title: Lesion enhancement diminishes with time in primary progressive multiple sclerosis.
abstract: Fewer gadolinium-enhancing lesions are seen in established primary progressive multiple sclerosis (PPMS) compared with other subtypes. Previously, we found unexpectedly high enhancement levels in early PPMS (42%), suggesting an early inflammatory phase. The objective of this study was to investigate whether this level of enhancement was maintained, and whether it influenced clinical progression, over 5 years. Forty-five patients with PPMS, within 5 years of onset, were scored on the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC) and its subtests (including the timed walk test [TWT]) 6-monthly for 3 years, and at 5 years. T1-weighted brain and spinal cord images after triple dose gadolinium-DTPA, and T2-weighted brain sequences were also acquired. A mixed effect logistic model evaluated change in the percentage of patients with enhancing lesions. Ordinal logistic and multiple linear regression models identified predictors of progression, adjusted for T2 lesion load. The percentage of patients with enhancing lesions in the brain and spinal cord declined over 5 years (p = 0.03). Among patients with enhancement, more enhancing lesions at baseline predicted greater decline in mobility on the TWT over 5 years (p = 0.02). In conclusion, a proportion of patients with PPMS may undergo an early inflammatory phase, which has some impact on subsequent mobility.
authors.affiliation: Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London WC1N 3BG, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Khaleeli
authors.forename: O
authors.initials: O
authors.lastname: Ciccarelli
authors.forename: K
authors.initials: K
authors.lastname: Mizskiel
authors.forename: D
authors.initials: D
authors.lastname: Altmann
authors.forename: D H
authors.initials: DH
authors.lastname: Miller
authors.forename: A J
authors.initials: AJ
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003287:Contrast Media; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology; D013997:Time Factors; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA