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Multiple SclerosisThe New England Journal of Medicine, 378
- Publisher
- American Medical Association
- Copyright
- Copyright 2019 American Medical Association. All Rights Reserved.
- ISSN
- 2168-6149
- eISSN
- 2168-6157
- DOI
- 10.1001/jamaneurol.2019.2399
- Publisher site
- See Article on Publisher Site
Abstract
Key PointsQuestionAre chronic active multiple sclerosis (MS) lesions linked to patient disability and poor long-term lesion outcomes? FindingsIn this in vivo cohort study, the association was shown of chronic active/slowly expanding/smoldering MS lesions, which are detectable on high-field susceptibility-based magnetic resonance imaging (MRI) by their characteristic paramagnetic rims, with aggressive disease course and poor clinical outcomes despite approved disease-modifying therapy. Over time, rim lesions do not shrink slowly as other lesions do, but typically remain stable or even enlarge due to ongoing demyelination (confirmed pathologically in one of the patients who later came to autopsy). MeaningThese data provide in vivo evidence that inflammation in chronic active plaques is a prominent feature of MS that is linked to disability accumulation, suggesting a path forward for new susceptibility-based MRI clinical trials to test new types of treatment to ameliorate this process.
Journal
JAMA Neurology – American Medical Association
Published: Dec 12, 2019