title: Global N-acetylaspartate concentration in benign and non-benign multiple sclerosis patients of long disease duration.
abstract: OBJECTIVE
  To examine whether clinically benign multiple sclerosis patients (BMS) show similar losses of their global N-acetylaspartate (NAA) neuronal marker relative to more clinically disabled patients of similar disease duration.
  
  
  METHODS
  The whole-brain NAA concentration (WBNAA) was acquired with whole-head non-localizing proton MR spectroscopy. Fractional brain parenchymal volume (fBPV), T2 and T1 lesion loads, were obtained from the MRI in: (i) 24 BMS patients: 23.1 ± 7.2 years disease duration, median Expanded Disability Status Scale (EDSS) score of 2.0 (range: 0-3); (ii) 26 non-benign MS patients (non-BMS), 24.5 ± 7.4 years disease duration, median EDSS of 4.0 (range: 3.5-6.5); (iii) 15 healthy controls.
  
  
  RESULTS
  Controls' 12.4 ± 2.3mM WBNAA was significantly higher than the BMS's and non-BMS's 10.5 ± 2.4 and 9.9 ± 2.1mM (both p<0.02), but the difference between the patients' groups was not (p>0.4). Likewise, the controls' 81.2 ± 4.5% fBPV exceeded the BMS and non-BMS's 77.0 ± 5.8% and 76.3 ± 8.6% (p<0.03), which were also not different from one another (p>0.7). BMS patients' T1-hypointense lesion load, 2.1 ± 2.2 cm(3), was not significantly different than the non-BMS's 4.1 ± 5.4 cm(3) (p>0.08) and T2-hyperintense loads: 6.0 ± 5.7 cm(3) and 8.7 ± 7.8 cm(3), were also not different (p>0.1).
  
  
  CONCLUSIONS
  WBNAA differentiates normal controls from MS patients but does not distinguish BMS from more disabled MS patients of similar disease duration. Nevertheless, all MS patients who remain RR for 15+ years suffered WBNAA loss similar to the average RR MS population at fourfold shorter disease duration suggesting relative global neuronal sparing or leveling-off of the neurodegeneration rate.
authors.affiliation: Departments of Neurology and Neuroradiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
authors.forename: Lutz
authors.initials: L
authors.lastname: Achtnichts
authors.forename: Oded
authors.initials: O
authors.lastname: Gonen
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Rigotti
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Naegelin
authors.forename: Iris-Katharina
authors.initials: IK
authors.lastname: Penner
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bendfeldt
authors.forename: Jochen
authors.initials: J
authors.lastname: Hirsch
authors.forename: Michael
authors.initials: M
authors.lastname: Amann
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kappos
authors.forename: Achim
authors.initials: A
authors.lastname: Gass
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D001923:Brain Chemistry; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D020528:Multiple Sclerosis, Chronic Progressive / Q000378:metabolism* / Q000473:pathology*; D011522:Protons; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D011522:Protons; D001224:Aspartic Acid; C000179:N-acetylaspartate
keywords: Benign; MR spectroscopy; Multiple sclerosis; WBNAA
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