Five years of grey matter loss in early primary progressive MS

Grey matter atrophy starts early in primary progressive MS (PPMS). What was unknown was whether it advances evenly across the brain, or whether — as in other neurodegenerative diseases — different regions are affected at different rates.

This NeuroImage study, first-authored by Dr Arman Eshaghi, followed 36 people within five years of PPMS onset alongside 19 age- and sex-matched healthy controls, with clinical and imaging assessments at entry, yearly for three years, and again at five years. Disability was scored on the EDSS and the MS Functional Composite at every time point. An unbiased longitudinal voxel-based morphometry approach, using high-dimensional within-subject alignment, was applied to the serial scans to measure the rate of local volume change.

Patients deteriorated significantly over the five years, and showed greater grey matter loss than controls bilaterally in the cingulate cortex, thalamus, putamen, precentral gyrus, insula and cerebellum. Critically, the rate was not uniform: volume loss was fastest in the cingulate cortex. Regional atrophy in PPMS follows its own spatial and temporal pattern, and that pattern — not whole-brain volume — is where the relationship with disability lives. This was the earliest of the regional-atrophy studies that led to the staging and subtyping work at the centre of MS-PINPOINT.

Read the paper: Temporal and spatial evolution of grey matter atrophy in primary progressive multiple sclerosis.