing-remitting multiple sclerosis. Fluctuations in inflammatory WM lesions appear to be related to volume changes in WM over this time period.

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References

1.
Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998;338:278–285.
PubMed
Google Scholar
2.
Ferguson B, Matyszak MK, Esiri MM, Perry VH. Axonal damage in acute multiple sclerosis. Brain 1997;120:393–399.
PubMed
Google Scholar
3.
Evangelou N, Esiri MM, Smith S, Palace J, Matthews PM. Quantitative pathological evidence for axonal loss in normal appearing white matter in multiple sclerosis. Ann Neurol 2000;47:391–395.
PubMed
Google Scholar
4.
Bitsch A, Schuchardt J, Bunkowski S, Kuhlmann T, Bruck W. Acute axonal injury in multiple sclerosis. Correlation with demyelination and inflammation. Brain 2000;123:1174–1183.
PubMed
Google Scholar
5.
Kuhlmann T, Lingfeld G, Bitsch A, Schuchardt J, Bruck W. Acute axonal damage in multiple sclerosis is most extensive in early disease stages and decreases over time. Brain 2002;125:2202–2212.
PubMed
Google Scholar
6.
De Stefano N, Narayanan S, Francis SJ, et al. Diffuse axonal and tissue injury in patients with multiple sclerosis with low cerebral lesion load and no disability. Arch Neurol 2002;59:1565–1571.
PubMed
Google Scholar
7.
Davie CA, Barker GJ, Webb S, et al. Persistent functional deficit in multiple sclerosis and autosomal dominant cerebellar ataxia is associated with axon loss. Brain 1995;118:1583–1592.
PubMed
Google Scholar
8.
De Stefano N, Matthews PM, Fu L, et al. Axonal damage correlates with disability in patients with relapsing-remitting multiple sclerosis. Results of a longitudinal magnetic resonance spectroscopy study. Brain 1998;121:1469–1477.
PubMed
Google Scholar
9.
Bjartmar C, Kidd G, Mörk S, Rudick R, Trapp BD. Neurological disability correlates with spinal cord axonal loss and reduced N-acetyl aspartate in chronic multiple sclerosis patients. Ann Neurol 2000;48:893–901.
PubMed
Google Scholar
10.
Lovas G, Szilagyi N, Majtenyi K, Palkovits M, Komoly S. Axonal changes in chronic demyelinated cervical spinal cord plaques. Brain 2000;123:308–317.
PubMed
Google Scholar
11.
Kornek B, Storch MK, Weissert R, et al. Multiple sclerosis and chronic autoimmune encephalomyelitis: a comparative quantitative study of axonal injury in active, inactive, and remyelinated lesions. Am J Pathol 2000;157:267–276.
PubMed
Google Scholar
12.
Chard DT, Griffin CM, Parker GJ, Kapoor R, Thompson AJ, Miller DH. Brain atrophy in clinically early relapsing-remitting multiple sclerosis. Brain 2002;125:327–337.
PubMed
Google Scholar
13.
Miller DH, Barkhof F, Frank JA, Parker GJ, Thompson AJ. Measurement of atrophy in multiple sclerosis: pathological basis, methodological aspects and clinical relevance. Brain 2002;125:1676–1695.
PubMed
Google Scholar
14.
Rudick RA, Fisher E, Lee JC, Simon J, Jacobs L. Use of the brain parenchymal fraction to measure whole brain atrophy in relapsing-remitting MS. Multiple Sclerosis Collaborative Research Group. Neurology 1999;53:1698–1704.
PubMed
Google Scholar
15.
Simon JH, Jacobs LD, Campion MK, et al. A longitudinal study of brain atrophy in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Neurology 1999;53:139–148.
PubMed
Google Scholar
16.
Ge Y, Grossman RI, Udupa JK, et al. Brain atrophy in relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis: longitudinal quantitative analysis. Radiology 2000;214:665–670.
PubMed
Google Scholar
17.
Chard DT, Griffin CM, Rashid W, et al. Progressive grey matter atrophy in clinically early relapsing remitting multiple sclerosis. Mult Scler 2004;10:387–391.
PubMed
Google Scholar
18.
Dalton CM, Chard DT, Davies GR, et al. Early development of multiple sclerosis is associated with progressive grey matter atrophy in patients presenting with clinically isolated syndromes. Brain 2004;127:1101–1107.
PubMed
Google Scholar
19.
Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983;13:227–231.
PubMed
Google Scholar
20.
Chard DT, Griffin CM, McLean MA, et al. Brain metabolite changes in cortical gray and normal-appearing white matter in clinically early relapsing-remitting multiple sclerosis. Brain 2002;125:2342–2352.
PubMed
Google Scholar
21.
Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444–1452.
PubMed
Google Scholar
22.
Fischer JS, Jak AJ, Kniker JE, et al. Administration and scoring manual for the multiple sclerosis functional composite measure (MSFC). New York: Demos, 1999.
Google Scholar
23.
Cutter GR, Baier ML, Rudick RA, et al. Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain 1999;122:871–882.
PubMed
Google Scholar
24.
