Clinical Relevance of Brain Volume Measures in Multiple Sclerosis

TY - JOUR

T1 - Clinical Relevance of Brain Volume Measures in Multiple Sclerosis

AU - De Stefano, Nicola

AU - Airas, Laura

AU - Grigoriadis, Nikolaos

AU - Mattle, Heinrich P

AU - O'Riordan, Jonathan

AU - Oreja-Guevara, Celia

AU - Sellebjerg, Finn

AU - Stankoff, Bruno

AU - Walczak, Agata

AU - Wiendl, Heinz

AU - Kieseier, Bernd C

PY - 2014/2

Y1 - 2014/2

N2 - Multiple sclerosis (MS) is a chronic disease with an inflammatory and neurodegenerative pathology. Axonal loss and neurodegeneration occurs early in the disease course and may lead to irreversible neurological impairment. Changes in brain volume, observed from the earliest stage of MS and proceeding throughout the disease course, may be an accurate measure of neurodegeneration and tissue damage. There are a number of magnetic resonance imaging-based methods for determining global or regional brain volume, including cross-sectional (e.g. brain parenchymal fraction) and longitudinal techniques (e.g. SIENA [Structural Image Evaluation using Normalization of Atrophy]). Although these methods are sensitive and reproducible, caution must be exercised when interpreting brain volume data, as numerous factors (e.g. pseudoatrophy) may have a confounding effect on measurements, especially in a disease with complex pathological substrates such as MS. Brain volume loss has been correlated with disability progression and cognitive impairment in MS, with the loss of grey matter volume more closely correlated with clinical measures than loss of white matter volume. Preventing brain volume loss may therefore have important clinical implications affecting treatment decisions, with several clinical trials now demonstrating an effect of disease-modifying treatments (DMTs) on reducing brain volume loss. In clinical practice, it may therefore be important to consider the potential impact of a therapy on reducing the rate of brain volume loss. This article reviews the measurement of brain volume in clinical trials and practice, the effect of DMTs on brain volume change across trials and the clinical relevance of brain volume loss in MS.

AB - Multiple sclerosis (MS) is a chronic disease with an inflammatory and neurodegenerative pathology. Axonal loss and neurodegeneration occurs early in the disease course and may lead to irreversible neurological impairment. Changes in brain volume, observed from the earliest stage of MS and proceeding throughout the disease course, may be an accurate measure of neurodegeneration and tissue damage. There are a number of magnetic resonance imaging-based methods for determining global or regional brain volume, including cross-sectional (e.g. brain parenchymal fraction) and longitudinal techniques (e.g. SIENA [Structural Image Evaluation using Normalization of Atrophy]). Although these methods are sensitive and reproducible, caution must be exercised when interpreting brain volume data, as numerous factors (e.g. pseudoatrophy) may have a confounding effect on measurements, especially in a disease with complex pathological substrates such as MS. Brain volume loss has been correlated with disability progression and cognitive impairment in MS, with the loss of grey matter volume more closely correlated with clinical measures than loss of white matter volume. Preventing brain volume loss may therefore have important clinical implications affecting treatment decisions, with several clinical trials now demonstrating an effect of disease-modifying treatments (DMTs) on reducing brain volume loss. In clinical practice, it may therefore be important to consider the potential impact of a therapy on reducing the rate of brain volume loss. This article reviews the measurement of brain volume in clinical trials and practice, the effect of DMTs on brain volume change across trials and the clinical relevance of brain volume loss in MS.

KW - Adjuvants, Immunologic

KW - Atrophy

KW - Brain

KW - Clinical Trials as Topic

KW - Cognition Disorders

KW - Cross-Sectional Studies

KW - Disability Evaluation

KW - Disease Progression

KW - Humans

KW - Magnetic Resonance Imaging

KW - Multiple Sclerosis

KW - Organ Size

KW - Sensitivity and Specificity

U2 - 10.1007/s40263-014-0140-z

DO - 10.1007/s40263-014-0140-z

M3 - Journal article

C2 - 24446248

SN - 1172-7047

VL - 28

SP - 147

EP - 156

JO - CNS Drugs

JF - CNS Drugs

IS - 2

ER -