Cortical atrophy is relevant in multiple sclerosis at clinical onset.
BACKGROUND
Increasing evidence suggests relevant cortical gray matter pathology in patients with Multiple Sclerosis (MS), but how early this pathology begins; its impact on clinical disability and which cortical areas are primarily affected needs to be further elucidated.


METHODS
115 consecutive patients (10 Clinically Isolated Syndrome (CIS), 32 possible MS (p-MS), 42 Relapsing Remitting MS (RR-MS), 31 Secondary Progressive MS (SP-MS)), and 40 age/gender-matched healthy volunteers (HV) underwent a neurological examination and a 1.5 T MRI. Global and regional Cortical Thickness (CTh) measurements, brain parenchyma fraction and T2 lesion load were analyzed.


RESULTS
We found a significant global cortical thinning in p-MS (2.22 +/- 0.09 mm), RR-MS (2.16 +/- 0.10 mm) and SP-MS (1.98 +/- 0.11 mm) compared to CIS (2.51 +/- 0.11 mm) and HV (2.48 +/- 0.08 mm). The correlations between mean CTh and white matter (WM) lesion load was only moderate in MS (r = -0.393, p = 0.03) and absent in p-MS (r = -0.147, p = 0.422). Analysis of regional CTh revealed that the majority of cortical areas were involved not only in MS, but also in p-MS. The type of clinical picture at onset (in particular, pyramidal signs/symptoms and optic neuritis) correlated with atrophy in the corresponding cortical areas.


CONCLUSIONS
Cortical thinning is a diffuse and early phenomenon in MS already detectable at clinical onset. It correlates with clinical disability and is partially independent from WM inflammatory pathology.
Calabrese
Massimiliano
M
The Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Dept. of Neurosciences, University Hospital of Padova, Via Giustiniani 5, 35128 Padova, Italy. calabresem@hotmail.it
Atzori
Matteo
M
Bernardi
Valentina
V
Morra
Aldo
A
Romualdi
Chiara
C
Rinaldi
Luciano
L
McAuliffe
Matthew J M
MJ
Barachino
Luigi
L
Perini
Paola
P
Fischl
Bruce
B
Battistin
Leontino
L
Gallo
Paolo
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000150:complications / Q000175:diagnosis*; D002540:Cerebral Cortex / Q000473:pathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis*; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications / Q000175:diagnosis*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000175:diagnosis*; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D013577:Syndrome