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Regional variations in the extent and pattern of grey matter demyelination in multiple sclerosis: a comparison between the cerebral cortex, cerebellar cortex, deep grey matter nuclei and the spinal cord
  1. C P Gilmore1,
  2. I Donaldson1,
  3. L Bö2,3,
  4. T Owens4,
  5. J Lowe5,
  6. N Evangelou1
  1. 1
    Department of Neurology, Queens Medical Centre NHS Trust, Nottingham, UK
  2. 2
    Department of Neuropathology, VU Medical Centre, Amsterdam, The Netherlands
  3. 3
    National Competence Centre for MS, Department of Neurology, Haukeland University Hospital, Bergen, Norway
  4. 4
    Department of Economics, University of Nottingham, UK
  5. 5
    Department of Neuropathology, University of Nottingham, UK
  1. Dr C P Gilmore, Department of Neurology, B Floor Medical School, Queen’s Medical Centre NHS Trust, Nottingham NG7 2UH, UK; chris.gilmore{at}


Background: Substantial grey matter (GM) demyelination occurs in both the cerebral cortex and spinal cord in multiple sclerosis (MS). GM demyelination also occurs in the cerebellar cortex and the deep GM nuclei of the brain. However, no study has made a direct “within subject” comparison of the extent of GM pathology between these regions.

Aim: To examine the extent and pattern of GM demyelination in the motor cortex, cingulate gyrus, cerebellum, thalamus and spinal cord in MS.

Methods: Postmortem study using material from 14 MS cases and three controls. Sections were taken from the five predetermined areas and stained for proteolipid protein. The extent of GM and white matter (WM) demyelination was assessed in each region.

Results and conclusion: Overall, 28.8% of the GM was demyelinated compared with 15.6% of the WM (p<0.001), with demyelination being greater in the GM than in the WM at each of the anatomical sites. There was substantial variation in the extent of demyelination between the different CNS regions. GM demyelination was most extensive in the spinal cord and cerebellum while WM demyelination was most prominent in the spinal cord.

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  • Funding: The study was supported by funding from the Multiple Sclerosis Society of Great Britain and Northern Ireland (grant No 801/03, NE).

  • Competing interests: None.

  • Ethics approval: The local research ethics committee approved the study.