2008
DOI: 10.1212/01.wnl.0000316810.01120.05
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Mechanisms of action of disease-modifying agents and brain volume changes in multiple sclerosis

Abstract: Disease-modifying agents (DMAs), including interferon beta (IFNbeta) and glatiramer acetate (GA), are the mainstays of long-term treatment of multiple sclerosis (MS). Other potent anti-inflammatory agents like natalizumab and different types of chemotherapeutics are increasingly being used for treatment of MS, particularly in patients with breakthrough disease activity. Brain volume (BV) loss occurs early in the disease process, accelerates over time, and may be only partially affected by DMA therapy. Low-dose… Show more

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Cited by 233 publications
(220 citation statements)
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“…40 A pseudoatrophy or anti-infl ammatory eff ect in white matter in the estriol group would be consistent with the reduction in relapse rates. Whether maintenance of higher estriol concentrations at 24 months in all participants in the estriol group could have resulted in more robust eff ects on relapses or enhancing lesions is unknown.…”
Section: All Patientsmentioning
confidence: 54%
“…40 A pseudoatrophy or anti-infl ammatory eff ect in white matter in the estriol group would be consistent with the reduction in relapse rates. Whether maintenance of higher estriol concentrations at 24 months in all participants in the estriol group could have resulted in more robust eff ects on relapses or enhancing lesions is unknown.…”
Section: All Patientsmentioning
confidence: 54%
“…This finding is in line with those of previous studies. 36 Previous clinical studies in MS have shown an association between whole-brain atrophy and an increases in lateral ventricle volume and have found that both measurements were associated with increased disability. 37,38 This association was confirmed in an earlier analysis of data from part of this cohort, 12 which showed that whole-brain volume was predictive of disability progression.…”
Section: Discussionmentioning
confidence: 96%
“…41 This phenomenon is called pseudo atrophy, and it seems to be directly associ ated with the resolution of ongoing white matter inflam mation induced at the time of treatment initiation. 32,[44][45][46][47] To identify pseudo atrophy during a clinical trial, brain volume should be measured every 3-6 months. 25 In addition to disease specific changes, lifestyle related factors (including alcohol consumption, smoking, dehy dration and BMI), genetics (such as the presence of an APOE*ε4 allele), and concomitant pathophysio logical conditions (such as diabetes and/or other cardio vascular risk factors) can affect brain volume.…”
Section: Focal Lesionsmentioning
confidence: 99%