Goodkin DE, Hertsgaard D, Seminary J. Upper extremity function in multiple sclerosis: improving assessment sensitivity with box-and-block and nine-hole peg tests. Arch Phys Med Rehabil 1988;69:850–854.
PubMed
Google Scholar
25.
Gronwall DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills 1977;44:367–373.
PubMed
Google Scholar
26.
Ashburner J, Friston K. Multimodal image coregistration and partitioning—a unified framework. Neuroimage 1997;6:209–217.
PubMed
Google Scholar
27.
Ashburner J, Friston KJ. Voxel-based morphometry—the methods. Neuroimage 2000;11:805–821.
PubMed
Google Scholar
28.
Chard DT, Parker JM, Griffin CM, Thompson AJ, Miller DH. The reproducibility and sensitivity of brain tissue volume measurements derived from an SPM-based segmentation methodology. J Magn Reson Imaging 2002;15:259–267.
PubMed
Google Scholar
29.
Plummer DL. Dispimage: a display and analysis tool for medical images. Rev Neuroradiol 1992;5:489–495.
Google Scholar
30.
Baltagi H. Econometric analysis of panel data. New York: John Wiley & Sons, 1995.
Google Scholar
31.
Cifelli A, Arridge M, Jezzard P, Esiri MM, Palace J, Matthews PM. Thalamic neurodegeneration in multiple sclerosis. Ann Neurol 2002;52:650–653.
PubMed
Google Scholar
32.
De Stefano N, Matthews PM, Filippi M, et al. Evidence of early cortical atrophy in MS: relevance to white matter changes and disability. Neurology 2003;60:1157–1162.
PubMed
Google Scholar
33.
Quarantelli M, Ciarmiello A, Morra VB, et al. Brain tissue volume changes in relapsing-remitting multiple sclerosis: correlation with lesion load. Neuroimage 2003;18:360–366.
PubMed
Google Scholar
34.
Sailer M, Fischl B, Salat D, et al. Focal thinning of the cerebral cortex in multiple sclerosis. Brain 2003;126:1734–1744.
PubMed
Google Scholar
35.
Miller DH, Rudge P, Johnson G, et al. Serial gadolinium enhanced magnetic resonance imaging in multiple sclerosis. Brain 1988;111:927–939.
PubMed
Google Scholar
36.
Katz D, Taubenberger JK, Cannella B, McFarlin DE, Raine CS, McFarland HF. Correlation between magnetic resonance imaging findings and lesion development in chronic, active multiple sclerosis. Ann Neurol 1993;34:661–669.
PubMed
Google Scholar
37.
Lai M, Hodgson T, Gawne-Cain M, et al. A preliminary study into the sensitivity of disease activity detection by serial weekly magnetic resonance imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry 1996;60:339–341.
PubMed
Google Scholar
38.
Bruck W, Bitsch A, Kolenda H, Bruck Y, Stiefel M, Lassmann H. Inflammatory central nervous system demyelination: correlation of magnetic resonance imaging findings with lesion pathology. Ann Neurol 1997;42:783–793.
PubMed
Google Scholar
39.
Ciccarelli O, Giugni E, Paolillo A, et al. Magnetic resonance outcome of new enhancing lesions in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 1999;6:455–459.
PubMed
Google Scholar
40.
Chard DT, Brex PA, Ciccarelli O, et al. The longitudinal relation between brain lesion load and atrophy in multiple sclerosis: a 14 year follow up study. J Neurol Neurosurg Psychiatry 2003;74:1551–1554.
PubMed
Google Scholar
41.
Raine CS, Wu E. Multiple sclerosis: remyelination in acute lesions. J Neuropathol Exp Neurol 1993;52:199–204.
PubMed
Google Scholar
42.
Prineas JW, Barnard RO, Kwon EE, Sharer LR, Cho ES. Multiple sclerosis: remyelination of nascent lesions. Ann Neurol 1993;33:137–151.
PubMed
Google Scholar
43.
Lassmann H, Bruck W, Lucchinetti C, Rodriguez M. Remyelination in multiple sclerosis. Mult Scler 1997;3:133–136.
PubMed
Google Scholar
44.
Inglese M, Li BS, Rusinek H, Babb JS, Grossman RI, Gonen O. Diffusely elevated cerebral choline and creatine in relapsing-remitting multiple sclerosis. Magn Reson Med 2003;50:190–195.
PubMed
Google Scholar
45.
van Walderveen MA, Kamphorst W, Scheltens P, et al. Histopathologic correlate of hyperintense lesions on T1-weighted spin-echo MRI in multiple sclerosis. Neurology 1998;50:1282–1288.
PubMed
Google Scholar
46.
McDonald WI, Miller DH, Barnes D. The pathological evolution of multiple sclerosis. Neuropathol Appl Neurobiol 1992;18:319–334.
PubMed
Google Scholar
47.
Paolillo A, Piattella MC, Pantano P, et al. The relationship between inflammation and atrophy in clinically isolated syndromes suggestive of multiple sclerosis. A monthly MRI study after triple-dose gadolinium-DTPA. J Neurol 2004;251:432–439.
PubMed
Google Scholar
48.
Kidd D, Barkhof F, McConnell R, Algra PR, Allen IV, Revesz T. Cortical lesions in multiple sclerosis. Brain 1999;122:17–26.
PubMed
Google Scholar
49.
Peterson JW, Bø L, Mork S, Chang A, Trapp BD. Transected neurites, apoptotic neurons, and reduced inflammation in cortical multiple sclerosis lesions. Ann Neurol 2001;50:389–400.
PubMed
Google Scholar
50.
