Contributions
Abstract: EP1458
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - Imaging
Background/Objective: Multiple sclerosis (MS) often affects women of reproductive age. Clinical disease stabilization in pregnancy, and transient recrudescence post-partum, is well accepted. We have previously shown elevated MRI-defined inflammatory disease activity in the 6 months post-partum. In the current study, we assessed the change in cerebral lesions and atrophy between pre-pregnancy and the post-partum period.
Methods: We retrospectively identified 16 consecutive patients with relapsing forms of MS with pre-pregnancy and post-partum 1.5T brain MRI separated by (mean±SD) 15.4±3.2 months. The baseline characteristics were age 33.0±4.1 years, disease duration 7.2±4.8 years, Expanded Disability Status Score (EDSS) 1.0±1.0, and timed 25 foot walk 4.5±0.6 seconds. Cerebral T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volumes were expert-quantified using a semi-automated edge finding tool and the number of gadolinium-enhancing (Gd+) lesions was assessed. An SPM12 pipeline assessed brain parenchymal fraction (BPF) and cortical gray matter fraction (cGMF). Paired t-tests assessed within subject MRI changes. For LV measures, both raw and the cube root transformation were analyzed. Spearman"s correlation coefficients assessed MRI-clinical associations.
Results: On-study increases were detected in both T1LV (p=0.046, p=0.023 with cube root transformation-CRT) and T2LV (p=0.022, CRT p=0.065). There were no significant on-study changes in Gd+ lesions, BPF, or cGMF (all p>0.15). There were no significant baseline clinical-MRI correlations.
Conclusions: Pregnancy is associated with increased cerebral lesions in patients with MS. However, a de-coupling is apparent, with brain volume relatively spared despite the increase in destructive (i.e. T1 hypointense) lesions. Our results may relate to an extended time off disease-modifying therapy, or hormonal and immunologic changes related to pregnancy. We hypothesize that pregnancy may be protective against the brain volume loss expected with the increase in lesion load.
Disclosure: Dr. Healy received consulting fees from Biogen and grant support from Genzyme, Merck Serono and Novartis.
Dr. Bakshi has received consulting fees from AbbVie, EMD Serono, Genentech, and Novartis. Dr. Bakshi has received research support from Biogen, EMD-Serono, Novartis, and Sanofi-Genzyme. Dr. Bakshi serves as Editor-in-Chief of the Journal of Neuroimaging.
Dr. Houtchens received consulting honorarium from Biogen, Teva, Novartis and Genzyme and grant support from Genzyme and Biogen.
Sheena Dupuy: nothing to disclose
Renxin Chu: nothing to disclose
Fariha Khalid: nothing to disclose
Study supported by: None
Abstract: EP1458
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - Imaging
Background/Objective: Multiple sclerosis (MS) often affects women of reproductive age. Clinical disease stabilization in pregnancy, and transient recrudescence post-partum, is well accepted. We have previously shown elevated MRI-defined inflammatory disease activity in the 6 months post-partum. In the current study, we assessed the change in cerebral lesions and atrophy between pre-pregnancy and the post-partum period.
Methods: We retrospectively identified 16 consecutive patients with relapsing forms of MS with pre-pregnancy and post-partum 1.5T brain MRI separated by (mean±SD) 15.4±3.2 months. The baseline characteristics were age 33.0±4.1 years, disease duration 7.2±4.8 years, Expanded Disability Status Score (EDSS) 1.0±1.0, and timed 25 foot walk 4.5±0.6 seconds. Cerebral T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volumes were expert-quantified using a semi-automated edge finding tool and the number of gadolinium-enhancing (Gd+) lesions was assessed. An SPM12 pipeline assessed brain parenchymal fraction (BPF) and cortical gray matter fraction (cGMF). Paired t-tests assessed within subject MRI changes. For LV measures, both raw and the cube root transformation were analyzed. Spearman"s correlation coefficients assessed MRI-clinical associations.
Results: On-study increases were detected in both T1LV (p=0.046, p=0.023 with cube root transformation-CRT) and T2LV (p=0.022, CRT p=0.065). There were no significant on-study changes in Gd+ lesions, BPF, or cGMF (all p>0.15). There were no significant baseline clinical-MRI correlations.
Conclusions: Pregnancy is associated with increased cerebral lesions in patients with MS. However, a de-coupling is apparent, with brain volume relatively spared despite the increase in destructive (i.e. T1 hypointense) lesions. Our results may relate to an extended time off disease-modifying therapy, or hormonal and immunologic changes related to pregnancy. We hypothesize that pregnancy may be protective against the brain volume loss expected with the increase in lesion load.
Disclosure: Dr. Healy received consulting fees from Biogen and grant support from Genzyme, Merck Serono and Novartis.
Dr. Bakshi has received consulting fees from AbbVie, EMD Serono, Genentech, and Novartis. Dr. Bakshi has received research support from Biogen, EMD-Serono, Novartis, and Sanofi-Genzyme. Dr. Bakshi serves as Editor-in-Chief of the Journal of Neuroimaging.
Dr. Houtchens received consulting honorarium from Biogen, Teva, Novartis and Genzyme and grant support from Genzyme and Biogen.
Sheena Dupuy: nothing to disclose
Renxin Chu: nothing to disclose
Fariha Khalid: nothing to disclose
Study supported by: None