title: Axonal damage in multiple sclerosis patients with high versus low expanded disability status scale score.
abstract: BACKGROUND
  The pathophysiological basis for differences in disability in patients with multiple sclerosis is unclear.
  
  
  METHODS
  We used magnetic resonance imaging to examine whether differences in disability in cohorts of multiple sclerosis patients with similar T2-weighted lesion volume and disease duration were associated with a more destructive disease process in the more disabled patients.
  
  
  RESULTS
  The benign and severely disabled groups had similar brain atrophy metrics and similar decreases of the neuronal marker, N-acetylaspartate, in the normal appearing white matter of the cerebrum on magnetic resonance spectroscopy examination in vivo. The severely disabled cohort had more spinal cord atrophy.
  
  
  CONCLUSIONS
  The dissociation of spinal cord atrophy and cerebral atrophy between these two groups suggests that the difference between the more benign and more disabled groups cannot be explained by a more aggressive pathological process that is affecting the entire neuroaxis in a homogeneous fashion.
authors.affiliation: Montreal Neurological Hospital, Department of Neurology and Neurosurgery, Montreal, Quebec, Canada.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Brass
authors.forename: Sridar
authors.initials: S
authors.lastname: Narayanan
authors.forename: Jack P
authors.initials: JP
authors.lastname: Antel
authors.forename: Yves
authors.initials: Y
authors.lastname: Lapierre
authors.forename: Louis
authors.initials: L
authors.lastname: Collins
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Arnold
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001284:Atrophy; D001369:Axons / Q000473:pathology*; D015415:Biomarkers; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D004185:Disability Evaluation; D006801:Humans; D008279:Magnetic Resonance Imaging; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000473:pathology*
chemical_list: D015415:Biomarkers; D001224:Aspartic Acid; C000179:N-acetylaspartate