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Cervical cord and brain grey matter atrophy independently associate with long-term MS disability
  1. U Bonati1,2,
  2. L K Fisniku1,2,
  3. D R Altmann1,3,
  4. M C Yiannakas1,2,
  5. J Furby1,2,
  6. A J Thompson1,4,
  7. D H Miller1,2,
  8. D T Chard1,2
  1. 1MS Nuclear Magnetic Research Unit, UCL Institute of Neurology, London, UK
  2. 2Department of Neuroinflammation, UCL Institute of Neurology, London, UK
  3. 3Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
  1. Correspondence to Dr Declan Chard, Department of Neuroinflammation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; d.chard{at}

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In MRI studies of multiple sclerosis (MS), brain grey matter (GM) and spinal cord atrophy correlate with disability.1 2 However, it is uncertain whether they independently associate with long-term disability. We measured upper cervical cord cross-sectional area (UCCA) in a cohort of patients ∼20 years after presenting with a clinically isolated syndrome (CIS) suggestive of MS. Associations of brain GM atrophy and white matter (WM) lesion load with disability had been previously observed in the cohort.1 We now report UCCA measurements and independent associations of the cord and brain measures with disability.

Seventy patients presenting with CIS had analysable brain and MRI scans acquired on a 1.5 T scanner after a median of 20 years (range 18–27). Clinically definite MS (CDMS) was diagnosed clinically.3 Disability was assessed with the expanded disability status scale (EDSS)4 and MS functional composite score (MSFC) plus its three components, paced serial auditory attention test (PASAT; 3 s interval), nine-hole peg test (9HPT) and 25-foot timed walk (T25FW). CDMS subgroups were defined as relapsing–remitting (RR) or secondary progressive (SP) MS; those with an EDSS ≤3 were classified as benign.5

At the 20-year follow-up, 27 remained CIS, 32 had RRMS (21 benign MS, 11 non-benign RRMS (EDSS>3)), and 11 had SPMS. UCCA and brain MR parameters were measured as previously described.1 2 UCCA was also measured in 17 healthy volunteers.

Statistical analysis was performed using the SPSS Version 11.0 (SPSS, Chicago, Illinois) and Stata 9.2 (Stata Corporation, College Station, Texas). Subgroup comparisons of UCCA were performed …

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  • Funding The NMR Research Unit is supported by the MS Society Great Britain and Northern Ireland, and Department of Health's NIHR Comprehensive Biomedical Research Centre at UCLH; UB is supported by the MS Society of Switzerland.

  • Competing interest AJT has received honoraria for consulting services, speaking, and serving on scientific advisory boards from Novartis, Eisai, Weleda/Society for Clinical Research, Hoffman La Roche, UCB Pharma, Serono Foundation, Sanofi-Aventis and the MS Society of Great Britain and Northern Ireland. He is Editor-in-Chief of Multiple Sclerosis for which he receives an honorarium from Sage Publications. DHM has received honoraria from UCB Pharma, Schering, Biogen Idec, GSK and Wyeth for consulting services, speaking and serving on a scientific advisory boards. He has received reimbursement for work as co-Chief Editor of Journal of Neurology, and research grant support from the MS Society of Great Britain and Northern Ireland, Wellcome Trust, Medical Research Council UK, Biogen Idec, Novartis, GlaxoSmithKline and Schering.

  • Ethics approval Ethics approval was provided by the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology Joint Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.