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Deep grey matter involvement in multiple sclerosis: key player or bystander?
  1. Izumi Kawachi
  1. Correspondence to Dr Izumi Kawachi, Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-ku, Niigata 951-8585, Japan; ikawachi{at}bri.niigata-u.ac.jp

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Multiple sclerosis (MS) has been classically considered to be an autoimmune and inflammatory demyelinating disease that primarily affects the white matter (WM) in the central nervous system. However, because WM demyelination by itself cannot explain the full extent of clinical disabilities including cognitive impairments in patients with MS, renewed interest in grey matter (GM) pathology is now emerging.1–4

GM lesions in MS are found in both cortical GM and deep GM by pathological and radiological studies. A 3D double inversion recovery technique on MRI enables a fivefold increase in the detection of cortical GM lesions, which are regarded as a better predictor of cognitive impairment than WM lesions in patients with MS. The cortical GM pathology is characterised as follows: …

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