title: Limited duration of the effect of methylprednisolone on changes on MRI in multiple sclerosis.
abstract: Treatment with methylprednisolone reduces the duration and severity of clinical relapses in multiple sclerosis (MS), while reducing the number of gadolinium-enhancing lesions on T1-weighted MRI. We performed serial MRI imaging after methylprednisolone treatment to see whether suppression of enhancement persists and whether related abnormalities on T2-weighted images disappear at follow-up. Thirteen patients with definite MS received a total of 31 courses of methylprednisolone over an average period of 50 weeks. Gadolinium-enhanced MRI was obtained before and after treatment, then at monthly intervals, using a standardised repositioning and imaging protocol. Two experienced readers in conference defined the number of active (gadolinium-enhancing and new or enlarging nonenhancing) lesions. We detected 609 active lesions on 195 examinations. Directly after treatment the reduction in the number of enhancing lesions was 78%, indicating restoration of the BBB and suppression of inflammation. It was uncommon for a lesion which stopped enhancing to show enhancement on a subsequent examination. No beneficial effect was observed on the rate of disappearance of related abnormalities on T2-weighted images, indicating persistent change such as oedema, cellular infiltration or demyelination. Moreover, in 89% of cases, an increase in the number of active lesions was observed before new clinical activity, if any, was observed (on average 52% earlier). MRI enabled us to demonstrate that the duration of the effect of methylprednisolone treatment is temporary (on average 9.7 weeks).
authors.affiliation: Department of Diagnostic Radiology, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
authors.forename: M W
authors.initials: MW
authors.lastname: Tas
authors.forename: S T
authors.initials: ST
authors.lastname: Frequin
authors.forename: P
authors.initials: P
authors.lastname: Scheltens
authors.forename: O R
authors.initials: OR
authors.lastname: Hommes
authors.forename: J J
authors.initials: JJ
authors.lastname: Nauta
authors.forename: J
authors.initials: J
authors.lastname: Valk
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D019786:Gadolinium DTPA; D008775:Methylprednisolone