Patterns of disease activity in multiple sclerosis: clinical and magnetic resonance imaging study.

Abstract

Objective-To compare the abnormalities shown by magnetic resonance imaging of the brain in three clinically distinct groups of patients with multiple sclerosis, and to correlate the extent of abnormality with the degree of clinical disability in the' three groups.Design-All patients underwent magnetic resonance imaging and full neurological examination, and their disability was scored according to the expanded Kurtzke disability state scale.

The pathogenesis of primary progressive multiple sclerosis: antibody-mediated attack and no repair?

“…Whereas the MRI focal lesion load in the brain in primary progressive MS is lower than in relapsingremitting MS and secondary progressive MS, 8,9 the focal lesion load in the spinal cord does not differ significantly among these forms. 9 Thus, a higher proportion of the total MRI lesion load is in the spinal cord in primary progressive MS. 9 However, it should be noted that the lesion load in the spinal cord compared to the brain is low in all forms of MS and therefore might not be as sensitive in detecting differences among the different forms.…”

“…2,5,6 Irreversible disability occurs sooner after clinical onset in primary progressive MS than in patients with an initial relapsing-remitting course. 7 In contrast, once irreversible disability occurs, the time course of progressive disability is similar in primary progressive and secondary progressive MS. 7 Primary progressive MS is more difficult to diagnose than relapsing-remitting MS for the following reasons: (1) in contrast to the relapsing-remitting pattern which occurs in few neurological diseases other than MS, the progressive neurological deterioration over months and years that occurs in primary progressive MS is also typical of many other neurological diseases; (2) the variety of neurological symptoms and signs occurring in primary progressive MS tends to be more limited than in relapsingremitting MS, and this also reduces the distinctiveness of the clinical features; (3) there are fewer MRI focal brain lesions 8,9 and less frequent gadolinium-enhancing brain lesions 10 in primary progressive MS than in relapsing-remitting / secondary progressive MS; and (4) oligoclonal immunoglobulin (Ig) bands restricted to the cerebrospinal fluid (CSF) occur less frequently in male patients with a later onset and progressive myelopathy, 11 that is the type of patient likely to have primary progressive MS. New diagnostic criteria have recently been proposed for definite primary progressive MS; 12,13 however, the absolute requirement for evidence of intrathecal IgG synthesis will significantly reduce the diagnostic sensitivity.…”

“…Although the total brain white matter focal lesion load is considerably lower in primary progressive MS than in secondary progressive MS, 8,39 diffuse lesions on T2-weighted and proton density-weighted imaging occur more commonly in the brain and spinal cord in primary progressive MS than in secondary progressive MS. 39 Furthermore, magnetization transfer imaging in primary progressive MS has revealed the presence of diffuse tissue damage undetectable by conventional MRI, the extent of which matches that of patients with secondary progressive MS with similar levels of disability. 41 The contribution of cerebral cortical damage to neurological impairment in MS also needs to be considered.…”

Aphasia in Multiple Sclerosis

“…Thompson et al [10] could not find any relation between the degree of clinical disability and the extent of abnormality shown by MRI: patients with clinically benign disease often had extensive abnormalities and those with primary progressive disease had surprisingly few lesions [10].…”

Multiple sclerosis presenting as late functional deterioration after poliomyelitis

“…The clinical diagnosis became apparent with the subsequent development of characteristic clinical features including optic nerve, brainstem, cerebellum and spinal cord involvement. One patient had relapsing and remitting multiple sclerosis and the remaining four secondary progressive MS. 4 In one patient a diagnosis of clinically definite MS was made and no further investigations were undertaken because of her severe disability. In the remaining four patients, oligoclonal bands were present in two of the three patients in whom lumbar puncture was performed, evoked potentials were abnormal in four and MRI scan showed multiple periventricular white matter lesions in four patients.…”