Bø L, Vedeler CA, Nyland H, Trapp BD, Mork SJ. Intracortical multiple sclerosis lesions are not associated with increased lymphocyte infiltration. Mult Scler 2003;9:323–331.
PubMed
Google Scholar
51.
Allen IV, McKeown SR. A histological, histochemical and biochemical study of the macroscopically normal white matter in multiple sclerosis. J Neurol Sci 1979;41:81–91.
PubMed
Google Scholar
52.
Fernando KT, McLean MA, Chard DT, et al. Elevated white matter myo-inositol in clinically isolated syndromes suggestive of multiple sclerosis. Brain 2004;127:1361–1369.
PubMed
Google Scholar
53. Abstract.
Vrenken H, Barkhof F, Castelijns JA, et al. Total NAA unchanged, creatine and myo-inositol elevated in MS normal-appearing white matter. Mult Scler 2003;9(suppl 1):S62.
Google Scholar
54.
Kapeller P, McLean MA, Griffin CM, et al. Preliminary evidence for neuronal damage in cortical gray matter and normal appearing white matter in short duration relapsing-remitting multiple sclerosis: a quantitative MR spectroscopic imaging study. J Neurol 2001;248:131–138.
PubMed
Google Scholar
55. Abstract.
Pelletier D, Srinivasan R, Sailasuta N, et al. Excessive levels of glutamate and glial activity in multiple sclerosis measured by high field MR spectroscopy. Neurology 2004;62(suppl 5):A426.
Google Scholar
56.
Losseff NA, Wang L, Lai HM, et al. Progressive cerebral atrophy in multiple sclerosis. A serial MRI study. Brain 1996;119:2009–2019.
PubMed
Google Scholar
57.
Fisher E, Rudick RA, Cutter G, et al. Relationship between brain atrophy and disability: an 8-year follow-up study of multiple sclerosis patients. Mult Scler 2000;6:373–377.
PubMed
Google Scholar
58.
Turner B, Lin X, Calmon G, Roberts N, Blumhardt LD. Cerebral atrophy and disability in relapsing-remitting and secondary progressive multiple sclerosis over four years. Mult Scler 2003;9:21–27.
PubMed
Google Scholar
59.
Fox NC, Jenkins R, Leary SM, et al. Progressive cerebral atrophy in MS: a serial study using registered, volumetric MRI. Neurology 2000;54:807–812.
PubMed
Google Scholar
60.
Molyneux PD, Kappos L, Polman C, et al. The effect of interferon beta-1b treatment on MRI measures of cerebral atrophy in secondary progressive multiple sclerosis. European Study Group on Interferon beta-1b in secondary progressive multiple sclerosis. Brain 2000;123:2256–2263.
PubMed
Google Scholar
61.
Amato MP, Bartolozzi ML, Zipoli V, et al. Neocortical volume decrease in relapsing-remitting MS patients with mild cognitive impairment. Neurology 2004;63:89–93.
PubMed
Google Scholar

Information & Authors

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Published In

Neurology®
Volume 64 • Number 6 • March 22, 2005
Pages: 1001-1007

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© 2005.

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Published online: March 21, 2005
Published in print: March 22, 2005

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Affiliations & Disclosures

M. Tiberio, MD
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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D. T. Chard, MRCP
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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D. R. Altmann, DPhil
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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G. Davies, MRCP
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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C. M. Griffin, MD
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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W. Rashid, MRCP
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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J. Sastre-Garriga, MD
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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A. J. Thompson, FRCP
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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D. H. Miller, FRCP
From NMR Research Unit, Departments of Neuroinflammation (Drs. Tiberio, Altmann, Griffin, and Miller, and D.T. Chard, G. Davies, and W. Rashid) and Headache, Brain Injury and Rehabilitation (Drs. Sastre-Garriga and Thompson), Institute of Neurology, and Department of Medical Statistics, School of Hygiene and Tropical Medicine (Dr. Altmann), University College London, UK; and Department of Neurological and Psychiatric Sciences (Dr. Tiberio), University of Padua, Italy.
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Notes

Address correspondence and reprint requests to Prof. D.H. Miller, NMR Research Group, Institute of Neurology, Queen Square, London WC1N 3BG, UK; e-mail: [email protected]

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