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  • Progressive ventricular enlargement in patients with clinically isolated syndromes is associated with the early development of multiple sclerosis

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Progressive ventricular enlargement in patients with clinically isolated syndromes is associated with the early development of multiple sclerosis
  1. C M Dalton1,
  2. P A Brex1,
  3. R Jenkins2,
  4. N C Fox2,
  5. K A Miszkiel3,
  6. W R Crum2,
  7. J I O'Riordan1,
  8. G T Plant4,
  9. A J Thompson1,
  10. D H Miller1
  1. 1NMR Research Unit, Institute of Neurology, London, UK
  2. 2Dementia Research Group, Institute of Neurology, London, UK
  3. 3Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
  4. 4Moorfields Eye Hospital, London, UK
  1. Correspondence to:
 Professor D H Miller, NMR Research Group, Institute of Neurology, Queen Square, London WC1N 3BG, UK;
 d.miller{at}ion.ucl.ac.uk

Abstract

Background: In patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS), the extent of brain magnetic resonance imaging (MRI) lesion load influences the probability and time to development of clinically definite MS. Cerebral atrophy is recognised in established MS, but its time of onset and whether, in early disease, it is related to MRI lesion load or clinical outcome is less certain.

Objectives: This study investigated ventricular enlargement over one year in CIS patients and explored its relation with lesion load and clinical outcome.

Methods: A semi-automated thresholding technique for measuring ventricular volume (MIDAS) was applied to MRI scans in a cohort of 55 patients with CIS, recruited consecutively and imaged within three months of the onset of symptoms and again after one year.

Results: Clinical MS had developed after one year in 16 of 40 patients with an abnormal baseline T2 scan and 2 of 15 with a normal scan. Significant ventricular enlargement was seen in 27 of 55 patients who fulfilled the new McDonald MRI criteria for MS using all available MRI at clinical follow up (median increase 0.3 cm3, p=0.005) Significant increase in ventricular volume was also seen in the 18 of 55 patients who developed clinical MS over the follow up period (median increase 0.5 cm3, p=0.006). There were significant but modest correlations between baseline lesion measures and subsequent ventricular enlargement.

Conclusions: (1) Lesions and atrophy are both associated with early relapse leading to a diagnosis of clinical MS; (2) while lesions contribute to the development of atrophy, atrophy may also develop by other mechanisms. This suggests that MR measures have a complementary role in monitoring the course of MS, even from the earliest clinical stage.

  • multiple sclerosis
  • clinically isolated syndromes
  • ventricles
  • CIS, clinically isolated syndromes
  • MS, multiple sclerosis
  • MRI, magnetic resonance imaging
  • NAA, N-acetyl aspartate

https://doi.org/10.1136/jnnp.73.2.141

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    Footnotes

    • Funding: The NMR Research Unit receives a programme grant from the MS Society of Great Britain and Northern Ireland. Dr Dalton is supported by Elan Pharma. Drs Brex and O'Riordan were supported by Schering AG. Dr Fox holds an MRC Clinical Scientist Fellowship and Dr Crum is supported as part of an MRC programme grant.

    • Competing interests: none declared.