title: Cortical atrophy is relevant in multiple sclerosis at clinical onset.
abstract: 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.
authors.affiliation: 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
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Calabrese
authors.forename: Matteo
authors.initials: M
authors.lastname: Atzori
authors.forename: Valentina
authors.initials: V
authors.lastname: Bernardi
authors.forename: Aldo
authors.initials: A
authors.lastname: Morra
authors.forename: Chiara
authors.initials: C
authors.lastname: Romualdi
authors.forename: Luciano
authors.initials: L
authors.lastname: Rinaldi
authors.forename: Matthew J M
authors.initials: MJ
authors.lastname: McAuliffe
authors.forename: Luigi
authors.initials: L
authors.lastname: Barachino
authors.forename: Paola
authors.initials: P
authors.lastname: Perini
authors.forename: Bruce
authors.initials: B
authors.lastname: Fischl
authors.forename: Leontino
authors.initials: L
authors.lastname: Battistin
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
mesh_terms: 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