Cervical spinal cord atrophy impact on quality of life in MS: A neuroimaging study

Published:April 17, 2019DOI:https://doi.org/10.1016/j.jns.2019.04.022
      Multiple sclerosis (MS) is a progressive neurologic disease, which usually affects younger individuals and causes significant permanent disability. It is believed that pathophysiology of MS possesses two arms: inflammatory demyelination and neurodegeneration with resultant brain and spinal cord tissue atrophy due to significant tissue loss. In the past two decades, the role of central nervous system (CNS) tissue atrophy has been emerging as a significant marker of disability in MS patients and substantial research efforts have been focused on the gray matter as well as white matter volume loss in the context of the neurodegenerative arm of this progressive neurologic disease. More neurologists and neuroimagers recognize the concept of the brain and spinal cord atrophy and realize their compromising impact, as an independent variable, on the quality of life and long term disability of MS patients [
      • Chataway J.
      • Schuerer N.
      • Alsanousi A.
      • et al.
      Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomised, placebocontrolled, phase 2 trial.
      ]. In particular, spinal cord atrophy has captured significant research attention. In a longitudinal study, Stevenson et al. [
      • Stevenson V.L.
      • Leary S.M.
      • Losseff N.A.
      • Parker G.J.
      • Barker G.J.
      • Husmani Y.
      • Miller D.H.
      • Thompson A.J.
      Spinal cord atrophy and disability in MS: a longitudinal study.
      ] evaluated progressive cervical cord atrophy in a cohort of MS patients with progressive MS and found that during one year of follow up, the mean upper cervical cord area showed a decrease of −3.53 mm3 in those with primary progressive MS (n = 12) as compared to −0.26 mm3 in those with secondary progressive MS (n = 6). Despite the small number of patients, their findings evidently illuminated the rising concept of “cord atrophy” in MS. Another study by Agosta et al. [
      • Agosta F.
      • Absinta M.
      • Sormani M.P.
      • Ghezzi A.
      • Bertolotto A.
      • Montanari E.
      • Comi G.
      • Filippi M.
      In vivo assessment of cervical cord damage in MS patients: a longitudinal diffusion tensor MRI study.
      ] also measured the cervical cord injury in MS patients. The investigators measured the cervical cord atrophy in participants with primary progressive (n = 15), secondary progressive (14), and relapsing-remitting (n = 13) MS. They stated that the decline in cervical cord area during a mean of 2.4 years by 3.1 mL in patients with primary progressive MS, as compared with 2.2 mL in secondary progressive and 5.4 mL in patients with relapsing-remitting MS. Such exploratory and objective observations extensively highlighted the presence and progressive nature of spinal cord atrophy during MS pathogenesis. Previously, it has also been demonstrated that spinal cord atrophy may occur independently from brain atrophy in MS patients [
      • Bonati U.
      • Fisniku L.K.
      • Altmann D.R.
      • et al.
      Cervical cord and brain grey matter atrophy independently associate with long-term MS disability.
      ,
      • Cohen A.B.
      • Neema M.
      • Arora A.
      • et al.
      The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis.
      ,
      • Kearney H.
      • Rocca M.
      • Valsasina P.
      • et al.
      Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration.
      ]. Spinal cord damage and atrophy, and more specifically, the cervical cord atrophy is frequently observed in MS patients and is associated with progressive illness course as well as significant disability. Such advancing disability potentially comprises the quality of life of MS patients and limits their physical capabilities.

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      References

        • Chataway J.
        • Schuerer N.
        • Alsanousi A.
        • et al.
        Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomised, placebocontrolled, phase 2 trial.
        Lancet. 2014; 383: 2213-2221
        • Stevenson V.L.
        • Leary S.M.
        • Losseff N.A.
        • Parker G.J.
        • Barker G.J.
        • Husmani Y.
        • Miller D.H.
        • Thompson A.J.
        Spinal cord atrophy and disability in MS: a longitudinal study.
        Neurology. 1998; 51: 234-238
        • Agosta F.
        • Absinta M.
        • Sormani M.P.
        • Ghezzi A.
        • Bertolotto A.
        • Montanari E.
        • Comi G.
        • Filippi M.
        In vivo assessment of cervical cord damage in MS patients: a longitudinal diffusion tensor MRI study.
        Brain. 2007; 130: 2211-2219
        • Bonati U.
        • Fisniku L.K.
        • Altmann D.R.
        • et al.
        Cervical cord and brain grey matter atrophy independently associate with long-term MS disability.
        J. Neurol. Neurosurg. Psychiatry. 2011; 82: 471-472
        • Cohen A.B.
        • Neema M.
        • Arora A.
        • et al.
        The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis.
        J. Neuroimaging. 2012; 22: 122-128
        • Kearney H.
        • Rocca M.
        • Valsasina P.
        • et al.
        Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration.
        Mult. Scler. (Houndmills, Basingstoke, England). 2014; 20: 72-80
        • Zurawski J.
        • Glanz B.I.
        • Healy B.C.
        • Tauhid S.
        • Khalid F.
        • Chitnis T.
        • Weiner H.L.
        • Bakshi R.
        The impact of cervical spinal cord atrophy on quality of life in multiple sclerosis.
        J. Neurol. Sci. 2019;