Disability Improvement Is Associated with Less Brain Atrophy Development in Multiple Sclerosis

Abstract

BACKGROUND AND PURPOSE: It is unknown whether deceleration of brain atrophy is associated with disability improvement in patients with MS. Our aim was to investigate whether patients with MS with disability improvement develop less brain atrophy compared with those who progress in disability or remain stable. MATERIALS AND METHODS:We followed 980 patients with MS for a mean of 4.8 6 2.4 years. Subjects were divided into 3 groups: progress in disability (n ¼ 241, 24.6%), disability improvement (n ¼ 101, 10.3%), and stable (n ¼ 638, 65.1%) at follow-up. Disability improvement and progress in disability were defined on the basis of the Expanded Disability Status Scale score change using standardized guidelines. Stable was defined as nonoccurrence of progress in disability or disability improvement. Normalized whole-brain volume was calculated using SIENAX on 3D T1WI, whereas the lateral ventricle was measured using NeuroSTREAM on 2D-T2-FLAIR images. The percentage brain volume change and percentage lateral ventricle volume change were calculated using SIENA and NeuroSTREAM, respectively. Differences among groups were investigated using ANCOVA, adjusted for age at first MR imaging, race, T2 lesion volume, and corresponding baseline structural volume and the Expanded Disability Status Scale.RESULTS: At first MR imaging, there were no differences among progress in disability, disability improvement, and the stable groups in whole-brain volume (P ¼ .71) or lateral ventricle volume (P ¼ .74). During follow-up, patients with disability improvement had the lowest annualized percentage lateral ventricle volume change (1.6% 6 2.7%) followed by patients who were stable (2.1% 6 3.7%) and had progress in disability (4.1% 6 5.5%), respectively (P , .001). The annualized percentage brain volume change values were À0.7% 6 0.7% for disability improvement, À0.8% 6 0.7% for stable, and À1.1% 6 1.1% for progress in disability (P ¼ .001). CONCLUSIONS:Patients with MS who improve in their clinical disability develop less brain atrophy across time compared with those who progress. ABBREVIATIONS: DMT ¼ disease-modifying therapies; EDSS ¼ Expanded Disability Status Scale; LVV ¼ lateral ventricle volume; PBVC ¼ percentage brain volume change; PLVVC ¼ percentage lateral ventricle volume change; PP ¼ primary-progressive; RR ¼ relapsing-remitting; SP ¼ secondary-progressive; T2-LV ¼ T2 lesion volume M S is an autoimmune disease of the central nervous system characterized by focal and diffuse inflammation 1 and neurodegeneration that presents with central, peripheral, and regional brain atrophy. 2,3 Brain atrophy measurement is one of the key biomarkers in MS 4,5 because it can be assessed in vivo by MR imaging. Brain atrophy is accelerated in patients with MS,6 persists during the course of the disease, and is clinically meaningful since the earliest disease stages. 7 Brain atrophy is related to short-and long-term physical and cognitive clinical deterioration, more robust than other measures of disease burden and lesion activity. 5,8,9

Thalamic atrophy measured by artificial intelligence in a multicentre clinical routine real-world study is associated with disability progression

“…DP was defined as an increase from baseline EDSS of at least 1.0 point, or 0.5 if the baseline EDSS score was >5.5 32. Disability improvement (DI) was defined as a reduction from the baseline EDSS score of at least 1.0 point if the baseline score was 2.0–5.5, or 0.5 if the baseline score was >5.5, as previously reported 32. Stable disability status was defined as non-occurrence of DP or DI 32…”

“…Disability improvement (DI) was defined as a reduction from the baseline EDSS score of at least 1.0 point if the baseline score was 2.0–5.5, or 0.5 if the baseline score was >5.5, as previously reported 32. Stable disability status was defined as non-occurrence of DP or DI 32…”

Predicting disability worsening in relapsing and progressive multiple sclerosis

“…Cerebral atrophy over a 1 to 2-year period was a predictor of EDSS at 5 [58] and 10 years [59], although brain volume only explains a small proportion of the total variance associated with disease progression. Interestingly, patients with disability improvement have the lowest annualized percentage lateral ventricle volume loss, followed by patients who are stable; those with progression in disability have the highest rates of brain atrophy [60 ▪▪ ]. Brain atrophy measures have historically been difficult to follow clinically due to technical and feasibility issues.…”

Brain volume loss in Japanese patients with multiple sclerosis is present in the early to middle stage of the disease

“…To date, short-term changes (over 1 year) in brain volume are predictive of clinical status (i.e. diagnosis of MS or disability status) in clinically isolated syndromes (CISs) [ 9 , 10 ], relapsing–remitting MS (RRMS) [ 11 ], and primary progressive MS [ 12 ], either in isolation or combined with lesion-related parameters [ 13 , 14 ].…”