title: A regional consensus recommendation on brain atrophy as an outcome measure in multiple sclerosis.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory and neurodegenerative processes leading to irreversible neurological impairment. Brain atrophy occurs early in the course of the disease at a rate greater than the general population. Brain volume loss (BVL) is associated with disability progression and cognitive impairment in patients with MS; hence its value as a potential target in monitoring and treating MS is discussed.
  
  
  METHODS
  A group of MS neurologists and neuro-radiologists reviewed the current literature on brain atrophy and discussed the challenges in assessing and implementing brain atrophy measurements in clinical practice. The panel used a voting system to reach a consensus and the votes were counted for the proposed set of questions for cognitive and brain atrophy assessments.
  
  
  RESULTS
  The panel of experts was able to identify recent studies, which demonstrated the correlation between BVL and future worsening of disability and cognition. The current evidence revealed that reduction of BVL could be achieved with different disease-modifying therapies (DMTs). BVL provided a better treatment and monitoring strategy when it is combined to the composite measures of "no evidence of disease activity" (NEDA). The panel recommended a set of cognitive assessment tools and MRI methods and software applications that may help in capturing and measuring the underlying MS pathology with high degree of specificity.
  
  
  CONCLUSIONS
  BVL was considered to be a useful measurement to longitudinally assess disease progression and cognitive function in patients with MS. Brain atrophy measurement was recommended to be incorporated into the concept of NEDA. Consequently, a consensus recommendation was reached in anticipation for implementation of the use of cognitive assessment and brain atrophy measurements on a regional level.
authors.affiliation: Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait. alroughani@gmail.com.|Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait. alroughani@gmail.com.
authors.forename: Raed
authors.identifier: http://orcid.org/0000-0002-7111-0480
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: Division of Neurology (Neuroscience Institute), Hamad General Hospital, Doha, Qatar.
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.affiliation: Department of Neurology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan.
authors.forename: Khalid
authors.initials: K
authors.lastname: El Salem
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Jasem
authors.initials: J
authors.lastname: Al-Hashel
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: K John
authors.initials: KJ
authors.lastname: Alexander
authors.affiliation: Department of Radiology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Mohamed Assem
authors.initials: MA
authors.lastname: Abdelrazek
authors.affiliation: Department of Neurology, Salmaniya Hospital & AGU, Manama, Bahrain.
authors.forename: Adel
authors.initials: A
authors.lastname: Aljishi
authors.affiliation: Department of Neurology, Royal Hospital, Muscat, Oman.
authors.forename: Jaber
authors.initials: J
authors.lastname: Alkhaboori
authors.affiliation: Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Faisal
authors.initials: F
authors.lastname: Al Azri
authors.affiliation: Department of Radiology, Royal Hospital, Muscat, Oman.
authors.forename: Nahida
authors.initials: N
authors.lastname: Al Zadjali
authors.affiliation: Royal Medical Services, Amman, Jordan.
authors.forename: Majed
authors.initials: M
authors.lastname: Hbahbih
authors.affiliation: Division of Neurology (Neuroscience Institute), Hamad General Center, Doha, Qatar.
authors.forename: Tag Eldin
authors.initials: TE
authors.lastname: Sokrab
authors.affiliation: Medical Manger-Gulf Countries, Novartis pharmaceuticals, Dubai, United Arab Emirates.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Said
authors.affiliation: Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Àlex
authors.initials: À
authors.lastname: Rovira
mesh_terms: D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: Brain atrophy; Cognitive impairment; Consensus; Disability progression; Middle East; Multiple sclerosis; NEDA