Cervical Cord Atrophy, Lesions Predict Disability in Multiple Sclerosis

4. Diagnostic Challenges
4. Diagnostic Challenges
Compared to RRMS, progressive MS had greater cord atrophy and lesions.

Among patients with progressive and relapsing-remitting multiple sclerosis (RRMS), cervical cord atrophy and lesions were associated with clinical disability severity across phenotypes, according to data presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress in Barcelona.

For the study, Navid Seraji-Bozorgzad, MD, of Wayne State University School of Medicine in Detroit, and colleagues aimed to determine the association between MS phenotypes and spinal cord atrophy, spinal cord lesions, and disability. They evaluated cervical cord volume and lesions in patients with RRMS and progressive — both primary and secondary — MS.

One hundred and fifty patients with MS were enrolled in the study, of whom 93 had RRMS and 57 had progressive MS. Patients mean age was 41.3 years; disease duration was 11.2 years; Expanded Disability Status Scale (EDSS) score was 3.8, and mean cervical cord cross-sectional area at C2 level (CSA-C2) was 80.2 mm2.

Results indicated significant correlations between the following metrics: EDSS and CSA (–0.75; P<.0001); EDSS and cervical cord T2 lesions (CCTL; 0.64; P<.0001); and CCTL and CSA (–0.53; P<.0001).

In sub-analysis, lesions of at least one cord were reported in 61% of RRMS patients compared with 91% of progressive MS patients (P<.0001). Also reported was a higher mean CSA-C2 in the RRMS cohort (87.3 mm2 vs. 68.6 mm2; P<.0001) and a higher mean CCTL in the progressive cohort (1.9 vs. 0.7; P<.0001).

Additional data indicated that in the RRMS cohort, correlation between EDSS and CSA was –0.36 (P=.0004), and correlation between EDSS and CCTL was 0.18 (P=.07), whereas in the progressive cohort, the correlation between EDSS and CSA was –0.39 (P=.002), and between EDSS and CCTL was 0.42 (P=.001). In regression analysis, CSA-C2 and CCTL predicted EDSS-measured clinical disability severity.

“Cervical cord atrophy and lesions predict the severity of clinical disability across phenotypes,” Dr. Seraji-Bozorgzad and colleagues concluded. “The number of spinal cord lesions correlated with spinal cord atrophy. Progressive MS has significantly greater cord atrophy and lesions compared to RRMS. This may serve as a potential biomarker in longitudinal therapeutic studies in progressive MS.”

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  1. Seraji-Bozorgzad N et al. Abstract P966. Presented at: The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress; Oct. 7-10, 2015; Barcelona.