Thalamic Atrophy Predicts 5-Year Disability Progression in Multiple Sclerosis.

Katariina Hänninen,Jyrki Lötjönen,Matias Viitala,Teemu Paavilainen,Merja Soilu-Hänninen,Juha Rinne,Jari O Karhu,Juha Koikkalainen

doi:10.3389/fneur.2020.00606

Abstract

Purpose: Thalamus is among the first brain regions to become atrophic in multiple sclerosis (MS). We studied whether thalamic atrophy predicts disability progression at 5 years in a cohort of Finnish MS patients.Methods: Global and regional brain volumes were measured from 24 newly diagnosed relapsing MS (RMS) patients 6 months after initiation of therapy and from 36 secondary progressive MS (SPMS) patients. The patients were divided into groups based on baseline whole brain parenchymal (BP) and thalamic atrophy. Standard scores (z scores) were computed by comparing individual brain volumes with healthy controls. A z score cutoff of −1.96 was applied to separate atrophic from normal brain volumes. The Expanded Disability Status Scale (EDSS), brain magnetic resonance imaging (MRI) findings, and relapses were assessed at baseline and at 2 years and EDSS progression at 5 years.Results: Baseline thalamus volume predicted disability in 5 years in a logistic regression model (p = 0.031). At 5 years, EDSS was same or better in 12 of 18 patients with no brain atrophy at baseline but only in 5 of 18 patients with isolated thalamic atrophy [odds ratio (OR) (95% CI) = 5.2 (1.25, 21.57)]. The patients with isolated thalamic atrophy had more escalations of disease-modifying therapies during follow-up.Conclusion: Patients with thalamic atrophy at baseline were at a higher risk for 5-year EDSS increase than patients with no identified brain atrophy. Brain volume measurement at a single time point could help predict disability progression in MS and complement clinical and routine MRI evaluation in therapeutic decision-making.

Highlights

Multiple sclerosis (MS) is the most common chronic, progressive neurological disease among young adults
We previously showed that MS patients with isolated thalamic atrophy, detected at a single time point measurement, were at a higher risk for Expanded Disability Status Scale (EDSS) increase and not reaching NEDA-3 at 2 years, than patients with no identified brain atrophy [10]
The grouping was performed as such because we aimed to study whether the difference in disability progression we found between groups 1 and 2 in our previous study with the same patients [10] was still detectable at 5 years after baseline

Summary

Introduction

Multiple sclerosis (MS) is the most common chronic, progressive neurological disease among young adults. Inflammation, demyelination, and axonal loss in the central nervous system occur from early on in the disease course. Neurodegenerative processes act as one of the major contributors to the long-term disability accumulation in MS [1]. Thalamic Atrophy Predicts MS Disability disease-modifying treatments (DMTs) has emphasized the importance to initiate treatment as early as possible. Choosing the correct treatment for an MS patient requires careful consideration of disease activity, treatment efficacy, and sideeffect profile [2]. Patients are typically selected for the most intensive therapies on the basis of clinical and radiological features predictive of a poor outcome, but more sophisticated predictive models to capture prognosis and treatment response are needed [3]

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