Contributions
Abstract: P315
Type: Poster
Abstract Category: Clinical aspects of MS - 3 Paediatric MS
Background: Recent studies showed that children with multiple sclerosis (MS) have failure of age-expected brain growth. However, the onset and extent of brain volume loss remains unclear. We aimed to evaluate brain growth in a European cohort of children with MS treated with basic disease-modifying and second line therapies.
Goal: Longitudinal assessment of brain volumes in paediatric MS patients at disease onset and at 2 years follow-up (FU).
Methods: High-resolution MRI scans from 38 patients (mean age 14.6±1.7 years; 20 female) with paediatric MS at first attack and after 2 years from Germany and Austria were compared to controls from the NIH Paediatric MRI Data Repository (661 scans, 349 children; age 10-22). Normalized whole brain (WB), grey matter (GM), peripheral grey matter (pGM), white matter (WM) and ventricular cerebrospinal fluid (vCSF) volumes were measured using FSL SIENAX. Age- and sex-specific z scores were calculated based on controls.
Results: Paediatric MS patients had significant brain atrophy at disease onset (reduced WB (1634.8 cm3±61.4 vs. 1738.1±86.3; p< 0.001), GM (901.8±56.6 vs. 973.1±71.6; p< 0.001), pGM (707.5±50.0 vs. 780.6±60.1; p< 0.001), and WM volumes (733.1±66.8 vs. 765.1±49.0; p< 0.001)) as well as after 2 years compared to controls. The z scores of all brain structures were significantly smaller than zero at baseline (all p< 0.001) and at 2 years FU (all p< 0.003). Accordingly, vCSF volume was significantly increased at baseline (31.8±9.2 vs. 26.4±8.7; p< 0.001) and after 2 years with significantly higher z scores than zero at both time points (all p< 0.003).
Over the course of 2 years, patients z-scores showed a significantly accelerated atrophy rate for WB (-1.49±0.82 vs. -1.09±0.79; p=0.006) and WM (-0.93±1.28 vs. -0.52±1.66; p=0.036), but not for GM (-1.41±1.24 vs. -1.12±1.33; p=0.110) and pGM volumes (-1.36±1.18 vs. -1.37±1.44; p=0.956) compared to controls. Correspondingly, vCSF volume showed a significantly higher increase over 2 years (1.27±1.60 vs. 0.49±0.86; p=0.001) compared to controls.
Conclusion: Already at disease onset, paediatric MS patients show significant brain atrophy, affecting WB, GM and WM volumes compared to controls. In addition, patients continue to have accelerated WM and WB volume loss within 2 years compared to controls despite disease-modifying therapies. Marked brain atrophy already at disease onset and continuing brain volume loss over time indicate early neurodegeneration in paediatric MS patients.
Disclosure:
F. Bartels: nothing to disclose
C. Finke: nothing to disclose
K. Rostásy: Scientific adviser on Fingolimod paediatric MS treatment trial - Novartis
E.-M. Hennes: nothing to disclose
M. Baumann: nothing to disclose
M. Schimmel: nothing to disclose
M. Blankenburg: nothing to disclose
B. Anlar: nothing to disclose
K. Nobis: nothing to disclose
B. Bajer-Kornek: nothing to disclose
Abstract: P315
Type: Poster
Abstract Category: Clinical aspects of MS - 3 Paediatric MS
Background: Recent studies showed that children with multiple sclerosis (MS) have failure of age-expected brain growth. However, the onset and extent of brain volume loss remains unclear. We aimed to evaluate brain growth in a European cohort of children with MS treated with basic disease-modifying and second line therapies.
Goal: Longitudinal assessment of brain volumes in paediatric MS patients at disease onset and at 2 years follow-up (FU).
Methods: High-resolution MRI scans from 38 patients (mean age 14.6±1.7 years; 20 female) with paediatric MS at first attack and after 2 years from Germany and Austria were compared to controls from the NIH Paediatric MRI Data Repository (661 scans, 349 children; age 10-22). Normalized whole brain (WB), grey matter (GM), peripheral grey matter (pGM), white matter (WM) and ventricular cerebrospinal fluid (vCSF) volumes were measured using FSL SIENAX. Age- and sex-specific z scores were calculated based on controls.
Results: Paediatric MS patients had significant brain atrophy at disease onset (reduced WB (1634.8 cm3±61.4 vs. 1738.1±86.3; p< 0.001), GM (901.8±56.6 vs. 973.1±71.6; p< 0.001), pGM (707.5±50.0 vs. 780.6±60.1; p< 0.001), and WM volumes (733.1±66.8 vs. 765.1±49.0; p< 0.001)) as well as after 2 years compared to controls. The z scores of all brain structures were significantly smaller than zero at baseline (all p< 0.001) and at 2 years FU (all p< 0.003). Accordingly, vCSF volume was significantly increased at baseline (31.8±9.2 vs. 26.4±8.7; p< 0.001) and after 2 years with significantly higher z scores than zero at both time points (all p< 0.003).
Over the course of 2 years, patients z-scores showed a significantly accelerated atrophy rate for WB (-1.49±0.82 vs. -1.09±0.79; p=0.006) and WM (-0.93±1.28 vs. -0.52±1.66; p=0.036), but not for GM (-1.41±1.24 vs. -1.12±1.33; p=0.110) and pGM volumes (-1.36±1.18 vs. -1.37±1.44; p=0.956) compared to controls. Correspondingly, vCSF volume showed a significantly higher increase over 2 years (1.27±1.60 vs. 0.49±0.86; p=0.001) compared to controls.
Conclusion: Already at disease onset, paediatric MS patients show significant brain atrophy, affecting WB, GM and WM volumes compared to controls. In addition, patients continue to have accelerated WM and WB volume loss within 2 years compared to controls despite disease-modifying therapies. Marked brain atrophy already at disease onset and continuing brain volume loss over time indicate early neurodegeneration in paediatric MS patients.
Disclosure:
F. Bartels: nothing to disclose
C. Finke: nothing to disclose
K. Rostásy: Scientific adviser on Fingolimod paediatric MS treatment trial - Novartis
E.-M. Hennes: nothing to disclose
M. Baumann: nothing to disclose
M. Schimmel: nothing to disclose
M. Blankenburg: nothing to disclose
B. Anlar: nothing to disclose
K. Nobis: nothing to disclose
B. Bajer-Kornek: nothing to disclose