17.05.2024 | Original Communication
Neuroimaging assessment of facility-bound severely-affected MS reveals the critical role of cortical gray matter pathology: results from the CASA–MS case-controlled study
verfasst von:
Robert Zivadinov, Dejan Jakimovski, Alex Burnham, Jens Kuhle, Zachary Weinstock, Taylor R. Wicks, Murali Ramanathan, Tommaso Sciortino, Mark Ostrem, Christopher Suchan, Michael G. Dwyer, Jessica Reilly, Niels Bergsland, Ferdinand Schweser, Cheryl Kennedy, David Young-Hong, Svetlana Eckert, David Hojnacki, Ralph H. B. Benedict, Bianca Weinstock-Guttman
Erschienen in:
Journal of Neurology
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Abstract
Background
A subgroup of people with multiple sclerosis (pwMS) will develop severe disability. The pathophysiology underlying severe MS is unknown. The comprehensive assessment of severely affected MS (CASA–MS) was a case-controlled study that compared severely disabled in skilled nursing (SD/SN) (EDSS ≥ 7.0) to less-disabled (EDSS 3.0–6.5) community dwelling (CD) progressive pwMS, matched on age-, sex- and disease-duration (DDM).
Objectives
To identify neuroimaging and molecular biomarker characteristics that distinguish SD/SN from DDM–CD progressive pwMS.
Methods
This study was carried at SN facility and at a tertiary MS center. The study collected clinical, molecular (serum neurofilament light chain, sNfL and glial acidic fibrillary protein, sGFAP) and MRI quantitative lesion-, brain volume-, and tissue integrity-derived measures. Statistical analyses were controlled for multiple comparisons.
Results
42 SD/SN and 42 DDM–CD were enrolled. SD/SN pwMS showed significantly lower cortical volume (CV) (p < 0.001, d = 1.375) and thalamic volume (p < 0.001, d = 0.972) compared to DDM–CD pwMS. In a logistic stepwise regression model, the SD/SN pwMS were best differentiated from the DDM–CD pwMS by lower CV (p < 0.001) as the only significant predictor, with the accuracy of 82.3%. No significant differences between the two groups were observed for medulla oblongata volume, a proxy for spinal cord atrophy and white matter lesion burden, while there was a statistical trend for numerically higher sGFAP in SD/SN pwMS.
Conclusions
The CASA–MS study showed significantly more gray matter atrophy in severe compared to less-severe progressive MS.